Gastric Cancer Flashcards
Epidemiology of gastric cancer
Fifth most common cancer globally
Second highest cause of cancer realted deaths, usually because its late presentation.
Types of gastric cancer
Majority arise from gastric mucosa as adenocarcinomas.
Remainder will be a mixture of connective tissue, lymphoid or neuroendocrine malignancies.
Risk factors
Due to improved diet and treatment of H. pylori infections the rates of gastric cancer have fallen in the past few decades.
It remains extremely common however in far eastern countries like Japan and Korea.
Major risk factors:
Male gender
H. pylori infection
Increasing age
Smoking
Alcohol consumption
Other risk factors such as….
Salt in diet
+ve FH
Pernicious anaemia
Clinical features
Usually vague and non-specific and only present in advanced
Dyspepsia unresponsive to PPi treatment
Dysphagia
Early satiety
Vomiting
Melaena
Anorexia
Weight loss
Anaemia
Examination findings
In late stages…
Epigastric mass
Troisier sign (presence of palpable left supraclavicular node (Virchow node))
Considered a sign of metastatic disease
Hepatomegaly, ascities, jaundice or acanthosis nigricans are other signs of metastatic disease
Dx
Peptic ulcer disease
GORD
Gallstone disease
Pancreatic cancer
Laboratory investigations
Any patient presenting with clinical features of gastric cancer including haematemesis or melaena should have urgent bloods with FBC and LFTs
Primary investigation of any suspected gastric cancer
Urgent upper GI endoscopy (OGD) and then biopsy if anything is found.
CT scan may show thickening of the gastric wall but does not allow direct visualisation or biopsy which means OGD is better.
What should biopsies from suspected gastric malignancies be sent for?
Histology
CLO test (H. pylori)
HER2/neu protein expression to allow for targeted monoclonal therapies if present
What investigations are done for staging and to plan treatment?
CT Chest-Abdomen-Pelvis and staging laparoscopy to look for peritoneal metastases.
Gastric cancers are done by TNM staging.
Why are PET scans not often use in gastric cancer staging?
They are not very PET avid as they do not take up the radioactive tracer well.
General management
Should be discussed at a specialist upper GI cancer MDT meeting for definitive management or potential palliation decisions
Adequate nutrition is essential and patient should undergo nutritional status assessment
Many patients will need definitive nutritional support both pre or post-treatment via an NG tube or RIG tube.
What is the mainstay curative treatment for gastric cancer?
Surgery and patients who are fit enough should be offered peri-operative chemotherapy which is usually 3 cycles of neoadjuvant and 3 cycles of adjuvant therapy.
What surgery is done in proximal gastric cancers?
Total gastrectomy
What surgery is done in distal gastric cancers (antrum or pylorus)?
Subtotal gastrectomy
What surgicaly technique is most commonly used?
Roux-en-Y reconstruction as it gives the best functional result in particular with less bile reflux.
Post-gastrectomy, distal oesophagus is end-to-end anastomosed directly to the small bowel.
And the duodenum is then end-to-side anastomosed also the the small bowel.
