Gastric Cancer

Question 1

Definition

Answer 1

· Cancer of the stomach. Most commonly adenocarcinoma

o Rarer causes of gastric cancer:
· Lymphoma
· Leiomyosarcoma
· Stromal tumours

Question 2

Aetiology

Answer 2

Unknown

Environment and genetics

Question 3

Risk factors

Answer 3

o Smoked and processed foods
o Smoking
o Alcohol
o Helicobacter pylori infection
o Atrophic gastritis
o Pernicious anaemia
o Partial gastrectomy
o Gastric polyps

Question 4

Epidemiology

Answer 4

· COMMON cause of cancer death worldwide
· Highest incidence in JAPAN (and Asia in general)
· 6th most common cancer in the UK
· Usual age of presentation: > 50 yrs

Question 5

Presenting symptoms

Answer 5

· Often asymptomatic early
· Early satiety
· Epigastric discomfort
· Systemic symptoms: weight loss, anorexia, nausea/vomiting
· Dysphagia (in tumours of the gastric cardia)
· Symptoms of metastases (e.g. ascites, jaundice

Question 6

Signs on physical examination

Answer 6

· Epigastric mass
· Abdominal tenderness
· Ascites
· Signs of anaemia
· Virchow’s Node (aka Troisier’s sign)
· Sister Mary Joseph’s Nodule (metastatic node on the umbilicus)
· Krukenberg’s Tumour (ovarian metastases)

Question 7

Investigations

Answer 7

· Upper GI endoscopy
· Bloods - FBC (check for anaemia), LFTs
· CT/MRI - for staging
· Endoscopic USS - assess depth of gastric invasion and lymph node involvement