Gastric cancer Flashcards
What is the sister Mary Joseph nodule?
It is a swollen lymph node in the umbilicus
What is the Blumers shelf?
A collection of tumour cells we feel rectally
What are the 4 regions of the stomach?
- Fundus
- Body
- Antrum
- Pyloric sphincter
- Cardia
What are the 4 types of gastric cancer?
- Adenocarcinoma-95%
- lymphoma-15%
- GIST-3%
- Carcinoid
What age is the peak incidence of gastric cancer?
6rth decade/70 years
What are the risk factors for gastric cancer?
- Nutritional
- high nitrate diet, smoked and pickled food, dirty drinking water, not enough fruits and vegetables - Medical:
- obesity
- smoking
- family history
- H.Pylori
- poor socio-economic background
- previous gastric surgery
How do we classify gastric CA according to Bormann’s classification?
1. type 1- polyploid or fungating type 2-ulcerating with raised edges type 3- ulcerating with infiltration into wall type 4-diffuse infiltration type 5-unclassified
What is linitus plastica?
It is when the entire stomach is lined with type 4 cells
What is the initial presentation of patients with gastric ca?
- early satiety
- abdominal pain
- weight loss
- fatigue to iron deficiency
- nausea+vomiting
What are the physical examination signs you would find?
- hepatomegaly and epigastric mass
- ascites
- sister mary jospeh nodule at the umbilcus
- Virchows lymph node at the supra-clavicular region
- Krukeneberg- ovarian mass
- Blumer’s shelf-palpable mass in pouch of douglas
What special investigations do we do here?
- Upper gastroscopy with biopsy
2. Bloods: FBC, Urea and electrolytes, creatinine, liver function tests, coagulation studies
What special investigations do we do here?
- Upper gastroscopy with biopsy
- Bloods: FBC, Urea and electrolytes, creatinine, liver function tests, coagulation studies
- ascitic tap for cytology
- CXR and liver ultrasound to stage
- CT scan is expensive but more effective-chest and abdomen
What is the treatment for gastric ca?
- surgical resection if there’s no metastases
2. palliation
What surgery do we do for distal ca?
sub total gastrectomy with billroth 1,2 or roux and y
What do we do for more proximal tumours?
Total gastrectomy with roux and y and ossible lymph node resection
What is the magic regime?
This is when the patient who has neoadjuvant therapy is given a further 3 cycles of chemotherapy after surgery
This increases the survival rates by at least 15%
What are the different palliative options?
- Radiotherapy for pain or bleeding that opiates cannot fix
- bypass with gastrojejunostomy to pass through the tumour
- self expanding metal stent
What are the two main causes of gastric lymphoma?
- H. pylori and immunsuppression(HIV)
Which age is affected by gastric lymphoma?
60-70 years
What are the two ways we can stage gastric lymphoma?
- low grade MALT-mucosa associated lymphoid tissue usually requires H. pylori eradication
- high grade MALT- usually requires chemotherapy and radiotherapy
What special investigations would you do in Gastric lymphoma?
- bone marrow biopsy and CT abdo, chest and neck
2. test for H. pylori
What are the GIST tumours?
gastrintestinal stromal tumours that occur in the 6th decade
They are submucosal or originate from the muscularis propria and release tyrosine kinase from the cells of Cajal
What is the survival rate of gastric lymphomas?
75-95%
What is the survival rate of GIST?
50%
How does GIST usually present?
- usually with epigastric pain and upper GI bleeding from the ulceration
What special investigatons do you need to do for a GIST?
CT abdomen and chest to look for mets
endoscopy but not biopsy
What is the treatment for GIST?
Surgical resection with no lymph node dissection
- usually gastric wedge dissection
- we can try imitinab (gleevec) which is a tyrsine kinase inhibitor
