Gastric Cancer

Question 1

What is gastric cancer?

Answer 1

Gastric cancer, also known as stomach cancer, is a type of cancer that begins in the cells lining the stomach. It can develop in any part of the stomach and may spread to other parts of the body.

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Question 2

What are the 4 main types of gastric cancer?

Answer 2

The main types include:
- Adenocarcinoma: The most common type, originating in the parietal cells of the stomach lining.
- Lymphoma
- Gastrointestinal stromal tumor (GIST): A rare type that starts in the stomach’s connective tissue.
- Neuroendocrine tumors: Rare tumors that originate from hormone-producing cells.

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Question 3

Most common type of gastric cancer

Answer 3

Adenocarcinoma (90%)

Question 4

What are the characteristics of adenocarcinoma in gastric cancer?

Answer 4

Originates in the glandular cells of the stomach lining. Often found in the antrum or body of the stomach.

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Question 5

What is a cell type found in gastric and colon adenocarcinomas that indicates poor differnetiation and aggressive behaviour?

Answer 5

Signet ring cell, (mucin filled cells that push the nucleus to the side)

Question 6

What are the characteristics of gastric lymphoma? Which two types are there?

Answer 6

Mainly includes MALT (mucosa-associated lymphoid tissue) lymphoma and diffuse large B-cell lymphoma.

Often associated with Helicobacter pylori infection.

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Question 7

Where do gastrointestinal stromal tumors (GISTs) originate from?

Answer 7

GISTs are rare tumors that originate from the **interstitial cells of Cajal **in the gastrointestinal tract.

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Question 8

What are interstitial cells of cajal also called?

Answer 8

‘pacemakers of the gut’

Produce slow electrical waves that cause smooth muscles to contract at a steady pace. From stomach to colon.

Question 9

Who tends to get gastric cancers?

Answer 9

Middle-aged to older males, Southeast asians, Eastern Europeans, South americans.

Consider dietary and drinking habits.

Question 10

What are the risk factors for gastric cancer? List 5 by its significance.

Answer 10

• Helicobacter pylori infection (adenocarcinoma)
• Chronic gastritis
• Smoking
• Diet high in salty and smoked foods
• Family history of gastric cancer
• EBV
• Obesity
• Certain genetic conditions (e.g., Lynch syndrome).

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Question 11

Which cancers do H. pylori typically cause?

Answer 11

Adenocarcinomas and MALT lymphomas.

Question 12

What are the common symptoms of gastric cancer?

Answer 12

• Early stages are non-specific: e.g. indigestion, mild epigastric discomfort/early satiety.
• Late stages: epigastric mass, persistent pain, Loss of appetite, unintentional weight loss, fatigue, anaemia
• Dysphagia
• Black, tarry stools (indicative of bleeding).

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Question 13

How is the pain associated with gastric cancer different from PUD?

Answer 13

PUD presents with epigastric pain often relieved by food or antacids, whereas gastric cancer pain is typically persistent and progressive.

Question 14

Signs of gastric cancer metastasis found on clinical exam.

Answer 14

• Virchow’s node (left supraclavicular lymph node enlargement)
• Sister Mary Joseph node (periumbilical nodule - on belly button).
• Hepatomegaly
• Ascites

Question 15

Next steps upon suspecting gastric cancer.

Answer 15

Suspected cancer pathway amd irgent upper GI endoscopty.

Question 16

How is gastric cancer diagnosed?

Answer 16

• Endoscopy and biopsy
• Imaging tests: Such as CT scans.
• Blood tests: To check for anemia, LFTs

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Question 17

How might gastric cancers be staged?

Answer 17

• CT-scan
• Endoscopic ultrasound (gastric wall)
• Staging laparoscopy (Often performed before surgery to exclude peritoneal metastases, may be missed by CT)
• PET-CT for distant mets.

Question 18

What are the treatment options for gastric cancer?

Answer 18

• Surgery: Partial or total gastrectomy.
• Chemotherapy/radiotherapy/targeted/immunotherapy.

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Question 19

Palliative gastric cancer treatment.

Answer 19

• Radiotherapy/pain relief
• Endoscopic stenting (due to gastric oulet obstruction)
• Nutritional supplementation.