Gastric Cancer

Question 1

Gastric Adenocarcinoma

Intestinal Type

Diffuse (linitis plastica)

Cell adhesion
Cell structure
Patho
Pt

Answer 1

I- Present
Intestinal metaplasia
Tubular/glandular
Inflam/diet/environment
Older, Males

D- defective, lost ecadherin
Infiltrating, signet ring
Genetic
Young, M + F

Question 2

Intestinal tupe gastric ca results from

area

Answer 2

chronic inflamm, H pylori

proximal stomach

Question 3

Pathogenesis

Non-atrophic gastritis
Atrophic
Intestinal metaplasia
Dysplasia
Invasive adeno

H pylori tumorigenesis

Answer 3

N- H pylori, w lymphocytic infil w superimposed PMNs
A- loss of gastric glands (parietal, chief, mucus) first neoplastic step
IM- glands at junction of antrum/body, hypoCl
D- cells appear, dont penetrate
IA- ulcerated mass forms

generation of NO- leading to DNA abnormalities

Question 4

Diffuse characteristics

Commonly invade

Infiltration of a broad region of gastric wall occurs, resulting in a

Answer 4

rapid, early metastasis

gastric wall, going to esophagus, proximal duodenum

thickened stomach

Question 5

Spread via

Direct extension

Lymphatic

Hematogenous

Answer 5

D- pancreas, colon, liver
peritoneal seeding (malignant ascites/mets to ovary, perumbical region SMJ nodes)

L- intra-ab and supraclavicular LN

H- liver

Question 6

Common area for gastric ca

Dietary risks

Answer 6

East A, East Europe, South America

salt preserved foods, nitrates

Question 7

CM

Most are ___ with superficial gastric adeno

Progressive sx

Diffuse sx

Answer 7

Asx

vague ab pain, anorexia, wl
NV (pyloric area), dysphagia (GE jxn)

Nausea, early satiety (poor stomach distensibilty)

Question 8

Rf

PE findings

Answer 8

hx of gastric ulcer, occult bleeding (heme +, Fe def anemia)

Colonic obstruction (extrinsic comp)
Virchows (lymph)
SMJ (peritoneal)
Enlarged ovary (Krukenburg)
Blumers shelf
Malign ascites

Question 9

Test of choice

Visualize

Linitis plastius finding

Endoscopic findings

Suspicious ulcers require

Answer 9

upper endoscopy

Gastric ulcer, exophytic/rugal folds

Leather flask, stiff

Ulcer w irregular margins, nodular mucosal folds, lost rugal folds

biopsy

Question 10

Biopsy findings

Intestinal type

Diffuse type

Answer 10

bulky, glands with broad cohesive cells, vacuoles, abundant mucin

marked thickened gastric wall, signet rings

Question 11

Mx is targeted at

Localized distal dz

Localized proximal dz

Intestinal more susceptible to

Diffuse more susceptible to

Answer 11

resection of tumor/LN

subtotal gastrectomy

total gastrectomy

5FU, oxaliplantin

cisplatin

Question 12

Primary gastric lymphoma

more likely to be

risk increased with

sx

Appearance

Characterstic findings

Answer 12

typical extranodal site for lymphoma

H pylori (MALT)

epigastric pain, fullness, satiety, fatigue

ulcerations, thick mucosa

B cells inf gastric wall, well diff (MALT) or poorly diff high grade lymphoma (Large cell)

Question 13

PGL tx

well diff MALT

Localized high grade

Answer 13

Ab therapy to eradicate H pylori

subtotal gastrectomy, chemo

Question 14

Gastric sarcoma

types

Rarely

Heme spread

Answer 14

leiomyosarcoma/GI stromal tumors

metastasize

Liver/lungs