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Z - Cancer Care Old > Gastric Cancer > Flashcards

Gastric Cancer Flashcards

1
Q

How common in gastric cancer, compared to other cancers, in the UK?

A

6th most common cancer in the UK

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2
Q

What % of all cancers in the UK does gastric cancer account for?

A

5%

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3
Q

How common is gastric cancer, compared to other cancers, in the UK?

A

2nd most common cancer worldwide

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4
Q

What is the male:female ratio of gastric cancer?

A

1.8 : 1

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5
Q

What % of cases of gastric cancer are diagnosed in people aged 55 or older?

A

95%

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6
Q

What is the average age of presentation of gastric cancer?

A

65

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7
Q

What is happening to the incidence of gastric cancer in the developed world?

A

It is falling

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8
Q

What may the fall in rates of gastric cancer in the developed world be due to?

A

Better food preservation

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9
Q

What are the risk factors for gastric cancer?

A
  • Blood group A
  • Geographic variation
  • Dietary factors
  • H. Pylori infection and atrophic gastritis
  • Vagotomy and partial gastrectomy
  • Family history
  • Obesity
  • Radiation
  • Lower socioeconomic class
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10
Q

What countries have high rates of gastric cancer?

A
  • China

- Japan

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11
Q

What is the main contributing factor to the geographic variation of gastric cancer?

A

Diet

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12
Q

What dietary factors increase the risk of gastric cancer?

A
  • Nitrosamines

- Diet high in salty foods

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13
Q

How can chronic atrophic gastritis contribute to the development of gastric cancer?

A

Leads to decrease in acid secretion with resulting bacterial overgrowth and an increase in nitrates

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14
Q

What conveys the familial risk in gastric cancer?

A

Mutation of the cadherin-1 gene (CDH1)

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15
Q

What might contribute to a late diagnosis of gastric cancer?

A

Routine use of PPIs without investigation with endoscopy

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16
Q

At what time after surgery does vagotomy and partial gastrectomy increase the risk of gastric cancer?

A

20 years

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17
Q

What are the types of gastric cancer?

A
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Lymphoma
  • Gastrointestinal stromal tumours
  • Neuroendocrine tumours
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18
Q

What % of gastric cancers are adenocarcinomas?

A

More than 95%

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19
Q

What can gastric adenocarcinomas be further classified into?

A
  • Intestinal

- Diffuse

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20
Q

What type of gastric adenocarcinoma has a better prognosis?

A

Intestinal

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21
Q

What kind of patient is intestinal adenocarcinoma associated with?

A

Older patients

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22
Q

Where is intestinal adenocarcinoma more commonly found?

A

Distal stomach

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23
Q

What type of gastric adenocarcinoma is more common?

A

fusse

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24
Q

What % of gastric cancers are squamous cell carcinomas?

A

4%

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25
Q

What are the symptoms of early stage gastric cancer?

A

May be asymptomatic, or have vague and non-specific symptoms, e.g. dyspepsia, tiredness, or anorexia

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26
Q

How will most patients with gastric cancer present?

A
  • Vague epigastric discomfort, which is worse with meal
  • Weight loss
  • Early satiety
  • Anorexia
  • Dysphagia
  • Vomiting 🤮
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27
Q

What are the features of advanced gastric cancer?

A
  • Ascites
  • Jaundice
  • Melaena
  • Hepaomegaly
  • Lymph node involvement
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28
Q

What % of patients with gastric cancer have liver metastases?

A

25%

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29
Q

How might lymph node involvement present in gastric cancer?

A
  • Virchow’s note in left SCF

- Palpable epigastric mass

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30
Q

What is a rare complication of gastric cancer?

A

Transcoelomic spread to the ovaries (Krukenberg tumour)

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31
Q

When is referral to a specialist for urgent endoscopy and review required in suspected gastric cancer?

A

Patients >55 years presenting with dyspepsia alone
Patients <55 years presenting with dysphagia, vomiting, anorexia, weight loss, or symptoms associated with GI bleeding, e.g. breathlessness, tiredness

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32
Q

What investigations may be done in suspected gastric cancer?

A
  • FBC and LFTs
  • Endoscopy with biopsy
  • Barium studies
  • Imaging
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33
Q

What might FBC show in gastric cancer?

A

Microcytic anaemia

34
Q

What causes microcytic anaemia in gastric cancer?

A
  • Blood loss

- Iron deficiency

35
Q

Why might LFTs be abnormal in gastric cancer?

A

Due to liver metastasis

36
Q

What might be required if gastric ulceration is noted on endoscopy?

A

A repeat endoscopy to confirm healing

37
Q

Why is important to do a repeat endoscopy if gastric ulceration is noted on endoscopy?

A

A non-healing ulcer may suggest the possibility of malignancies

38
Q

When might barium studies be done in suspected gastric cancer?

A

In patients non-tolerant of endoscopy

39
Q

What is the limitation of barium studies in gastric cancer?

A

Can’t take biopsy for histological examination

40
Q

What imaging might be done in gastric cancer?

A
  • Ultrasound of liver
  • CXR
  • CT of thorax and abdomen
  • PET
41
Q

What is the purpose of ultrasound of the liver and CXR in gastric cancer?

A

Screen for metastasis

42
Q

When will CT and PET be required in gastric cancer?

A

In patients with more advanced disease

43
Q

What is the purpose of CT scanning in advanced gastric cancer?

A

Demonstrate involvement of local lymph nodes and identify metastasis

44
Q

What is PET used for in gastric cancer?

A

Increasing use for the detection of disease spread

45
Q

What is Tx in gastric cancer?

A

Primary tumour cannot be evaluated

46
Q

What is T0 in gastric cancer?

A

There is no evidence of primary tumour in the stomach

47
Q

What is T1 in gastric cancer?

A

Carcinoma in situ

48
Q

What is T2 in gastric cancer?

A

Tumour invading into the muscularis propria/submucosa

49
Q

What is T3 in gastric cancer?

A

Tumour has penetrated the serosa

50
Q

What is T4 in gastric cancer?

A

Tumour has invaded organs surrounding the stomach

51
Q

What is Nx in gastric cancer?

A

Regional lymph nodes cannot be evaluated

52
Q

What is N0 in gastric cancer?

A

No regional lymphadenopathy

53
Q

What is N1 in gastric cancer?

A

Regional lymph node involvement (1 or 2 lymph nodes)

54
Q

What is N2 in gastric caner?

A

Regional lymph node involvement (7-15 lymph nodes)

55
Q

What is N3 in gastric cancer?

A

Regional lymph node involvement (16+ lymph nodes)

56
Q

What is Mx in gastric cancer?

A

Distant metastases cannot be evaluated

57
Q

What is M0 in gastric cancer?

A

No distant metastases

58
Q

What is M1 in gastric cancer?

A

Distant metastases

59
Q

What is the only significant curative intervention for gastric cancer?

A

Surgery with laparotomy

60
Q

What is surgery with laparotomy often preceded by in gastric cancer?

A

Laparoscopic staging

61
Q

What % of patients with gastric cancer are suitable for surgery?

A

About 50%

62
Q

When might a subtotal gastrectomy be sufficient in gastric cancer?

A

For antral cancers

63
Q

What is the advantage of a subtotal gastrectomy compared to total?

A

Fewer complications

64
Q

What is meant by extensive lymphadenectomy in gastric cancer?

A

Removing all lymph nodes along the coeliac axis, and hepatic and splenic arteries

65
Q

What is the advantage of extensive lymphadenectomy in gastric cancer?

A

Allows more accurate staging, and appears to improve survival

66
Q

What treatment do patients with mid-gastric tumours require?

A

Total gastrectomy

67
Q

What treatment do patients with tumours of the gastro-oesophageal junction require?

A

Subtotal resection of the oesophagus, in addition to the cardia and gastric fundus

68
Q

What treatment might be curative for early-stage disease?

A

Endoscopic mucosal resection

69
Q

What is the limitation of surgery in gastric cancer?

A

There are high relapse rates following surgery, and the benefits of adjuvant chemotherapy aren’t great

70
Q

What should patients with relapse of gastric cancer after surgery be considered for?

A

Clinical trials

71
Q

How effective is adjuvant radiotherapy in the treatment of gastric cancer?

A

It reduces locoregional relapse, but does not alter survival

72
Q

When might patients with locally advanced gastric cancer become operable?

A

Following neoadjuvant chemotherapy or chemoradiation

73
Q

How is metastatic gastric cancer treated?

A

Combination chemotherapy

74
Q

How effective is combination chemotherapy in gastric cancer?

A

Has a response rate of about 35%, but does not significantly improve survival

75
Q

What should patients with metastatic gastric cancer be considered for?

A

Clinical trials of new targeted agents and biological therapies

76
Q

What palliative measures can be used in gastric cancer?

A
  • Endoscopic laser treatment

- Rigid or expandable metal stents

77
Q

What is the purpose of endoscopic laser treatment in the palliation of gastric cancer?

A

Reduce bleeding from intraluminal tumours

78
Q

What is the purpose of stents in the palliation of gastric cancer?

A

They can relieve dysphagia due to tumours of the oesophagogastric junction and cardia of the stomach

79
Q

What % of patients with gastric cancer in the UK present with advanced disease?

A

More than 50%

80
Q

What is the 5 year survival from gastric cancer in patients under 50?

A

16-22%

81
Q

What is the 5 year survival from gastric cancer in patients over 70?

A

5-12%

82
Q

What is the median survival from gastric cancer for patients with advanced local disease or metastatic disease at presentation?

A

6 months

Z - Cancer Care Old (28 decks)

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