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
How frequent are other primary NHLs?
How frequent are secondary lymphomas?
Primary NHLs: Rare (1-4% of all GI malignancies)
Secondary involvement: common
Limited stage: 10%
Advanced: 60%
What are the risk factors for lymphomas?
Immunodeficiency/immunosuppression
Celiac disease
Autoimmune disorders
What is the presentation of lymphomas?
Epigastric pain: 78-93%
Anorexia: 47%
Weight loss: 25%
Nausea/vomiting: 18%
Occult GI bleed: 19%
B symptoms: 12%
Rarely perforation (risk after treatment)
What are the endoscopic appearances of lymphomas?
Mucosal erythema
Mass
Ulcer
Nodularity
Thickened gastric fold
What are gastric carcinoid tumors?
What acid conditions are they associated with?
Derived from enterochromaffin-like cells
Proliferate and transform in response to high circulating levels of gastrin
Achlorhydria: Atrophic gastritis
Ectopic gastrin secretion (Sporadic gastrinoma, MEN 1)
What is the sex/age bias for carcinoid?
What is the size?
What is the behavior?
What is the chance of metastasis?
Patients usually women in their 60s and 70s
Usually smaller than 1 cm and multiple
Usually indolent, nonfunctioning, and benign
Metastasis in < 10% of tumor < 2 cm, 20% in larger tumors
What is the relative incidence of the sporadic type?
What are their gastrin levels?
What is their behavior?
Sporadic type: 20% of gastric carcinoid tumors
Normal serum gastrin
Aggressive up to 65% present with hepatic or local metastases
What is the typical endoscopic appearance of carcinoid tumors?
Multiple masses
