Gastric neoplasia

Question 1

Risk factors for gastric neoplasia (6)

Answer 1

1. H. pylori
2. Smoking
3. Diet - pickled vegetables, high salt, red and processed meat, iodine deficiency
4. Obesity/GORD
5. Immunocompromise - AIDS, diabetes, pernicious anaemia
6. Family history

Question 2

The stomach cancer of a heavy smoker is most likely to be where?

Answer 2

Higher up, near the oesophagus

Question 3

Types of gastric neoplasia (3) and which is most common

Answer 3

1. Adenocarcinoma (90%)
2. MALT lymphoma
3. Carcinoid, stromal

Question 4

Two types of gastric adenocarcinoma and their histological features

Answer 4

1. Intestinal - irregular glands with multiple lumens and “back to back” appearance due to reduced stroma
2. Diffuse - discohesive mucus-secreting signet ring cells, macroscopically causes linitis plastica/leather-bottle stomach

Question 5

Symptoms of gastric neoplasia (6)

Answer 5

1. Heartburn/epigastric discomfort or pain
2. Nausea, LOA
3. Weight loss
4. Anaemia
5. Melaena
6. Dysphagia (higher cancer)

Question 6

Cutaneous manifestation of abdominal cancers

Answer 6

Acanthrosis nigricans

Question 7

Differentials for gastric cancer

Answer 7

Viral infection
Gastric ulcer
Tropical sprue
GORD

Question 8

Investigations for gastric cancer (7)

Answer 8

1. Bloods (FBE for anaemia, CEA for colon mets)
2. Faecal occult blood test
3. Gastroscopy with biopsy
4. Upper GI series
5. Abdo CT (invasion, lymph nodes)
6. Breath test (new)
7. PET scan (mets)

Question 9

Common sites of metastasis (5)

Answer 9

1. Liver
2. Lungs
3. Bone
4. Peritoneum
5. Lymph nodes

Question 10

5-year survival

Answer 10

10% (due to late presentation)