Gastric Cancer

Question 1

What are the risk factors for developing gastric cancer. (12)

Answer 1

Surgery is an independent risk factor for the late development of malignancy in the gastric remnant (increased risk after a partial gastrectomy).
Hyperchlorhydria.
Duodenal gastric reflux of bile.
Diet (high salt, high nitrate, pickling, low vitamin C).
Atrophic gastritis.
Smoking.
Blood group A.
Nitrosamine exposure.
Genetic predisposition (common loss of heterozygosity of tumour suppressor genes such as p53 - in 50% of all cancers).
Family history (first degree relatives of patients with gastric cancer have 2 to 3 times increased relative risk of developing the disease).
Pernicious anaemia.
H.pylori infection.

Question 2

How common is gastric cancer.

Answer 2

It is currently the 4th most common cancer found worldwide.

Question 3

What is the mortality associated with gastric cancer.

Answer 3

It is the second leading cause of cancer related mortality.

Question 4

What age group is most commonly affected with gastric cancer. (2)

Answer 4

Peak incidence 50-70 years.

It is rare under the age of 30.

Question 5

Where are the highest locations for gastric cancer. (3)

Answer 5

Eastern Asia.
Eastern Europe.
South America.

Question 6

What are most gastric cancers.

Answer 6

Adenocarcinomas.

Question 7

What is the ratio of men:women who are affected by gastric cancers.

Answer 7

2:1.

Question 8

Where is the highest incidence of gastric cancer.

Answer 8

Japan.

Question 9

What is the incidence of gastric cancer in the UK. (3)

Answer 9

It is the eighth most common cancer.
M: 16/100,000.
F: 9/100,000.

Question 10

What percentage of gastric cancers worldwide have detectable EBV.

Answer 10

2-16%.

Question 11

What is the overall incidence of gastric cancer in the UK.

Answer 11

23/100,000.

Question 12

How is gastric cancer classified.

Answer 12

Bormann classification.

Question 13

What is involved in the Bormann classification. (4)

Answer 13

Polypoid.
Ex-cavating.
Ulcerating and raised.
Diffusely infiltrative.

Question 14

What is ‘early’ gastric carcinoma. (2)

Answer 14

Gastric carcinomas that are confined to the mucosa and submucosa.
Regardless of the presence of lymph node metastases.

Question 15

What is the 5 year survival rate for ‘early’ gastric carcinoma.

Answer 15

90% (but many of these would have survived without treatment as well).

Question 16

How are ‘early’ gastric cancers usually detected in the UK.

Answer 16

Usually an incidental finding.

Question 17

What are the two major types of gastric cancer. (2)

Answer 17

Intestinal (type 1).

Diffuse (type 2).

Question 18

What are the symptoms of gastric cancer. (6)

Answer 18

Often non-specific:
Dyspepsia (for >1month and >50 years demands investigation).
Weight loss.
Vomiting (if the tumour encroaches on the pylorus).
Dysphagia (occurs if the tumour involves the fundus).
Anaemia.
Epigastric pain (advanced disease - relieved by food and antacids).

Question 19

What are the clinical signs of gastric cancer. (6)

Answer 19

Suggesting incurable disease:
Epigastric mass (50% with abdominal tenderness).
Hepatomegaly.
Jaundice.
Ascites.
Large left supraclavicular node (Virchow’s node - Trossier’s sign).
Acanthosis nigricans.

Question 20

What is the typical presentation of gastric cancer in the west. (2)

Answer 20

Locally advanced (inoperable) or metastatic disease.

Question 21

How does gastric cancer spread. (4)

Answer 21

Local.
Lymphatic.
Blood-borne.
Transoelomic (eg to ovaries = Krukenberg tumour).

Question 22

What is the gold standard for diagnosis of a gastric cancer.

Answer 22

Gastroscopy and multiple biopsies.

Question 23

What are intestinal (type 1) gastric cancers. (3)

Answer 23

Well formed glandular structures (differentiated).
Polypoid tumours or ulcerating lesions with heaped-up rolled edges.
Intestinal metaplasia is seen in the surrounding tissue.

Question 24

What are diffuse gastric cancers. (3)

Answer 24

Poorly cohesive cells (undifferentiated) that tend to infiltrate the gastric wall.
They may involve any part of the stomach, especially the cardia.
They have a worse prognosis than intestinal tumours.

Question 25

What is ‘lintis plastica’.

Answer 25

It occurs due to widely spreading submucosal gastric cancer causing diffuse thickening and rigidity of the stomach wall.

Question 26

Where can gastric carcinoma metastasize to. (4)

Answer 26

Liver.
Brain.
Bone.
Lung.

Question 27

What is the prognosis for patients with gastric adenoarcinoma.

Answer 27

5year survival rate is