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gastroenterology , hepatology and nutrition > Gastric cancer > Flashcards

Gastric cancer Flashcards

1
Q

gastric cancer is classified into benign and malignant what are the benign tumors ?

A

epithelial - adenoma

mesenchymal - leiomyoma , fibroma , hemangioma , lipoma , neurinoma

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2
Q

what are the malignant neoplasms of the stomach ?

A

adenocarcinoma

adeno-squamous carcinoma

squamous cell carcinoma

small cel carcinoma

gastric MALT lymphoma

GIST - gastrointestinal stromal tumor

leiomyosarcoma

neuroendocrine tumors - carcinoids

metastatic - melanoma and breast

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3
Q

what is the most common malignant cancer in the stomach ?

A

adenocarcinoma

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4
Q

adenocarcinoma is histologically classified into what categories ?

A

Lauren classification :

intestinal

diffuse type

and mixed morphology

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5
Q

describe intestinal gastric adenocarcinoma ?

A

majority of patients have this

different grades due to different differentiation usually retained glandular structure
minimum invasiveness
SHARP margins

associated with atrophic gastritis - intestinal metaplasia and dysplastic changes
often polypoid or exophytic bulky lesions

associated with environmental risk factor and diet

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6
Q

describe diffuse type of gastric cancer according to lauren classification

A

infiltrative - into the stomach wall without making obvious mass lesions/ deceptive margins - ulcerating lesions
and often intraperitoneal metastasis

WORST PROGNOSIS - POORLY DIFFRENTIATED - SIGNET RING CELLS

no associated with environmental risk factors and diet - more often in younger population and and family history of E catherine mutations

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7
Q

what is a diffuse type of gastric cancer according to lauren classification called ?

A

LITNIS PLASTICA - submucosal spread

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8
Q

what are the epidemiological factors in diffuse type and intestinal type gastric cancer

A

in intestinal type - most often affecting elder age

in diffuse type - often affecting younger age

in diffuse type - women affected more than man

and intestinal type- man more than women

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9
Q

what causes a higher risk for diffuse ype of gastric cancer occurring?

A

blood type A

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10
Q

how does intestinal type of gastric cancer spread ?

A

Early hematogenous rouute

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11
Q

how does the diffuse type of gastric cancer spread ?

A

Late lymphatic regionally and transmurally

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12
Q

in the cardia of the stomach the most common type of gastric cancer is ?

A

diffuse type

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13
Q

in the corpus antrum of the stomach the most common type of gastric cancer is ?

A

intestinal type

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14
Q

what are the established risk factors for gastric cancer ?

A

over 60

familial

geographical - japan , korea , south america

blood group A

smoking

helicobacter pylori infection

heavy metal exposition

nutrition - salt intake , tinned food , fried food , ad fatty food , alcohol , dyes , plastic packaging

high intact of zinc or copper in drinking water

previous gastric surgery / gastrectomy

pernicious anemia - atrophic gastritis

obesity - gastric cardia

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15
Q

helicobacter pylori infection increases the incidence of what type of gastric cancer the most ?

A

intestinal type in the corpus and antrum

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16
Q

what are the specific carcinogens for causing gastric cancer ?

A

nitrosamines , benspirene aflatoxin

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17
Q

what type of food gives protection for gastric cancer ?

A

fresh fruits and veg - tomatoes , onion , strawberries , grapes

aspirin

content of vit c , vit E , sélénium

b carotene

milk products , green tea

freshly cooked food

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18
Q

what is the change in the prevalence of the type of stomach cancer ?

A

the intestinal type has reduced however the diffuse type remains unchanged

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19
Q

what has happened to incidence of gastric cancer ?

A

it has decreased also its premalignant conditions

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20
Q

h pylori increases the chance of what type of gastric cancer ?

A

intestinal type

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21
Q

how does h pylori cause gastric cancer ?

A

long term sequel - through inflammation , atrophy , gastritis and achlorhydria and increase gastrin levels

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22
Q

the clinical outcome of H p infection is determined by what ?

A

pathogenic potential of the hp strain

and the secretory status

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23
Q

in what case does hp infection lead to higher risk of acquiring cancer ?

A

in low hcl secretion - ph of more than 4
hp progresses into pangastritis
chronic atrophic gastritis
and malignant transformation

hypo and achlorhydria

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24
Q

in what case does hp have more risk for becoming ulcers ?

A

in high hcl secretion = ph of less than 2
mainly leading to antra gastritis
increase gastrin secretion and HYPERCHLORHDRIA

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25
Q

which strains of h pylori are associated with increased risk for gastric cancer ? and why ?

A

CagA (+) due to increased colonisation in the gastric epithelium and pathogenicity

and induce secretion of IL-11/ 17

LESS GASTRIC acid secretion and more inflammation

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26
Q

WHAT ARE THE HERIDITORY RISK FACTORS FOR GASTRIC CANCER ?

A

hereditary diffuse gastric cancer - autosomal dominant
E- cadherin gene

non polyposis colorectal cancer

FAP - familial adenomatous polyposis

peutz jeghers

li - fraumeni syndrome

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27
Q

hereditary etiology has what type of gastric cancer ?

A

diffuse gastric cancer

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28
Q

hereditary diffuse gastric cancer also increases the risk for what types of cancer ?

A

breast cancer , colorectal cancer

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29
Q

what is the criteria for genetic counselling in hereditary diffuse gastric cancer ?

A

one relative with histologically confirmed diffuse type GC before 50 years of age

two relatives wit histologically confirmed diffuse HG at any age

leading to screening and prophylactic gastrectomy

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30
Q

what are the precancerous conditions for stomach cancer which are very rare ?

A

atrophic gastritis - chronic autoimmune gastritis
=15-20 percent

infections with h pylori = less than 1 percent

gastric polyposis - has some sort of connection where gastric cancer was found concomitant with adenomatous polyposis which was synchronous and metachronous - so gastric polps are removed due to the possibility in progression to neoplasia as a preventive measure

gastric ulcer

31
Q

what ca be the primary prophylaxis of gastric cancer ?

A

screening and eradication of hp in young

screening of risk group such as relatives of first degree , or hereditary gene mutation , over the age of 50 - through fluoroscopy , endoscopy , blood work

all patients with dyspepsia should be screened clinically and endoscopically

good nutrition

chemoprevention by giving cox 2 inhibitors - celecoxib and indomethacin

Polypectomy

new blood test for cancer screening proposed in japan
IgG antibodies against Hp

pepsinogen 1 and pepsinogen 2

acyl greyly and deacyl greyly

32
Q

there are four macroscopic forms of gastric cancer ?

A

polypoid - most likely the intestinal type

ulcerated

infiltrative

mixed forms

33
Q

with the diffuse the of gastric cancer what is there an excess production of ?

A

mucin production

- lintis plastica

34
Q

what is the japanese classification of early gastric cancer ?

A

protruding (polyp like)

superficial - (gastritis like) 
elevated plaque 
flat plaque 
depressed plaque 
confined to the mucosa

excavated (ulcer like) - the lowest point is in the submucosa

35
Q

which lymph nodes does gastric cancer metastasise into ?

A

the perigastric lymph nodes

36
Q

what are the symptoms go GC ?

A

unspecific early symptoms / or no symptoms at all.
heaviness after meals and stomach discomfort - patient begins to feel his stomach.
belching
distension of epigastrium
early satiety

epigastric pain - NOT THE INITIAL SYMPTOM
dyspepsia
nausea and vomiting

advanced gastric cancer :
weight loss / loss of appetites bleeding from GIT
anemia

37
Q

when endoscopy is done special attention to be paid to if there is ?

A

Local hyperemia
Local whitening
Abnormal vascular pattern

38
Q

how do we diagnose gastric cancer ?

A

1) upper Gi tract endoscopy with biopsy
2) CT with oral intravenous contrast
3) complete blood count

4) endoscopic ultrasound if no M1 disease is found
pathological pseudo kidney in epigastrium in advanced stages of CA

39
Q

how many biopsies should be taken when diagnosing gastric cancer ? and where are the taken from ?

A

6-10 biopsies

6-10 biopsies
from the base and from the four quadrants of the edges
more malignant tissues are present in th edge that the necrotic crater or centre

40
Q

metastasis of gastric cancer location is where ?

A

direct - momentum , pancreases , diaphragm

to the ovaries - tumor of krukenberg

and the douglas space

to the liver

periumbilical

41
Q

dd of gastric cancer ?

A

chronic gastritis
chronic callus gastric ulcer
benign stomach tumors

42
Q

what is the treatment of gastric cancer ?

A

stage 1 - endoscopic mucosal or endoscopic submucosal resection

more than stage 1 - preoperative chemotherapy
surgery - partial gastrectomy , / lymphnodectomy
splenectomy / total gastrectomy
and post operative chemotherapy

stage 4 - palliative radiotherapy - decreases bleeding , obstruction pain
surgery - pain relief and oral intake of food
palliative chemotherapy

43
Q

in metastatic stage 4 gastric cancer as chemotherapy what is given to achieve partial response and increase survival ?

A

FAM - 5FU ,adriamycin , mitomycyn C

44
Q

how to treat gastric malt lymphoma ?

A

low grade malignancy - complete resolution of neoplasm

high grade malignancy eradication of just h pylori is not only recommenced

45
Q

neuroendocrine gastric tumors of less than how many cm are of low risk ?

A

1cm

46
Q

neuroendocrine tumors of bigger than what cm are at high risk ?

A

2cm or more can metastasise

47
Q

neuroendocrine tumors arise in two pathways which are ?

A

de novo malignant transformation
- single , larger and more aggressive

loss of normal response to high serum gastrin
multiple and smaller size neoplasm

48
Q

what Lethe protective factors for neuroendocrine tumors ?

A

aspirin

49
Q

what are the risk factors specifically for neuroendocrine tumors ?

A

heavy smoking

family history or first line relatives of colorectal cancer

50
Q

GIST tumors are what kind of tumors ?

A

gastrointestinal stromal tumors arise from the interstitial cells of Canal

51
Q

what size predictable for the GIST tumor to be malignant ?

A

2-3cm

52
Q

GIST tumors respond to which type of treatment the best and why ?

A

GIST are kit positive (tyrosine kinase and CD 117 )

respond well to tyrosine kinase inhibitors - imatinib

53
Q

what type of cells are founding the carpia of the stomach ?

A

mucus secreting cells

54
Q

what is found in the antrum and the pylorus of the stomach ?

A

mucus producing and neuroendocrine cells

55
Q

gastric cancer is usually located where ?

A

40 percent the lower part
40 percent the middle part
incidence in the upper part such as the cardia of the stomach is increasing and the lower part is increasing

56
Q

eradication of h pylori is absolutely necessary when ?

A

patents with family history of gastric cancer

57
Q

in the pathophysiologof h pylori what type of cascade is triggered when infected with h pylori to lead to malignancy ?

A

correa cascade

58
Q

h pylori usually affects for what part of the stomach ?

A

antrum , body , fundus. NOT CARDIA

59
Q

what are the late complications of gastric cancer ?

A

pleural effusion

ascites

gastric outlet obstruction

intra or extra hepatic jaundice

60
Q

what are the signs for gastric cancer

A

low serum iron

accl ESR - medium

late stage :
palpable enlarged stomach with succession splash

hepatomegaly

metastasis - sister mary joseph nodule
virchow gland
irish node
blumer shelf - shelf like tumor anterior rectal wall

61
Q

what are the paraneoplastic syndrome in gastric cancer ?

A

dermatomyositis

acanthus nigerians

circinate erythema

peripheral thrombophlebitis

62
Q

if there is metastasise found in gastric cancer what testing should be done ?

A

microsatellite instability and deficient mismatch repair system

HER-neu and PD-L1

63
Q

when does endoscopic ultrasound become useful when detecting gastric cancer

A

when CT fails to define T and N stage

this can view the depth of the tumor

64
Q

what is the staging of gastric cancer ?

A

Tis -carcinoma in situ - without invasion of lamina propria

T1 - invades lamina propria but limited to the submucosa

T2 - tumor invades muscular propria

T3 - subserosal connective tissue invasion

T4 - tumor invades the serosa or adjacent structures

65
Q

what are the early post operative complications in gastric cancer ?

A

anastomotic failure
cholecystitis
pancreatitis

66
Q

what is the classification of MALT lymphoma ?

A

b cell non hodgkin lymphoma

categorised as either gastric or non gastric

67
Q

what is the etiology of gastric malt lymphomas ?

A

h pylori

68
Q

what is the etiology of non gastric Malt lymphoma ?

A

autoimmune diseases such as hashimoto thyroiditis , shores syndrome

69
Q

adenocarcinoma of the stomach is histologically divided into ?

A

-papillary
-tubular
mucinous
-signet ring cell

70
Q

adenocarcinoma of the stomach is locally classified into

A

cardia

  • esophageal like gastric cancer
  • distal stomach like cardia gastric cancer

non carda

  • diffuse
  • intestinal
71
Q

what is another classification for early gait cancer ?

A

Borman classification

72
Q

describe borman classification ?

A

polypoid
ulcerating
ulcerating and infiltrating
infiltrating- litnis plastica

73
Q

what is the definition of early gastric cancer

A

Early gastric cancer (EGC) is defined as invasive gastric cancer that invades no more deeply than the submucosa, irrespective of lymph node metastasis

gastroenterology , hepatology and nutrition (34 decks)

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