Gastric Cancer Flashcards
50-year-old man has had persistent nausea for 5 years with occasional vomiting. On physical examination there are no abnormal findings. He undergoes upper GI endoscopy, and a small area of gastric fundal mucosa has loss of rugal folds. Biopsies are taken and microscopically reveal well-differentiated adenocarcinoma confined to the mucosa. An upper GI endoscopy performed 5 years previously showed a pattern of gastritis and microscopically there was chronic inflammation with the presence of. Which of the following is the most likely risk factor for his neoplasm?
H. Pylori Infection
H. pyloriinfection can lead to chronic gastritis that promotes development of adenocarcinoma. The prognosis with early gastric carcinoma (EGC) is good, compared with other gastric cancers.
Pathology
95% are adenocarcinoma
Causes
Dietary carcinogens – nitrosamines, diet high in salt
H. Pylori
Chronic atrophic gastritis – 3x risk of gastric cancer
Cadherin-1 (CDH-1) associated with increased risk
Vagotomy/partial gastrectomy carry an increased risk
Pernicious anaemia
Blood group A: gAstric cAncer
Lifestyle: family history, obesity, radiation
2 types of Adenocarcinoma
Intestinal
Diffuse
Associations with Intestinal Types
Distally Well Differentiated Men Exhibit Blood borne metastases Seen in older patients Better prognosis
Associations with Diffuse Types
Younger Patients Women Poorly differentiated Composed of signet rings Associated with Blood type A Spreads via lymphatic system Poor prognosis
Presentation
Dyspepsia
Advanced Disease: eight loss, anorexia, early satiety, vomiting
Advanced Signs:
Virchow’s node
ascites
Jaundice
Who gets Urgent endoscopy?
> 55 with recent onset dyspepsia or <55 years old with dysphagia, anorexia, vomiting and weight loss or GI bleeding
Imaging
CT chest, abdomen, pelvis : mestases
EUS: depth of invasion and lymph nodes
PET-CT: if CT uncertain
Laparascopy
Staging
TMN system
Investigations
FBC: microcytic anaemia
LFTs
A 38-year-old man has had upper abdominal pain for 3 months. For the past week he has had nausea. On physical examination a stool sample is positive for occult blood. An upper GI endoscopy reveals no esophageal lesions, but there is a solitary 2 cm diameter shallow, sharply demarcated ulceration of the stomach. Which of the following is most characteristic for this lesion?
AAntral location BPotential for metastases CIncreased gastric acid production. DNo need for biopsy EAccompanying pancreatic gastrinoma
A
A 62-year-old man has had anorexia, vomiting, and vague abdominal pain accompanied by weight loss of 6 kg over the past 2 months. Physical examination reveals supraclavicular non-tender lymphadenopathy. He becomes progressively cachectic. An abdominal CT scan shows the stomach is shrunken with the gastric wall thickened to 1 cm and with extensive overlying mucosal erosions. Multiple masses from 1 to 4 cm in size are scattered within the liver. Which of the following conditions most likely preceded development of his illness?
AAcquired immunodeficiency syndrome BHyperglycemia CChronic alcoholism DPernicious anemia ESystemic sclerosis FUse of NSAIDS
D) Pernicious Anaemia
This is linitis plastica of the stomach, which typically has a signet ring cell pattern of adenocarcinoma diffusely infiltrating the stomach. Autoimmune gastritis is a risk factor for this condition. The atropbic gastritis leads to loss of parietal cells that produce intrinsic factor needed for B12 absorption.
Management of Stage 0
Endoscopic mucosal resection
