Gastric cancer Flashcards
What is gastric cancer
malignant tumour arising from epithelial lining of stomach
What is the prevalence of gastric cancer
5th most common cancer world wide
cancer of older people and male predominant
What are most gastric cancer tumours
adenocarcinomas -
can also be lymphoma,GI stromal , carcinoi d
What is the difference between intestinal and diffuse gastric cancer
Intestinal adenocarcinomas are well differentiated and H .pylori associated while
Diffuse adenocarcinomas are poorly differentiated and associated with e. cadherin mutation
What would be the presenting history of someone with gastric cancer
Vague , epigastric abdominal pain
non-specific dyspepsia
weight loss/anorexia
nausea and vomiting
dysphagia
black stool/vomitting blood
bloatation
What are the red flags associated with dyspepsia?
ALARMS 55
Anaemia
Lethargy
Anorexia
Rapid onset
Melaena/haematemesis
swallowing difficulty
over 55
What may be seen on physical examination
abdominal tenderness
palpable lymph nodes
signs of mets disease- ascites/jaundice
-Hepatomegaly
-Lymphatic spread
What 2 things can lymphatic spread of gastric cancer cause
Virchows node - left supraclavicular lymph node
SIster Mary Joseph’s node- periumbilical nodule
What are risk factors for gastric cancer
past medical history , family history lifestyle factors
H.pylori - triggers inflammation of mucosa-atrophy and intestinal metaplasia
-pernicious anemia
-atrophic gastritis
-EBV infection
-Diet -salt and nitrates
-Smoking
-Blood group- more common in people with TYPE A
What are some investigations required
-Upper gastrointestinal endoscopy with biopsy
signet ring cells -
OGD IS FIRST LINE
-CT/MRI/PET scan for staging - next stage of management
-Endoscopic ultrasound with fine needle aspiration for lymphadenopathy and staging
-FBC- normal /microcytic anemia
- Barium studies for those who cannot tolerate upper GI endoscopy
What blood tests may be elevated in gatsric cancer
CEA
CA 19-9
but they are not specific
What is the management of gastric cancer
Endoscopic resection/gastrectomy can be performed for early stage disease
chemo /radio for more advanced disease
What kind of surgeries can be done for the different stages of cancer?
-Endoscopic mucosal resection for superficial early gastric cancer
-partial/total gastrectomy for distal gastric cancer
-chemoradiotherapy for localised disease but not suitable for surgery
-chemo/immuno for patients with metastatic disease
palliative care is also an option
What do the tumour stagings indicate for treatment
Localised disease (T1b-T2 , N0)
-surgery
-for more advanced ( T2 and any N ) perioperative/adjuvant chemo in addition to gastrectomy
Advanced and metastatic disease
-immuno and chemo for metatstic
-palliative care and best supportive care
What are some complications of gastric cancer
Haemorrhage
Obstruction
Perforation
