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Year 3 > Gastric cancer (GI) > Flashcards

Gastric cancer (GI) Flashcards

1
Q

Define gastric cancer.

A

Neoplasm that can develop in any portion of the stomach and may spread to the lymph nodes and other organs

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2
Q

What is the most common form of gastric cancer and where is it found?

A

Usually adenocarcinoma found on the lesser curvature

(Rarely lymphoma or leiomyosarcomas)

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3
Q

Describe the epidemiology of gastric cancer. (2)

A
  • M>F
  • > 50 years old
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4
Q

What are some subtypes of gastric cancer? (3)

A
  • tumours that are positive for EBV
  • microsatellite unstable tumours
  • genomically stable tumours, chromosomal unstable tumours
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5
Q

What is the pathophysiology of gastric cancer? (2)

A
  • loss of tumour suppressor gene - H. pylori increases p53 mutations
  • over-expression of proto-oncogenes: RAS, c-MYC and ERB2 (HER2/neu)
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6
Q

What is key to diagnosis of gastric cancer?

A

Presence of risk factors

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7
Q

What are the clinical features of gastric cancer? (7)

A
  • abdominal pain - vague in early stages, epigastric tenderness, may present as dyspepsia
  • weight loss
  • lymphadenopathy:
    • Virchow’s node: left supraclavicular node
    • Sister Mary Joseph’s nodule: periumbilical nodule
    • Irish node: left axillary node
  • nausea & vomiting
  • dysphagia (proximal, GO junction and gastric cardia tumours)
  • lower GI bleeding (–> melaena) + haematemesis
  • acanthosis nigricans - symmetrical, brown, velvety plaques on neck, axilla or groin
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8
Q

What might you see on examination in gastric cancer? (3)

A
  • anaemia - blood loss, ACD
  • lymphadenopathy
  • acanthosis nigricans - symmetrical, brown, velvety plaques on neck, axilla or groin
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9
Q

What is Virchow’s node (gastric cancer)?

A

Lymphadenopathy in left supraclavicular area - sign of lymphatic spread / gastric malignancu

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10
Q

What is a Sister Mary Joseph nodule (gastric cancer)?

A

Metastatic node on umbilicus (periumbilical nodule)

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11
Q

What is an Irish node (gastric cancer)?

A

Left axillary node

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12
Q

What is a Krukenberg tumour (gastric cancer)?

A

Ovarian mass as a result of metastasis from a gastric tumour - rare presentation in women

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13
Q

What are some signs of metastasis of gastric cancer?

A

Ascites and jaundice

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14
Q

What are the red flag symptoms for gastric cancer? (8)

A
  • new-onset dyspepsia in a patient aged >55
  • unexplained persistent vomiting
  • unexplained weight loss (>10%)
  • progressively worsening dysphagia
  • odynophagia
  • epigastric pain
  • GI bleeding / anaemia
  • early satiety
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15
Q

What are some risk factors for gastric cancer?

A
  • pernicious anaemia (antibodies against gastric parietal cells –> reduced IF and B12 deficiency = macrocytic anaemia)
  • H. pylori
  • N-nitroso compounds (generated after consumption of nitrates - vegetables and cured meat)
  • diet: low in fruit and veg, high salt and nitrates
  • smoking
  • Fx / ethnicity: Japan, China
  • blood group A
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16
Q

How can H. pylori increase risk of gastric cancer?

A

Triggers inflammation of mucosa –> atrophy and intestinal metaplasia –> dysplasia

17
Q

What is the first-line investigation done for gastric cancer?

A

Upper GI endoscopy/OGD with biopsy

18
Q

What might be seen in upper GI endoscopy with biopsy in gastric cancer?

A

Signet ring cells (contain a large vacuole of mucin which displaces nucleus to one side) - larger numbers = worse prognosis

Ulcer, mass or mucosal changes

19
Q

What scans are needed after upper GI endoscopy with biopsy, for gastric cancer diagnosis? (5)

A
  • CT CAP for staging in ALL patients
  • endoscopic ultrasound with FNA - helps with TNM staging
  • MRI helps identify metastatic spread to liver
  • PET-CT (staging)
  • pre-operative staging laparoscopy
20
Q

What might FBC show in gastric cancer?

A

Anaemia

21
Q

What might LFTs show in gastric cancer?

A

Deranged LFTs in metastasis

22
Q

What are some differential diagnoses for gastric cancer?

A
  • peptic ulcer disease (red flags = gastric cancer)
  • benign oesophageal stricture (Hx GORD)
  • achalasia (suspect malignancy in patients with Sx <6 months, >60y and excessive WL)
23
Q

Who do we refer to OGD on 2WW for gastric cancer? (2)

A
  • dysphagia (any age)
  • 55+ with weight loss + upper abdominal pain/reflux/dyspepsia
24
Q

Who do we refer for non-urgent OGD - gastric cancer? (2)

A
  • haematemesis
  • > /=55 + treatment-resistant dyspepsia OR upper abdominal pain with low Hb OR raised platelet count/N&V + weight loss, upper abdominal pain, dyspepsia, reflux
25
Q

What do we do with patients who do not meet the referral criteria (gastric cancer)?

A

Do the other if 1 does not work:

Trial full dose PPI for 1 month OR test and treat H. pylori

26
Q

What surgeries are there for gastric cancer? (3)

A
  • total gastrectomy (proximal tumours)
  • partial gastrectomy (distal tumours)
  • endoscopic mucosal resection (T1a)
27
Q

What non-surgical treatment is also available for gastric cancer?

A

Chemotherapy - increases survival in metastasis

28
Q

How do we manage gastric cancer if localised + fit for surgery?

A
  • proximal tumours - total gastrectomy
  • distal tumours - subtotal/partial gastrectomy
  • T1a - endoscopic mucosal resection
  • perioperative chemotherapy/postoperative chemoradiation (T2+)
    • perioperative: epirubicin + cisplatin + fluorouracil
    • postoperative: radiotherapy 5/7 for 5/52 + fluorouracil
29
Q

How do we manage gastric cancer if localised + UNfit for surgery?

A

Chemoradiation or radiotherapy (adverse effects: nausea, vomiting, weight loss, diarrhoea)

30
Q

How do we manage gastric cancer if advanced + metastatic? (2)

A
  • chemoradiation or chemotherapy and/or immunotherapy (e.g. anti-PD1 antibody checkpoint inhibitors - pembrolizumab)
  • palliative gastrectomy - may improve Sx like bleeding and obstruction
31
Q

What parameters do we need to monitor during treatment of gastric cancer? (2)

A
  • monitor FBC during chemotherapy
  • monitor vitamin B12 in gastrectomy - can lead to deficiency –> neurological Sx = careful nutrition post-surgery recommended
32
Q

What are some complications of gastric cancer? (7)

A
  • malnutrition
  • paraneoplastic syndrome
  • metastases
  • gastric obstruction, GI bleeding, gastric perforation
  • postoperative: gastroparesis, pneumonia, infection, MI, anastomotic leak
  • chemotherapy-related complications: febrile neutropenia, thrombocytopenia, nausea
  • radiotherapy-related complications: anorexia, thrombocytopenia, nausea
33
Q

Describe the prognosis of gastric cancer.

A
  • poor as no early signs - usually diagnosed very late
  • if diagnosed at very early stage, 5 year survival = 95%

Year 3 (148 decks)

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