Gastric Neoplasms

Question 1

Risk factors for gastric cancer

Answer 1

Male:female is 2:1. H. Pylori causes most cases. Risk factors: Smoking, high salt, dietary nitrates, pickled foods, family history and pernicious Anaemia.

Question 2

Symptoms and signs of gastric cancer

Answer 2

Epigastric pain, N+V, weight loss, anorexia. Pain constant and severe, relieved by antacids. N+V is severe and frequent with dysphagia and early satiety.

Later metastatic signs: ascites, jaundice, bone pain, epilepsy, SOB. Virchow’s Node palpable. Patients may have palpable epigastric mass.

Question 3

Classification and natural history of gastric cancers

Answer 3

Adenocarcinomas make up 90% of cancers.
Intestinal (Type 1): well to moderately differentiated glandular structures with multiple lumens. Associated with H. Pylori and can be polypoid (presents earlier with bleeding and easier to resect) or ulcerative (raised edge and necrotic base).
Diffuse (Type 2): Poorly cohesive signet ring cells, keeps mucous inside.

Question 4

History of cancers

Answer 4

Most adenocarcinomas are antral. Adenocarcinoma spreads locally and to nodes. Invasion through perioteneum causes malignant ascites. Metastasis can occur to the ovary or to the umbilicus.

Question 5

Diagnostic methods

Answer 5

Gastroscopy and biopsy. Staging via CT.