Gastric Cancer Flashcards
What are the incidence of gastric cancer
= incidence of adenocarcinaom at gastro-oesophageal junction
- 23/100,000 a year in the uK
- wide unexplained geographical variations
- more like in male than female
What are the risk factors of gastric cancer
- pernicious anaemia
- Blood group A
- H.Pylori
- atrophic gastritis
- adenomatous polyps
- lower social class
- smoking
- diet
- nitrosamine exposure
What are the symptoms of gastric cancer
Often non-specific
- dyspepsia
- weight loss
- vomiting
- dysphagia
- anaemia
What are the signs of gastric cancer
Suggests incurable disease
- epigastric mass
- hepatomegaly
- jaundice
- ascites
- Virchow’s node
- acanthosis nigricans
How does gastric cancer spread
- local
- lymphatic
- blood borne
- transcoelemic (e.g. to ovaries)
what investigations do you use for gastric cancer
- Gastroscopy and multiple ulcer edge biopsies
- EUS - to evaluate depth of invasion
- CT/MRI - for staging
- Staging laparoscopy - for locally advanced tumours
- Cytology of peritoneal washings - to identify peritoneal metastases
What is the treatment of early stage gastric cancer
may be resectable endoscopically
What is the treatment of more advanced distal tumours
- partial or total gastrectomy
What other treatments for gastric tumours are there
- Combination chemotherapy – appears to increase survival in advanced disease perioperatively
- Surgical palliation – for obstruction, pain, haemorrhage
- Targeted therapies likely to have an increasing role, eg trastuzumab for HER-2-positive tumours
What are the types of gastrectomy
- Curative gastrectomy - localised lesion
- Total gastrectomy - lesions in proximal third or extensive infiltrated disease
- partial gastrectomy - lesions in distal two thirds
What is a Billroth I
- partial gastrectomy with simple gasproduodenal re-anastomosis
What is a billroth II gastrectomy
partial gastrectomy with gastrojejunal anastomosis; duodenal stump is oversewn (leaving blind afferent loop) and anastomosis is achieved by a longitudinal incision into the proximal jejunum
What is a roux-en Y
following total or partial gastrectomy, the proximal duodenal stump is oversewn, the proximal jejunum is divided from the distal duodenum and connects with the oesophagus (or proximal stomach after partial gastrectomy), while the distal duodenum is connected to the distal ileum
What is the benefit of lymph node clearance
- limited benefit and increased morbidity with extended lymph node resections (D2 or D3) over resection limited to perigastric lymph nodes (D1)
What are the complications of gastrectomy
- abdominal fullness - feeling of early satiety (+/- discomfort and distension) improving with time
- afferent loop syndrome
- diarrhoea
- gastric tumour - rare complication of any surgery which reduces acid production
- amylase increases
- dumping syndrome
- weight loss
- bacterial overgrowth
- anaemia
- Oesteomalacia
