Gastric Cancer

Question 1

What is the incidence of gastric cancer?

Answer 1

23/100,000

Question 2

When is gastric cancer most common?

Answer 2

50’s

Question 3

What is the male to female ratio of gastric cancer?

Answer 3

M:F = 2:1

Question 4

Where is gastric cancer more common?

Answer 4

Japan
Eastern Europe
China
S. America

Question 5

What are the risk factors for gastric cancer?

Answer 5

Atrophic gastritis
Diet 
Smoking
Blood group A
Low socio-economic background
Familial
Partial gastrectomy

Question 6

How can atrophic gastritis increase the risk of gastric cancer?

Answer 6

It can cause intestinal metaplasia

Question 7

What can cause atrophic gastritis?

Answer 7

Pernicious anaemia

H. Pylori

Question 8

What dietary factors increase the risk of gastric cancer?

Answer 8

Increases nitrates

Question 9

What foods have high nitrates?

Answer 9

Foods that are smoked, pickled, or salted

Question 10

How do nitrates increase the risk of gastric cancer?

Answer 10

Nitrates form carcinogenic nitrosamines in the GIT

Question 11

How can gastric cancer risk be familial?

Answer 11

If there is a familial E. cadherin abnormality

Question 12

What kind of cancers are gastric cancers?

Answer 12

Mainly adenocarcinomas

Question 13

Where are gastric cancers usually located?

Answer 13

On gastric antrum

Question 14

What gastric cancer might H. Pylori lead to?

Answer 14

MALToma

Question 15

On what basis can gastric cancers be classified?

Answer 15

Depth of invasion
Microscopic appearance
Bormann Classification

Question 16

Where do early gastric cancers invade?

Answer 16

The mucosa or submucosa

Question 17

Where do late gastric cancers invade?

Answer 17

Muscularis propria

Question 18

What are the classifications of gastric cancers based on their microscopic appearance?

Answer 18

Intestinal

Diffuse

Question 19

How do intestinal gastric cancers appear?

Answer 19

Bulky, glandular tumours with heaped ulceration

Question 20

How do diffuse gastric cancers appear?

Answer 20

Infiltrate, with signet ring cell morphology

Question 21

What is the Bormann classification of gastric cancers?

Answer 21

1. Polypoid/fungating
2. Excavating
3. Ulcerating and raised
4. Linitis plastica

Question 22

How does linitis plastica appear?

Answer 22

Leather-bottle like thickening, with flat rugae

Question 23

What are the symptoms of gastric cancer?

Answer 23

Weight loss and anorexia
Dyspepsia
Dysphagia
Nausea and vomiting

Question 24

What is meant by dyspepsia?

Answer 24

Epigastric or retrosternal pain/discomfort

Question 25

What is the problem with the symptoms of gastric cancer?

Answer 25

They usually present late

Question 26

What are the signs of gastric cancer?

Answer 26

``` Anaemia Epigastric mass Jaundice Ascites Hepatomegaly Virchow's node Acanthosis nigricans ```

Question 27

What are the complications of gastric cancer?

Answer 27

Perforation Upper GI bleed Gastric outlet obstruction

Question 28

How might an upper GI bleed caused by gastric cancer present?

Answer 28

Haematemesis | Melaena

Question 29

How might gastric cancer spread?

Answer 29

``` Within the stomach Direct invasion Lymphatic Blood Transcoelomic ```

Question 30

What develops when gastric cancer spreads within the stomach?

Answer 30

Linitis plastica

Question 31

Where might gastric cancer spread through direct invasion?

Answer 31

Pancreas

Question 32

What might occur with lymphatic spread of gastric cancer?

Answer 32

Enlarged Virchow's node

Question 33

Where might gastric spread by blood?

Answer 33

Liver | Lung

Question 34

What can result from the transcoelomic spread of gastric cancer?

Answer 34

Krukenberg tumour | Sister Mary Joseph nodule

Question 35

What is a Krukenberg tumour?

Answer 35

A ovarian tumour with signet ring morphology

Question 36

What causes Sister Mary Joseph nodules?

Answer 36

Umbilical mets

Question 37

What investigations are done in gastric cancer?

Answer 37

Bloods Imaging Staging

Question 38

What bloods should be done in gastric cancer?

Answer 38

FBC LFTs Clotting

Question 39

What imaging should be done in gastric cancer?

Answer 39

CXR USS Gastroscopy (and biopsy) Barium meal

Question 40

What is the purpose of CXR in gastric cancer?

Answer 40

Look for mets

Question 41

What is the purpose of US in gastric cancer?

Answer 41

Liver mets

Question 42

What investigations are done for staging in gastric cancer?

Answer 42

Endoluminal US CT/MRI Diagnostic laparoscopy

Question 43

What are the options in the management of gastric cancer?

Answer 43

Medical palliation Surgical palliation Curative surgery

Question 44

What is involved in medical palliation in gastric cancer?

Answer 44

Analgesia PPI Secretion control Chemotherapy

Question 45

What chemotherapy may be used in palliation for gastric cancer?

Answer 45

Epirubicin 5FU Cisplatin

Question 46

What is involved in surgical palliation in gastric cancer?

Answer 46

Pyloric stenting | Bypass procedures

Question 47

What are the options for curative surgery in gastric cancer?

Answer 47

Early gastric cancer may be resected endoscopically | Partial or total gastrectomy

Question 48

What is the overall 5 year survival rate for gastric cancer?

Answer 48

<10%

Question 49

What is the 5 year survival rate for people with gastric cancer who have surgery?

Answer 49

20-50%