Gastric Neoplasm Flashcards
What is the global epidemiology of gastric adenocarcinoma?
4th most common cancer
1M cases, 800K deaths annually
70% in developing countries
Declining for distal cancers
What is the national epidemiology of gastric adenocarcinoma?
What racial bias?
What sex bias?
What age bias?
15th most common cancer
Most common with Asian, Hispanic, Black over White
More common in men, older age
What risk factors are there for gastric adenocarcinoma? (4)
Higher latitudes
Smoking
Salt
Nitrates
What is the relative prevalence of intestinal type gastric adenocarcinoma?
Where does it occur?
What is the major risk factor?
What is the cellular background?
What is the gender/age bias?
Most common (50-75%)
Occurs in distal stomach
H. pylori infection main risk factor
Also increased with pernicious anemia
Background of intestinal metaplasia
Precursor stem cells from bone marrow, not gastric epithelium
More common in men, older age
What is the precursor lesion for diffuse type?
What is the gender/age bias?
Is there an H. pylori relationship?
What is the blood type association?
What is the histologic finding?
What is the relative behavior?
Precursor lesion unknown
Younger age, no gender difference
Not H. pylori-related
Associated with blood group A
Signet ring cell histology - Mucin-filled vacuole displaces nucleus
More aggressive behavior
What are the genetics of the hereditary diffuse type of gastric adenocarcinoma?
Which gene is primarily mutated?
What is the age of onset?
What other cancer is associated?
Autosomal dominant with high penetrance - 80% of carriers will develop disease
Mutation in E-cadherin gene (CDH1) -Tumor suppressor gene affecting cellular adhesion/motility, Mutations also seen in 50% of sporadic diffuse gastric cancers
Average age of onset is 38 years (<1% risk before age 20, 4% risk by age 30)
Increased risk of breast cancer (39% risk of lobular breast cancer by age 80)
What other heritable associations are there for gastric adenocarcinoma?
Familial Adenomatous Polyposis (FAP)
Lynch syndrome
Peutz-Jeghers syndrome
Li-Fraumeni
What is the prevalence of diffuse type EBV-associated gastric adenocarcinoma?
What is the age/sex bias?
What is the epidemiology in the developed countries?
Relative aggressiveness?
About 10% of gastric carcinomas world wide
Male predominant
No age predilection
Higher proportion of all cancers in developed countries
Less aggressive behavior
Epidemiology of Adenocarcinoma of Cardia
Which cancer is it similar to?
What risk factors are associated with it?
Rising incidence
Similar to esophageal adenocarcinoma in GERD
Lack of H. pylori
Male
Obesity
Smoking
Presentation of Gastric Adenocarcinoma
Abdominal pain
Early satiety and nausea
Weight loss
Dysphagia
Vomiting
Gastrointestinal bleeding/perforation
What is the gross morphologic presentation of adenocarcinoma?
Ulcer, mass, ulcerated mass
Linitis plastica
What are the survival rates dependent on for adenocarcinoma?
Staging
What is the most common extranodal site of lymphoma?
Gastric (80% of all GI lymphomas)
What is the age relationship of gastric lymphoma?
What is the sex bias of gastric lymphoma?
What type of lymphomas are they typically?
What is the main primary lymphoma?
Peak incidence between 50-60 years
Slight male predominance
Vast majority are non-Hodgkin lymphoma
MALToma
Where are MALTomas from?
What association do they have?
What are the prognosis and prognostic indicators?
Exranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue
Strongly associated with H. pylori
80% regression with eradication
Does not extend below submucosa
No t(11:18) chromosomal location
