Gastric Carcinoma Flashcards

1
Q

Are peptic ulcers due to cancer?

A

No, they are a good example of chronic inflammation

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2
Q

What is Zollinger-Ellison syndrome + how does it lead to peptic ulceration?

A
  • tumours from pancreas, stomach or duodenum secrete large amounts of gastrin (gastrinomas)
  • cause excess gastric acid secretion
  • therefore increased acid attack -> weakened defence system against peptic ulcer
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3
Q

What are complications of peptic ulcers?

A
  • bleeding
  • perforation
  • stricture formation
  • malignant change
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4
Q

How might stricture formation due to peptic ulcer present?

A
  • due to healing of the ulcer by fibrosis
  • may present as obstruction
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5
Q

Is the development of carcinoma a common complication of peptic ulcers?

A
  • No, it’s rare
  • in fact, it’s now believed that reports of malignant transformation in peptic ulcers probably represents cases in which a lesion thought to be a chronic peptic ulcer was actually an ulcerated carcinoma from start
  • ulcerated gastric carcinomas typically have a rolled edge
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6
Q

What investigation should be done from any suspected peptic ulcer in the oesophagus or stomach to rule out that it isn’t actually an ulcerated cancer?

A

Biopsy

NB. Dudoenal cancer is v rare and so chance of duodenal cancer masquerading as a peptic ulcer is remote. Hence duodenal ulcers do not need to be biopsied to exclude malignancy unless there are worrying endoscopic features.

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7
Q

Who is gastric cancer common in? Has the incidence changed?

A
  • peak incidence in over 50yr age group
  • M > F
  • incidence has fallen in west over last 50yrs
  • reduction due to falling prevalence of H pylori infection and an improved diet
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8
Q

What are important risk factors for developing gastric cancer?

A
  • H Pylori infection (but remember, most ppl w H Pylori infection will not develop cancer)
  • cigarette smoking
  • alcohol
  • diet: food w/ nitrates/nitrite components; salt-based preservatives
  • autoimmune gastritis
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9
Q

How might gastric cancer present?

A
  • history of new-onset dyspepsia (esp in a pt >55y)
  • unintended weight loss
  • progressive dysphagia
  • vomiting
  • Virchow’s node palpable (left supraclavicular fossa) - Troiser’s sign
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10
Q

What kind of cancer are gastric cancers?

A
  • adenocarcinomas
  • arising from glandular mucosa
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11
Q

What are the 2 main types of gastric adenocarcinoma and how do they differ?

A
  • intestinal-type adenocarcinomas - show gland formation, lined by mucus-secreting cells. Better prognosis than diffuse-type (but still poor 5 year survival). Tend to occur in older individuals.
  • diffuse-type adenocarcinomas - consist of ‘signet-ring’ cells, with a diffuse pattern of infiltration. Very aggressive -> v bad prognosis. Tends to occur in a younger age group.
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12
Q

They key investigation for gastric cancer is endoscopy and biopsy. What important info does biopsy give us?

A
  • type of cancer (usually squamous cell carcinoma or adenocarcinoma)
  • the grade - well, moderately or poorly differentiated

Histology shows signet ring cells, contain large vacuole of mucin which displaces nucleus to one side. Higher number of signet ring cells are associated with a worse prognosis.

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13
Q

How is gastric cancer staged?

A
  • TNM system
  • CT or endoscopic USS
  • Endoscopic USS superior
  • CT CAP first-line staging in most centres
  • Laparoscopy to identify occult peritoneal disease
  • PET CT (for junctional tumours)
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14
Q

What is the treatment for gastric carcinoma?

A
  • proximally sited disease greater than 5-10cm from O-G jxn may be treated by sub-total gastrectomy
  • total gastrectomy if tumour <5cm from O-G jxn
  • for type 2 junctional tumours (extending to oesophagus) → oeseophagogastrectomy
  • early gastric cancer confined to mucosa → endoscopic sub mucosal resection
  • lymphadenectomy D2 nodal dissection
  • adjunctive chemotherapy
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15
Q

All pts with gastric cancer are discussed at the MDT meeting to decide on most appropriate treatment: curative or palliative. What is the prognosis of gastric cancer?

A
  • very poor prognosis
  • around 5% survival at 5 years
  • mainly bc tumour is usually at high stage on presentation
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