Gastric Cancer Flashcards
Gastric Cancer
Gastric cancer=
Gastric Cancer: Aetiology
- H-pylori - chronic inflammation, atrophic gastritis, intestinal metaplasia, dysplasia, and eventually, gastric adenocarcinoma.
Additional risk factors implicated in the development of gastric cancer include: - Dietary factors: High salt intake, consumption of smoked or preserved foods, and low intake of fruits and vegetables
- Smoking
- Alcohol consumption
- Perniciousanaemia ( immune system to attack the cells in your stomach that produce the intrinsic factor, which means your body is unable to absorb vitamin B12) and atrophic gastritis
- Family history of gastric cancer
- Genetic syndromes (e.g., hereditary diffuse gastric cancer, Lynch syndrome)
Gastric Cancer: Symptoms
- Dyspepsiaor indigestion
- Epigastric pain
- Early satiety or postprandial fullness
- Weight loss
- Anaemia
- Nausea and vomiting
- Gastrointestinal bleeding (e.g., melena,haematemesis)
Advanced disease may present with additional signs, such as palpable abdominal mass, ascites, and supraclavicular lymphadenopathy (Virchow’s node).
Gastric Cancer: Complcations
Obstruction
Tumour growth may obstruct the gastric outlet or the gastroesophageal junction, leading to vomiting, malnutrition, and dehydration.
Perforation
Gastric cancer can erode through the stomach wall, causing perforation, peritonitis, and sepsis.
Metastasis
Advanced gastric cancer can metastasize to distant organs, such as the liver, lungs, and peritoneum, leading to additional complications and challenges in management.
Treatment-Related Complications
Surgery, chemotherapy, and radiation therapy can cause complications, including infection, bleeding, anast
Gastric Cancer: Investigations
- diagnosis: endoscopy with biopsy
- staging: CT or endoscopic ultrasound with biopsy - endoscopic ultrasound has recently been shown to be superior to CT
- FBC: low Hb, raised platelet count
Gastric Cancer: Management
multidisciplinary approach, incorporating surgery, chemotherapy, radiation therapy, targeted therapy, and supportive care, depending on the tumour stage and patient factors.
Surgery
Surgery remains the cornerstone of curative treatment for localized gastric cancer. The extent of surgical resection depends on tumour location and stage:
- Partial gastrectomy: Removal of a portion of the stomach, suitable for early-stage, localized tumours
- Total gastrectomy: Removal of the entire stomach, often necessary for larger or more advanced tumours
- Lymph node dissection (D1 or D2) should be performed according to tumour stage and location. Minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, may be considered for selected cases.
Chemotherapy
Chemotherapy can be utilized in various settings:
- Neoadjuvant chemotherapy: Administered before surgery to shrink the tumour and improve resectability
- Adjuvant chemotherapy: Given after surgery to eradicate residual disease and decrease the risk of recurrence
- Palliative chemotherapy: Employed for metastatic or unresectable disease to control symptoms and prolong survival
- Common chemotherapeutic agents include fluoropyrimidines (e.g., 5-fluorouracil, capecitabine), platinum compounds (e.g., cisplatin, oxaliplatin), and taxanes (e.g., paclitaxel, docetaxel).
Radiation Therapy
Radiation therapy has a role in the management of gastric cancer in various scenarios:
- Neoadjuvant chemoradiation: Combined with chemotherapy, it may improve resectability and reduce the risk of local recurrence
- Adjuvant chemoradiation: Used to eliminate residual disease, lower the risk of local recurrence, and improve survival
- Palliative radiation: Can provide symptom relief for inoperable tumours or metastatic lesions causing pain or obstruction
Targeted Therapy
Targeted therapies can be beneficial for specific molecular subtypes of gastric cancer:
- Anti-HER2 therapy (e.g., trastuzumab, pertuzumab): Effective for HER2-positive tumours, used in combination with chemotherapy
- Anti-VEGF therapy (e.g., ramucirumab): Targets vascular endothelial growth factor, employed for advanced or metastatic disease
- Immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab): Effective in some cases of microsatellite instability-high (MSI-H) or PD-L1-positive tumours
Supportive and Palliative Care
Supportive and palliative care are essential components of gastric cancer management, addressing nutritional, psychological, and symptom-related concerns. Nutritional supplementation, pain management, and psychological support can improve patient quality of life and overall well-being.
