Gastric Cancer Flashcards
What type of cancer are most gastric cancers?
Adenocarcinoma from the gastric mucosa
What are risk factors for developing gastric cancer?
Male
H pylori infection
Increasing age
Smoking
Salt in diet
Heavy alcohol
Family hx
Pernicious anaemia (B12 deficiency - not enough intrinsic factor (necessary for B12 absorption) due to autoimmune attack on cells that create it in the stomach.
How does H pylori survive in the stomach acid and cause cancer
Produces urease enzyme that breaks down urea into CO2 and ammonia.
Ammonia neutralises stomach acid allowing the bacterium to create an alkaline microenvironment.
Cycle of repeated damage o epithelial cells leading to inflammation, ulceration and neoplasia
What are the clinical features of gastric cancer?
Vague, nonspecific Dyspepsia Dysphagia NV Melena HAematemesis
Weight loss
Anorexia
Anaemia
- late stage
What signs can be seen in gastric cancer?
Anaemia
Jaundice or hepatomegaly suggesting liver mets
Acanthosis nigerians - hyper pigmentation of the skin creases
TRoisier’s sign - enlarged Virchow’s node (L supraclavicular)
Palpable epigastric mass
Usually in late stages
What tests can be done for gastric cancer?
Urgent upper GI endoscopy, OGD Biopsies can be taken for: histology - classification and grading CLO test - for H pylori HER2/neu protein expression - targeted monoclonal therapies if present
What are the recommendations for urgent OGD referreal
Patients 55 or over with weight loss and either upper abdominal pain, reflux or dyspepsia
How is staging carried out for gastric cancer?
CT chest-abdo-pelvis Staging laparoscopy (to look for peritoneal metastases) TNM staging
What is the main treatment for gastric cancer?
Surgical
Achieve loco-regional control by removing the tumour and its local lymph nodes
Proximal gastric cancer - total gastrectomy
Distal gastric cancer (antrum or pylorus) - subtotal gastrectomy
What is the treatment for proximal gastric cancers?
Total gastrectomy - oesophagus to small bowel, duodenum sealed proximally
What is the treatment for distal gastric cancer?
Antrum and pylorus - subtotal gastrectomy
What are the complications of gastrectomy?
Death, anastomotic leak, reoperation, dumping syndrome (large passage of hypertonic gastric contents into small intestine causes intraluminal fluid shift and intestinal distension - nausea vomiting, diarrhoea, hypovolaemia - symptathic response, tachycardia and sweating followed later by insulin surge leading to hypoglycaemia), vitamin B12 deficiency (pernicious anaemia)
What is pernicious anaemia?
(B12 deficiency - not enough intrinsic factor (necessary for B12 absorption) due to autoimmune attack on cells that create it in the stomach.
What should patients be offered prior to surgery if they are fit enough?
Peri-op chemotherapy (3 cycles of neoadjuvant and 3 cycles of adjuvant)
What is included in palliative management?
Chemotherpay
Supportive care
Stenting - for patients who have gastric outlet obstruction
Palliative surgery - distal gastrectomy or bypass surgery
