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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
What are the symptoms of early stage gastric cancer?
May be asymptomatic, or have vague and non-specific symptoms, e.g. dyspepsia, tiredness, or anorexia
26
How will most patients with gastric cancer present?
- Vague epigastric discomfort, which is worse with meal - Weight loss - Early satiety - Anorexia - Dysphagia - Vomiting 🤮
27
What are the features of advanced gastric cancer?
- Ascites - Jaundice - Melaena - Hepaomegaly - Lymph node involvement
28
What % of patients with gastric cancer have liver metastases?
25%
29
How might lymph node involvement present in gastric cancer?
- Virchow's note in left SCF | - Palpable epigastric mass
30
What is a rare complication of gastric cancer?
Transcoelomic spread to the ovaries (Krukenberg tumour)
31
When is referral to a specialist for urgent endoscopy and review required in suspected gastric cancer?
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
32
What investigations may be done in suspected gastric cancer?
- FBC and LFTs - Endoscopy with biopsy - Barium studies - Imaging
33
What might FBC show in gastric cancer?
Microcytic anaemia
34
What causes microcytic anaemia in gastric cancer?
- Blood loss | - Iron deficiency
35
Why might LFTs be abnormal in gastric cancer?
Due to liver metastasis
36
What might be required if gastric ulceration is noted on endoscopy?
A repeat endoscopy to confirm healing
37
Why is important to do a repeat endoscopy if gastric ulceration is noted on endoscopy?
A non-healing ulcer may suggest the possibility of malignancies
38
When might barium studies be done in suspected gastric cancer?
In patients non-tolerant of endoscopy
39
What is the limitation of barium studies in gastric cancer?
Can't take biopsy for histological examination
40
What imaging might be done in gastric cancer?
- Ultrasound of liver - CXR - CT of thorax and abdomen - PET
41
What is the purpose of ultrasound of the liver and CXR in gastric cancer?
Screen for metastasis
42
When will CT and PET be required in gastric cancer?
In patients with more advanced disease
43
What is the purpose of CT scanning in advanced gastric cancer?
Demonstrate involvement of local lymph nodes and identify metastasis
44
What is PET used for in gastric cancer?
Increasing use for the detection of disease spread
45
What is Tx in gastric cancer?
Primary tumour cannot be evaluated
46
What is T0 in gastric cancer?
There is no evidence of primary tumour in the stomach
47
What is T1 in gastric cancer?
Carcinoma in situ
48
What is T2 in gastric cancer?
Tumour invading into the muscularis propria/submucosa
49
What is T3 in gastric cancer?
Tumour has penetrated the serosa
50
What is T4 in gastric cancer?
Tumour has invaded organs surrounding the stomach
51
What is Nx in gastric cancer?
Regional lymph nodes cannot be evaluated
52
What is N0 in gastric cancer?
No regional lymphadenopathy
53
What is N1 in gastric cancer?
Regional lymph node involvement (1 or 2 lymph nodes)
54
What is N2 in gastric caner?
Regional lymph node involvement (7-15 lymph nodes)
55
What is N3 in gastric cancer?
Regional lymph node involvement (16+ lymph nodes)
56
What is Mx in gastric cancer?
Distant metastases cannot be evaluated
57
What is M0 in gastric cancer?
No distant metastases
58
What is M1 in gastric cancer?
Distant metastases
59
What is the only significant curative intervention for gastric cancer?
Surgery with laparotomy
60
What is surgery with laparotomy often preceded by in gastric cancer?
Laparoscopic staging
61
What % of patients with gastric cancer are suitable for surgery?
About 50%
62
When might a subtotal gastrectomy be sufficient in gastric cancer?
For antral cancers
63
What is the advantage of a subtotal gastrectomy compared to total?
Fewer complications
64
What is meant by extensive lymphadenectomy in gastric cancer?
Removing all lymph nodes along the coeliac axis, and hepatic and splenic arteries
65
What is the advantage of extensive lymphadenectomy in gastric cancer?
Allows more accurate staging, and appears to improve survival
66
What treatment do patients with mid-gastric tumours require?
Total gastrectomy
67
What treatment do patients with tumours of the gastro-oesophageal junction require?
Subtotal resection of the oesophagus, in addition to the cardia and gastric fundus
68
What treatment might be curative for early-stage disease?
Endoscopic mucosal resection
69
What is the limitation of surgery in gastric cancer?
There are high relapse rates following surgery, and the benefits of adjuvant chemotherapy aren't great
70
What should patients with relapse of gastric cancer after surgery be considered for?
Clinical trials
71
How effective is adjuvant radiotherapy in the treatment of gastric cancer?
It reduces locoregional relapse, but does not alter survival
72
When might patients with locally advanced gastric cancer become operable?
Following neoadjuvant chemotherapy or chemoradiation
73
How is metastatic gastric cancer treated?
Combination chemotherapy
74
How effective is combination chemotherapy in gastric cancer?
Has a response rate of about 35%, but does not significantly improve survival
75
What should patients with metastatic gastric cancer be considered for?
Clinical trials of new targeted agents and biological therapies
76
What palliative measures can be used in gastric cancer?
- Endoscopic laser treatment | - Rigid or expandable metal stents
77
What is the purpose of endoscopic laser treatment in the palliation of gastric cancer?
Reduce bleeding from intraluminal tumours
78
What is the purpose of stents in the palliation of gastric cancer?
They can relieve dysphagia due to tumours of the oesophagogastric junction and cardia of the stomach
79
What % of patients with gastric cancer in the UK present with advanced disease?
More than 50%
80
What is the 5 year survival from gastric cancer in patients under 50?
16-22%
81
What is the 5 year survival from gastric cancer in patients over 70?
5-12%
82
What is the median survival from gastric cancer for patients with advanced local disease or metastatic disease at presentation?
6 months

Z - Cancer Care Old (28 decks)

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