Gastric cancer Flashcards
What is the most common type of gastric cancer?
Adenocarcinoma
What are the risk factors for gastric cancer?
Smoking
Pernicious anaemia
H. pylori infection
High alcohol intake
Smoked and preserved foods
Obesity
Blood type A
Gastric adenomatous polyps
Lynch sydrome
What is the clinical presentation of gastric cancer?
Anaemia
Weight loss
Anorexia
Melaena
Haematemesis
Dysphagia
Lymphadenopathy
Abdominal pain
What are the criteria for 2ww referral for upper GI endoscopy?
Dysphagia OR
>55 years with weight loss and one of:
- Epigastric pain
- Reflux
- Dyspepsia
What is the first line investigation for gastric cancer?
Upper GI endoscopy and biopsy
What are the differentials for gastric cancer?
Peptic ulcer disease
Gastritis
Gastrointestinal stromal tumour (GIST)
What further investigations are useful in the diagnosis of gastric cancer?
CT CAP for detection of metastatic disease
PET - staging
Staging laparoscopy - looking for peritoneal metastasis
HER-2 testing
Endoscopic ultrasound - staging
What is the management of gastric cancer?
Oesophagogastrectomy
- Tumours that extend into the oesophagus
Total gastrectomy
- Proximal tumours within 5cm of the GOJ
Sub-total gastrectomy
- If the tumour is <5cm away from the GOJ
Endoscopic submucosal resection
Chemotherapy
- Offer chemotherapy to ALL PATIENTS before and after surgery
What are the complications of gastric cancer?
Bleeding
Gastric outlet obstruction
Perforation
Metastasis
What are the complications of gastrectomy?
Malabsorption
Small bowel bacterial overgrowth
Dumping syndrome
What is dumping syndrome?
Where sugar moves too quickly into the small bowel
- Early dumping syndrome occurs 30 minutes after a meal and can cause dizziness/palpitations
- Late dumping syndrome occurs more than 30 minutes after a meal, and can result in hyperinsulinemia and subsequent hypoglycaemia
