GASTRIC CANCER

Question 1

Overview (4)

Answer 1

1- Fourth most common cancer worldwide
2- Second leading cause of cancer-related mortality
3- More common in Japan and Chile, and relatively less common in US
4- Incidence increases with age and is more in men

Question 2

Etiology

Answer 2

• Unknown; H.pylori and pernicious anemia are implicated causing chronic gastritis —> atrophic gastritis and premalignant intestinal metaplasia
• Other risk factors are:
  
  • Lifestyle (tobacco smoking- diets low in fruits and vegetables or high in salted-smoked or preserved food)
  • Pernicious anemia history of gastric cancer
  • After partial gastrectomy

Question 3

Pathology

Answer 3

• Tumors most commonly in the antrum and almost always adenocarcinomas
• Types:
  
  • Intestinal Type 1: Localized ulcerated lesions with rolled edges
  • Diffuse Type 2: Diffuse with extensive submucosal spread, giving a picture of linitis plastica on histology: signet ring cells

Question 4

Clinical Features (7)

Answer 4

1- Pain similar to peptic ulcer (most common symptom)
2- Advanced disease: nausea, weight loss, early satiety, anemia, haematemesis
3- Symptoms related to location of tumor:
- Tumors near to pylorus present with outflow obstruction —> vomiting
- Tumors near to cardia present with vomiting and dysphagia
4- May have palpable epigastric mass or Sister Mary Joseph nodule (palpable nodule that is often protruding to umbilicus)
5- Lymph node sometimes felt in supraclavicular fossa (Virchow’s node)
6- If metastasis in peritoneum or liver —>ascites and hepatomegaly is present
7- Skin manifestations occasionally associated:
- Dermatomyositis, Acanthosis nigricans, Ichythyosis

Question 5

Investigations (2)

Answer 5

1- Gastroscopy and biopsy (initial)
2- CT, EUS, and Laparoscopy (staging)

Question 6

Management (3)

Answer 6

1- Surgery is most effective if tumor is operative
2- Adjuvant (postoperative) chemotherapy for advanced disease
3- Chemotherapy may sometimes be used for unresectable lesions

Question 7

Prognosis (2)

Answer 7

1- Overall survival is poor (5-year survival is generally 10%)
2- 5-year survival after curative surgery is 50%