Gastric Cancer

Question 1

Define gastric cancer?

Answer 1

Cancer of the stomach

Question 2

What is the most common cause of gastric cancer?

Answer 2

Adenocarcinoma

Question 3

What are the rarer causes of gastric cancer?

Answer 3

Lymphoma
Leiomyosarcoma
Stromal Tumours

Question 4

Is gastric cancer genetic?

Answer 4

Genetic and Environmental

Question 5

What are the risk factors for gastric cancer?

Answer 5

Smoked and processed foods
Smoking 
Alcohol 
H.Pylori infection
Atrophic gastritis 
Pernicious Anaemia 
Partial Gastrectomy 
Gastric polyps

Question 6

What is the epidemiology of gastric cancer?

Answer 6

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 is > 50 yrs

Question 7

What are the presenting symptoms of gastric cancer?

Answer 7

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 8

What are the signs of gastric cancer on physical examination?

Answer 8

Epigastric mass 
Abdominal Tenderness 
Ascites 
Signs of anaemia 
Virchow's node (aka Troisier's node)
Sister Mary Joseph's Nodule 
Krukenberg's Tumour

Question 9

What is Sister Mary Joseph’s nodule?

Answer 9

Metastatic node on the umbilicus

Question 10

What is Krukenberg’s Tumour?

Answer 10

Ovarian Metastases

Question 11

What are the appropriate investigations of gastric cancer?

Answer 11

Upper GI endoscopy
Bloods - FBC (check for anaemia), LFTs
CT/MRI - for staging
Endoscopic USS

Question 12

Why do we do an Endoscopic USS for gastric Cancer?

Answer 12

Assess depth of gastric invasion and lymph node involvement