Gastric cancer Flashcards
What type of tumours can occur in the stomach?
- Adenocarcinoma
- GI stromal cell tumour
- Lymphoma
- Hodgkin’s disease
Which part of the stomach do cancers usually arise?
Antrum (~50%)
Body = 25% GOJ = 25%
What are the risk factors for gastric cancer?
- H Pylori gastritis
- Genetics
- M>F
- Smoking
- Eating lots of salty/smoked food
- Pernicious anaemia
Describe the macroscopic appearance of gastric cancers.
- polypoid fungating - tumour erupts from gastric mucosa
- polypoid with ulceration - tumour looks like a volcano crate with raised edges but cut out middle
- ulcerating - the edges are craggy and the middle is cut away
- diffuse infiltrating (linitis plastic) - leather bottle stomach - barely raised craggy edges
Describe the microscopic appearance of gastric cancers.
- Adenocarcinoma (95%)
(a) intestinal:
- 55% of gastric adenocarcinoma
- originates from a foci of cells that have undergone intestinal metaplasia
- presents as a polypoid or ulcerating mass
- occurs in older patients
- prognosis a little better than signet ring
(b) diffuse (signet ring):
- 30% of gastric adenocarcinomas
- originates from mucous neck cells in gastric pits
- presents as diffuse infiltrating carcinoma
- occurs in young patients
- poor prognosis - Undifferentiated carcinoma (GIST or lymphoma) (5%)
How can gastric cancers spread?
- Directly to adjacent structures
- Transcoelomic to the ovaries (krukenberg sign), usually diffuse infiltrating type
- Via lymphatics
- Haematologically to the liver
What is usually the prognosis for gastric cancers?
- Early stage: tumour confined to mucosa or submucosa (>90% 5 year survival)
- Late stage: tumour also in the muscularis propria or has spread (<15% 5 year survival )
- Most are diagnosed at stage 3/4 due to non-specific presentation
What are the S+S of gastric cancer?
- belching
- bloating
- dyspepsia
- abdo pain
- anorexia
- weight loss
- melaena
- anaemia
- may have a palpable epigastric mass
- may have a palpable supraclavicular lymph node (Virchow’s node/Trosier’s sign)
How are gastric cancers diagnosed?
- Endoscopy
- Endoscopic US
- Barium meal
Describe stage 1 of gastric cancer.
Stage 1A:
- cancer is contained within the inner lining of the stomach, and no lymph nodes are affected
Stage 1B:
- cancer is still contained within the stomach lining, but has spread to 1 or 2 lymph nodes
- lymph nodes are unaffected, but the cancer has spread to muscles that surround the inner lining
Describe stage 2 of gastric cancer.
Stage 2A:
- cancer is still contained within stomach lining, but has spread to between 3-6 lymph nodes
- spread into surrounding muscles and to 1 or 2 lymph nodes, or the lymph nodes are unaffected, but the cancer has spread to the outer layer of the stomach
Stage 2B:
- cancer still contained inside the lining, but has now spread into 7+ lymph nodes
- spread into the muscles and also to between 3-6 lymph nodes
- spread into the outer layer of the stomach and also into 1 or 2 lymph nodes
- lymph nodes are still unaffected, but the cancer has spread outside the stomach
Describe stage 3 of gastric cancer.
Stage 3A:
- cancer has spread into surrounding muscles and into seven or more lymph nodes
- cancer has spread into the outer layer of the stomach and also to between three and six lymph nodes
- cancer has spread outside of the stomach and also into one or two lymph nodes
Stage 3B:
- cancer has spread into the outer layer of the stomach and also into seven or more lymph nodes
- cancer has spread outside of the stomach and also to between three and six lymph nodes
- cancer has spread further outside of the stomach into surrounding tissue and may also affect up to two lymph nodes
Stage 3C:
- cancer has spread beyond the stomach into nearby tissues, organs and also into three or more lymph nodes
Describe stage 4 of gastric cancer.
Cancer has spread to another part of the body such as liver or lungs
