Gastric Carcinoma Flashcards
What gender and age group is gastric carcinoma more prevalent in?
Male
70-80 age group
What are the risk factors of gastric carcinoma?
- H. Pylori infection
- EBV infection
- Diet (salty, spicy, nitrates)
- Smoking
- Alcohol
- Obesity
- Age
- Blood group A
- Autoimmune gastritis
- Pernicious anaemia
What are the clinical features of gastric carcinoma?
- Anorexia or weight loss
- Nausea or vomiting
- Dysphagia
- Virchows Nodes above left supraclavicular fossa
- Dyspepsia
What are the 2 main types of carcinomas in gastric carcinomas?
=> Adenocarcinomas:
- Intestinal types - Better prognosis occur in older population. Well differentiated and caused by H. Pylori. Gland formation
- Diffuse type - Poorer prognosis occur in younger population. Poorly differentiated and caused by mutation of CDH1 gene. Signet cell formation (vacuoules form in cells and push nucleus to one side of cell)
What are the investigations in suspected gastric carcinomas?
=> Endoscopy + biopsy
- Used for diagnosis
=> CT or endoscopic ultrasound
Used for staging
What are the techniques used to determine the stage of the cancer?
=> CT scanning of chest and abdomen
- Routine first line investigation in most centres
=> Laparoscopy
=> PET CT
- Particularly for junctional tumours
Some gastric cancers spread to the lower oesophagus. What are the different types of gastro-oesophageal cancers?
=> Type 1
- True oesophageal cancers
- May arise from Barrett’s oesophagus
=> Type 2
- Carcinoma of the cardia
=> Type 3
Sub cardial cancers that spread across the junction
What is the management of gastric carcinoma?
- Chemotherapy pre or post operatively
- Proximal cancers 5-10 cm from the OG junction require sub total gastrectomy
- Total gastrectomy if tumour < 5 cm from the OG junction
- Type 2 require oesophagogastrectomy (removal of part of stomach, part of oesophagus and nearby nodes)
