Gastric cancer

Question 1

What are the factors associated with adenocarcinoma (intestinal type) of the stomach?

Answer 1

H. pylori 
Smoking 
Diets high in salt 
Pernicious anaemia 
Partial gastrectomy 
Japan
Type A blood 
Autoimmune gastritis
Achlorhydria

Question 2

What are the clinical features of gastric cancer?

Answer 2

Occur in the antrum and usually adenocarcinomas 
Epigastric pain 
Nausea, anorexia, weight loss
Vomiting (esp if tumour near pylorus)
Haematemesis 
Meleana
Dysphagia 
Anaemia 
Palpable epigastric mass with abdominal tenderness
Virchow's node 
Dermatomyositis
Acanthosis nigricans
Sister Mary Joseph (enlarged belly button)
Troisier's sign (enlarged virchows node)

Question 3

What are the investigations done for carcinoma of the stomach?

Answer 3

FBC and liver biochemistry
Gastroscopy and biopsy
Barium meal (filling defect, irregular ulcer with rolled edges)

Question 4

What occurs in diffuse gastric adenocarcinoma?

Answer 4

Gastric linitis- leather bottle (submucosa becomes thicker and more rigid)
Signet ring cells in connective tissue

Question 5

What are the characteristics of carcinoid tumours in the stomach?

Answer 5

Neuroendocrine cells
Well differentiated
From mucosa as poly
In intestine and pancreas

Question 6

What are the complications of gastric adenocarcinoma?

Answer 6

Metastasis- peritoneum, lymph nodes (umbilicus, virchows), liver, ovaries (krukenberg)
Paraneoplastic syndromes: leser trelat sign (keratosis), polyarteritis nodosa (kidney failure, MI), trousseau syndrome (migratory thrombosis)
Pseudoachalasia Syndrome (stricture gastroeosophageal junction)

Question 7

What are the types of gastric cancer?

Answer 7

Adenocarcinoma (columnar glandular epithelium)
Lymphoma (lymphocytes)
Carcinoid tumor (G cells in stomach)
Leiomyosarcoma (smooth muscle cells)

Question 8

What are the types of adenocarcinoma?

Answer 8

Intestinal type (well differentiated)
Diffuse (undifferentiated)

Question 9

Intestinal

Answer 9

H. Pylori
Metaplasia- stomach cells- intestinal epithelium
Lesser curvature of antrum- large, irregular ulcer with heaped edges

Question 10

Diffuse

Answer 10

Any part of stomach 
Genetic mutations in CDH1
Increased ability to spread and invade 
Gastric linitis (leather bottle) (invades connective tissue of sub-mucosa)
Signet ring cells

Question 11

Lymphomas

Answer 11

H. pylori- B-cell proliferation

Question 12

Carcinoid

Answer 12

Neuroendocrine cells
Well differentiated
From mucosa as polyp
Intestine, pancreas or stomach

Question 13

Leiomyosarcomas

Answer 13

Spindle, epithelial or undifferentiated

Question 14

Complications of gastric adenocarcinoma?

Answer 14

Metastasis- lymph node, umbilicus, virchow’s, liver, krukenberg (ovaries)
Paraneoplastic syndromes- Leser-trelat (brown spots), polyarteritis nodosa (kidney failure, MI), Trousseau syndrome, pseudoachalasia

Question 15

How is gastric cancer diagnosed?

Answer 15

Endoscopy
X-ray with barium contrast (complications)
CT- assess spread and staging

Question 16

What is gastric cancer pathology?

Answer 16

50-70y, Japanese
Most adenocarcinomas in antrum
Appear as polypoids/ulcerating lesions with rolled edges
Intestinal metaplasia in surrounding tissue: H. Pylori
Leather bottle stomach/linitis plastica: submucosal infiltration of tumour –> fibrous reaction –> small, thickened, contracted stomach
Mets: local invasion of abdominal viscera, lymphatic (Virchow’s), liver (portal dissemination)
Transcoelomic spread: peritoneal seedings, bilateral ovarian ‘Krukenberg’ tumours
Rare: stromal tumours (leiomyomas/leiomyosarcomas) from interstitial cells of Cajal

Question 17

Carcinoid tumour pathophysiology

Answer 17

Tumours of argentaffin cells, produce serotonin/prostaglandins
Can occur on tip of the appendix
10% associated with MEN-1 syndrome
Characteristically take up silver stains readily
>50y
Carcinoid syndrome: facial flush & diarrhoea