Gastric Neoplasms Flashcards

1
Q

What are the risk factors for gastric cancer?

A
H. pylori infection
High salt/nitrate diet
Smoking
Genetic factors (blood group A/HNPCC/japanese)
Pernicious anaemia
Adenomatous polyps
Low socio-economic status
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2
Q

What are the symptoms of gastric cancer?

A
Non-specific
Epigastric pain
Nausea/vomiting (vomiting if tumour near fundus)
Dysphagia (if tumour near fundus)
Anorexia/weight loss
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3
Q

What investigations are used to diagnose gastric cancer?

A

Endoscopy with biopsy
-can get signet ring appearance

CT for staging
Staging laparoscopy if no signs of mets

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4
Q

What are the signs of gastric cancer?

A
Palpable epigastric mass (50%)
Palpable Virchow's node
Peri-umbilical nodule
Hepatomegaly, Jaundice, Ascites
Acanthosis nigricans
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5
Q

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

A

Adenocarcinomas occuring in the antrum

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6
Q

How do gastric adenocarcinomas appear?

A

Polypoids/ulcerating lesions w/ rolled edges

Intestinal metaplasia in surrounding tissue

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7
Q

Describe the local infiltration of gastric adenocarcinomas

A

Submucosal infiltration

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

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8
Q

How do gastric cancers typically metastasise?

A

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

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9
Q

What are the possible effects of transcoeleomic spread?

A

Peritoneal seedings
-bilateral ovarian ‘Krukenberg’ tumours

Can spread to colon too

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10
Q

What are the rarer forms of gastric cancers?

A

Stromal tumours

  • leiomyomas/leiomyosarcomas arising from interstitial cells of Cajal
  • slower growing/benign
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11
Q

In which groups do gastric cancers most commonly occur?

A

50-70yrs

Japanese population

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12
Q

What are the management options for gastric cancer?

A

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)

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13
Q

What are the potential complications of a gastrectomy?

A
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
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14
Q

What is Dumping Syndrome?

A

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

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15
Q

What is the prognosis of gastric cancer?

A

<10% 5yr survival

<20% if radical surgery

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