Gastric Cancer Flashcards
What are the risk factors for developing gastric cancer. (12)
Surgery is an independent risk factor for the late development of malignancy in the gastric remnant (increased risk after a partial gastrectomy).
Hyperchlorhydria.
Duodenal gastric reflux of bile.
Diet (high salt, high nitrate, pickling, low vitamin C).
Atrophic gastritis.
Smoking.
Blood group A.
Nitrosamine exposure.
Genetic predisposition (common loss of heterozygosity of tumour suppressor genes such as p53 - in 50% of all cancers).
Family history (first degree relatives of patients with gastric cancer have 2 to 3 times increased relative risk of developing the disease).
Pernicious anaemia.
H.pylori infection.
How common is gastric cancer.
It is currently the 4th most common cancer found worldwide.
What is the mortality associated with gastric cancer.
It is the second leading cause of cancer related mortality.
What age group is most commonly affected with gastric cancer. (2)
Peak incidence 50-70 years.
It is rare under the age of 30.
Where are the highest locations for gastric cancer. (3)
Eastern Asia.
Eastern Europe.
South America.
What are most gastric cancers.
Adenocarcinomas.
What is the ratio of men:women who are affected by gastric cancers.
2:1.
Where is the highest incidence of gastric cancer.
Japan.
What is the incidence of gastric cancer in the UK. (3)
It is the eighth most common cancer.
M: 16/100,000.
F: 9/100,000.
What percentage of gastric cancers worldwide have detectable EBV.
2-16%.
What is the overall incidence of gastric cancer in the UK.
23/100,000.
How is gastric cancer classified.
Bormann classification.
What is involved in the Bormann classification. (4)
Polypoid.
Ex-cavating.
Ulcerating and raised.
Diffusely infiltrative.
What is ‘early’ gastric carcinoma. (2)
Gastric carcinomas that are confined to the mucosa and submucosa.
Regardless of the presence of lymph node metastases.
What is the 5 year survival rate for ‘early’ gastric carcinoma.
90% (but many of these would have survived without treatment as well).
How are ‘early’ gastric cancers usually detected in the UK.
Usually an incidental finding.
What are the two major types of gastric cancer. (2)
Intestinal (type 1).
Diffuse (type 2).
What are the symptoms of gastric cancer. (6)
Often non-specific:
Dyspepsia (for >1month and >50 years demands investigation).
Weight loss.
Vomiting (if the tumour encroaches on the pylorus).
Dysphagia (occurs if the tumour involves the fundus).
Anaemia.
Epigastric pain (advanced disease - relieved by food and antacids).
What are the clinical signs of gastric cancer. (6)
Suggesting incurable disease:
Epigastric mass (50% with abdominal tenderness).
Hepatomegaly.
Jaundice.
Ascites.
Large left supraclavicular node (Virchow’s node - Trossier’s sign).
Acanthosis nigricans.
What is the typical presentation of gastric cancer in the west. (2)
Locally advanced (inoperable) or metastatic disease.
How does gastric cancer spread. (4)
Local.
Lymphatic.
Blood-borne.
Transoelomic (eg to ovaries = Krukenberg tumour).
What is the gold standard for diagnosis of a gastric cancer.
Gastroscopy and multiple biopsies.
What are intestinal (type 1) gastric cancers. (3)
Well formed glandular structures (differentiated).
Polypoid tumours or ulcerating lesions with heaped-up rolled edges.
Intestinal metaplasia is seen in the surrounding tissue.
What are diffuse gastric cancers. (3)
Poorly cohesive cells (undifferentiated) that tend to infiltrate the gastric wall.
They may involve any part of the stomach, especially the cardia.
They have a worse prognosis than intestinal tumours.
What is ‘lintis plastica’.
It occurs due to widely spreading submucosal gastric cancer causing diffuse thickening and rigidity of the stomach wall.
Where can gastric carcinoma metastasize to. (4)
Liver.
Brain.
Bone.
Lung.
What is the prognosis for patients with gastric adenoarcinoma.
5year survival rate is
