Gastric cancer

Question 1

What is the most common type of gastric cancer?

Answer 1

Adenocarcinoma = 90%

Question 2

What are the different types of gastric cancer?

Answer 2

Adenocarcinoma
GIT stromal tumours - (ICC)
Neuroendocrine tumours

Question 3

What are the laurens classification of GIT tumours?

Answer 3

Intestinal - cohesive, gland forming, associated with environmental factors such as H.pylori and diet -> tend to grow from one site - more common
Diffuse = poorly differentiated, discohesive cells, genetic predisposition and worse prognosis -_ occurs throughout the stomach.

Question 4

What are the different molecular classifications of gastric cancer?

Answer 4

EBV positive - DNA hypermethylation
Microsatellite instability - elevated mutation rates and hypermethylation on specific repeated base sequences
Genomically stable - fewer distinctive genomic alteration
Chromosome instability - aneuploidy, increase RTK

Question 5

What are the different anatomical classifications of gastric cancer?

Answer 5

Proximal (cardia)
Distal (non-cardia

Question 6

What are the main risk factors for gastric cancer?

Answer 6

H.pylori infection -> chronic gastritis -> promotes cellular proliferation, angiogenesis and tissue remodelling.
Others = smoking, genetic (lynch syndrome), pernicious anemia, atrophic gastritis, FH
Diet - high salt, smoked/preserved foods, low fruit and vegetables
males 70yrs+

Question 7

What are the common signs and symptoms of gastric cancer?

Answer 7

Dyspepsia
Weight loss
Anaemia
Epigastric pain
Early satiety and postprandial fullness
Nausea and vomiting
Gastrointestinal bleeding - melena and haematemesis

Question 8

What are the signs/symptoms of a more advanced gastric cancer?

Answer 8

Abdominal mass
Ascities
Virchows node
Sister Mary Josepshs Node (periumbilical nodule)

Question 9

What is the gold standard investigation for gastric cancers?

Answer 9

Endoscopy and biopsy

Question 10

What are the different surgical treatment options for gastric cancer?

Answer 10

Main for curative localised disease:
Partial gastrectomy (early and localised)
Total gastrectomy (Larger or advanced)
Lymph node dissection (depending on stage and location)

Question 11

What is the purpose of chemotherapy in gastric cancer?

Answer 11

Neoadjuvant (shrink) or adjuvant (remove residual disease), palliatve (metastatic or unresectable disease)
Common: Fluoropyrimides, platinum compoounds (cisplatin), taxanes (paclitaxel, docetaxel)

Question 12

What targeted therapy might be offered for gastric cancer?

Answer 12

Targeted therapy: Anti-HER2 (trastuzumab), Anti-VEGF (ramucirumab), immune checkpoint inhibitors (pembrolizumab, used if PD-L1 positive or high micro instability.

Question 13

What is the typical prognosis for gastric cancer?

Answer 13

Generally poor - 5yr rate below 30%

Question 14

What are some complications of gastric cancer?

Answer 14

Obstruction – gastric outlet – pylorus or antrum – vomiting and weight loss
Bleeding – ulceration of a tumour, haematemesis, melena or anaemia

Perforation – peritonitis and sepsis

Question 15

Where might a gastric cancer metastasise to?

Answer 15

Liver mets
Ovarian mets (haemodynamic spread) - Krukenberg tumours - abdo distention and pain
Malignant ascites - peritoneal carcinomatosis

Question 16

What unusual signs can occur due to gastric cancer?

Answer 16

Paraneoplastic syndromes: acanthosis nigricans (dark velvety patches in body folds)

Trousseaus syndrome (hypercoagulable state)

Leser Trelat sign – rapid increase in size and number of seborrheic keratoses.

Question 17

What are the common investigations for gastric cancer?

Answer 17

Bedside - abdo exam, FIT test
Bloods - FBCs, U&Es, LFTs,
Imaging - upper Gi endoscopy and biospy
Other: genetic testing (HER2, Lynch syndrome)
Staging investigations: CT CAP, PET scan, Staging laproscopy.

Question 18

What classification system is used for the staging of gastric cancer?

Answer 18

Stewets classification