Gastric carcinoma Flashcards
1
Q
Describe gastric cancer?
A
- 5th most common globally
- 2nd highest cause of cancer related deaths due to advanced presentation
- Mostly adenocarcinomas arising from gastric mucosa
- Remainder are from connective tissue, lymphoid or neuroendocrine
2
Q
Risk factors for gastric carcinoma?
A
- Male gender
- H. pylori infection
- Increasing age
- Smoking, alcohol
- Gastric polyps
- Blood group A
- Negatively associated with duodenal ulcer
3
Q
What is the most important modifiable risk factor for gastric carcinoma?
A
H. pylori
4
Q
Describe H. pylori?
A
- Gram negative helical bacteria
- Produces urase enzyme
- Breaks urea into CO2 and ammonia
- Ammonia neutralises stomach acid creating an alkaline microenvironment
- Risk of gastric cancer is 6x higher in H. pylori infected individuals
5
Q
What are the clinical features of gastric carcinoma?
A
- Often vague and non-specific, late presentation
- Dyspepsia, Dysphagia
- Early satiety
- Vomiting, Melena
- Acanthosis nigricans
- Epigastric mass on palpation
6
Q
What are the NICE guideline recommendation for an urgent OGD?
A
- New-onset dysphagia
- Aged>55 with loss loss
- upper abdo pain or dyspepsia
7
Q
Differentials for gastric carcinoma?
A
- Peptic ulcer disease
- GORD
- Gallstones
- Pancreatic malignancy
8
Q
Describe the tetsts which can be used to diagnose gastric carcinoma?
A
- FBC, LFTs, amylase
- Upper GI endoscopy*
- Biopsies should be sent for:
- Histology (classification and grading of neoplasia)
- CLO test (presence of H. pylori)
- HER2/neu protein expression (allow for targeted monoclonal therapy if present)
- Biopsies should be sent for:
- CT CAP
- Staging laparoscopy
9
Q
Describe the management of gastric carcinoma?
A
- Asess nutritional status
- => nutritional support via NG tube or RIG tube
- Curative
- Surgery
- peri-operative chemotherapy
- 3 cycles neoadjuvant and 3 cycles adjuvant
- peri-operative chemotherapy
10
Q
Describe the surgical techniques involved in treatment gastric carcinoma?
A
- Remove tumour and its lymph nodes
- Proximal cancers => total gastrectomy
- Distal cancers (antrum/pylorus) => subtotal gastrectomy
- Reconstructing the alimentary anatomy
- Roux-en Y reconstruction
- EMR for early tumours
11
Q
Describe Roux-en Y reconstruction?
A
Look at diagram
12
Q
Describe the MAGIC trial?
A
- 13% 5 year survival advantage in patients who received peri-operative chemotherapy compared to those who underwent surgery alone.
- Chemo regimen:
- 5-FU, cisplatin and epirubicin
13
Q
What are the complications of gastrectomy?
A
- Death
- Anastomotic leak
- Re-operation
- Dumping syndrome
- Vitamin B12 deficiency
14
Q
What is gastric dumping syndrome?
A
- Complication of gastric bypass surgery
- Can occur early or late
- Managed with frequent, small volume meals, avoidance of simple carbohydrates and separation of eating and drinking
15
Q
Describe early Gastric dumping syndrome?
A
- 10-30 minutes post-prandial
- Large passage of gastric contents into the small intestine
- Results in intraluminal fluid shift and intestinal distension
- Causes N/V, diarrhoea and hypovolaemia
- Causes sympathetic response with tachycardia and sweating
