Gastric carcinoma

Question 1

What is stomach cancer

Answer 1

Stomach cancer is a neoplasm that can develop in any portion of the stomach and may spread to the lymph nodes and other organs

Question 2

What are types of stomach cancer

Answer 2

Adenocarcinoma (majority)

Lymohoma, GIST, neuroendocrine tumours, SCC can also all occur but are rare

Question 3

What are risk factors for gastric carcinoma?

Answer 3

H pylori + chronic gastritis 
poor diet
poor countries 
male
age > 50
smoking

Question 4

What are Sx of gastric cancer

Answer 4

Abdominal pain
weight loss
lymphadenopathy e.g. Virchow’s, SMJ nodule, left axillary node - these suggest disseminated disease

Dyspepsia
Anaemia
Dysphagia
Early satiety

Question 5

What are DDx for gastric cancer?

Answer 5

PUD
Benign oesophgeal stricture
Achalasia

Question 6

What Ix in gastric cancer?

Answer 6

Endoscopy with biopsy: take 7 for histology, CLO test, HER2/neu

EUS with FNA of regional nodes

CT or PET for staging

Staging laparoscopy if peritoneal mets suspected

Question 7

What are intestinal and diffuse types of gastric cancer?

Answer 7

Intestinal type: H pylori associated, usually distal stomach with ulcerated growth.

Diffuse type: mainly cardia, affecting younger people with worse prognosis.

Question 8

What is Rx of gastric cancer?

Answer 8

Surgery: gastrectomy (proximal = total, distal = subtotal)

Roux-en-Y reconstruction: distal oesophagus is end-to-end anastomosed directly to the small bowel, and the proximal small bowel is end-to-side anastomosed also to the small bowel

Adjuvant chemo

Nutrition: NG or PEG/RIG may be needed

Question 9

What are complications of gastrectomy?

Answer 9

• Death
	• Anastomotic leak 
	• Re-operation
	• Dumping syndrome
Vitamin B12 deficiency

Question 10

What is dumping syndrome

Answer 10

sudden passage of hypertonic gastric contents into small intestine, causing fluid shift and intestinal distension. Nausea, vomiting, diarrhoea, hypovolaemia

Question 11

What are palliative options for gastric cancer?

Answer 11

• Chemotherapy
• Best supportive care (nutrition, treatment of aspirations)
Stenting (for patients who have gastric outlet obstruction secondary to an obstructing cancer).

Question 12

What are complications of gastric cancer

Answer 12

• Gastric outlet obstruction
• IDA
• Perforation
Malnutrition