GASTRIC CANCER

Question 0

Prognosis of gastric cancer?

Answer 0

5yr survival rate of those undergoing complete resection 20% if distal, 10% if proximal.

Question 1

What are the types?

Answer 1

85% adenocarcinomas 
- diffuse type: absent cell cohesion 
- intestinal type: cohesive cells form gland like structures  
15% spread between 
- lymphomas 6% 
- GI stromal tumours 4%

Question 2

Risk factors?

Answer 2

SMOKING 
ALCOHOL 
H.PYLORI > CHRONIC GASTRITIS 
LOW SES
LONG TERM INGESTION OF NITRATES IN FOOD E.G. Dried, smoked and salted foods

Question 3

Clinical presentation?

Answer 3

Asymptomatic if superficial
Non-specific -> wt loss, fatigue, anorexia
Extensive spread -> dyspepsia, insidious epigastric pain, N + V (pylorus), dysphagja and early satiety (diffuse)

Question 4

What can gastric metastatic spread cause?

Answer 4

Supraclavicular (virchows)
Direct extension to pancreas, colon and liver
Ovary (kruckenbergs tumour)
Peri umbilical node (sister Mary Joseph node)
Liver

Question 5

What investigations?

Answer 5

CBE EUC LFTs
Rad 
- double contrast barium meal 
- gastroscopy with biopsy 
- ct chest abdomen pelvis to stage

Question 6

Management?

Answer 6

Stage with TNM (tumour size/depth, regional lymph node and distant metastases)

Surgical resection

• distal gastrectomy (bilroth I or II) for those with distal carcinoma
• total or near total gastrectomy (Roux en Y) for those with more proximal tumours
• lymphadenectomy

Adjuvant therapy

• neo-adjuvant chemotherapy
• gastric adenocarcinoma is radio resistant but can do chemo

Question 7

What is bilroth I and II?

Answer 7

1 - pylorus removed and proximal stomach is connected to duodenum
2 - greater curvature connected to first part of jejunum

Question 8

Roux en Y?

Answer 8

For more proximal tumours

Gastric bypass surgery