Gastric Neoplasms

Question 1

What are the risk factors for gastric cancer?

Answer 1

H. pylori infection
High salt/nitrate diet
Smoking
Genetic factors (blood group A/HNPCC/japanese)
Pernicious anaemia
Adenomatous polyps
Low socio-economic status

Question 2

What are the symptoms of gastric cancer?

Answer 2

Non-specific
Epigastric pain
Nausea/vomiting (vomiting if tumour near fundus)
Dysphagia (if tumour near fundus)
Anorexia/weight loss

Question 3

What investigations are used to diagnose gastric cancer?

Answer 3

Endoscopy with biopsy
-can get signet ring appearance

CT for staging
Staging laparoscopy if no signs of mets

Question 4

What are the signs of gastric cancer?

Answer 4

Palpable epigastric mass (50%)
Palpable Virchow's node
Peri-umbilical nodule
Hepatomegaly, Jaundice, Ascites
Acanthosis nigricans

Question 5

What is the most common type of gastric cancer and where is it commonly found?

Answer 5

Adenocarcinomas occuring in the antrum

Question 6

How do gastric adenocarcinomas appear?

Answer 6

Polypoids/ulcerating lesions w/ rolled edges

Intestinal metaplasia in surrounding tissue

Question 7

Describe the local infiltration of gastric adenocarcinomas

Answer 7

Submucosal infiltration

Can lead to marked fibrous reaction –> small, thickened and contracted stomach ‘leather bottle’

Question 8

How do gastric cancers typically metastasise?

Answer 8

Local by direct invasion of abdominal viscera
Lymphatic via Virchow’s
Liver via portal dissemination

Question 9

What are the possible effects of transcoeleomic spread?

Answer 9

Peritoneal seedings
-bilateral ovarian ‘Krukenberg’ tumours

Can spread to colon too

Question 10

What are the rarer forms of gastric cancers?

Answer 10

Stromal tumours

• leiomyomas/leiomyosarcomas arising from interstitial cells of Cajal
• slower growing/benign

Question 11

In which groups do gastric cancers most commonly occur?

Answer 11

50-70yrs

Japanese population

Question 12

What are the management options for gastric cancer?

Answer 12

Partial gastrectomy (if tumours in distal 2/3 stomach)
Total gastrectomy
Combination chemo
Endoscopic mucosal resection (if tumour confined to mucosa)
Stenting of pylorus (palliative, relieves obstruction)
Wide local excision (if stromal tumour)

Question 13

What are the potential complications of a gastrectomy?

Answer 13

Chronic diarrhoea/vomiting
Dumping syndrome
-nausea/diarrhoea/light headedness post meal due to accelerated gastric emptying 
Bacterial overgrowth w/ malabsorption
Anaemia (Fe/B12 deficiency)
Osteomalacia

Question 14

What is Dumping Syndrome?

Answer 14

3rd space fluid shifts due to food w/ high osmotic potential being ‘dumped’ in the jejunum

Question 15

What is the prognosis of gastric cancer?

Answer 15

<10% 5yr survival

<20% if radical surgery