Gastric Neoplasms

Question 1

What are the different classifications of gastric cancers?

Answer 1

90% Adenocarcinoma

10% GIST (Gastrointestinal stromal tumours)

Adenocarcinomas can be further differentiated into:

• Type 1 (intestinal)
• Type 2 (diffuse)

Adenocarcinomas usually spread to local structures and lymph nodes. May cause malignant ascites if spreads through the peritoneum.

Question 2

Describe the morphology and general prognosis of type 1 (intestinal) gastric adenocarcinoma?

Answer 2

Intestinal (type 1): moderately well defined glandular tubular structures. They may be:

• ulcerative
• polypoid (presents early with bleeding and are therefore usually resectable).

They are associated strongly with H.pylori infection (if a patient has an ulcer related to h.pylori less likely to get cancer)

Tend to have a better prognosis than type 2.

Question 3

Describe the morphology and general prognosis of type 2 (diffuse) gastric adenocarcinoma?

Answer 3

Diffuse (type 2): Poorly differentiated signet ring cells. Their is usually local infiltration and a worse prognosis.

Causes tightening and thickening of the stomach mucosa and therefore a reduction in the size of the lumen of the stomach and symptoms of anorexia.

Question 4

What are the symptoms and signs suggestive of gastric Ca?

Answer 4

Dyspepsia: +

• Nausea and Vomiting
• Weight Loss + Anorexia (early satiety)
• Dysphagia
• Iron deficiency anaemia
• Epigastric mass

Sign: Virchow’s node (suggests metastasis)

Question 5

What are the risk factors for developing a gastric carcinoma?

Answer 5

Age >55
Male (twice as common)
H. Pylori
FH
PMH: Atrophic gastritis, Pernicious anaemia

Lifestyle:
Low fruit and veg diet
Diet high in smoked/preserved food
Smoking

Question 6

What investigations would you do in a patient in which you suspected gastric cancer?

Answer 6

Routine bloods: (looking for iron deficiency anaemia on FBC)

Endoscopy and biopsy (all gastric ulcers should be biopsied).

Question 7

How would you investigate a confirmed gastric cancer?

Answer 7

Staging CT scan

If considering surgical resection: staging laparotomy to look for metastatic deposits.

Question 8

Describe the different curative surgical procedures?

Answer 8

Depends on site of tumour.

In antral cancers then a subtotal gastrectomy can be performed essentially leaving the fundus of the stomach which is anastomosed to a loop of jejunum.

OR

Total gastectomy: the whole of the stomach is removed and the oesophagus is anastomosed with the jejunum.

Question 9

Describe the palliative care options for a patient with gastric cancer?

Answer 9

Chemotherapy to prolong life

Subtotal gastrectomy or gastrojejunostomy can be performed on distal obstructing tumours.

In proximally obstructing tumour can perform stenting of gastric cardia tumours.

Usually palliative care treatment: control pain, secretions, nausea etc

Question 10

What is the general prognosis of gastric carcinoma?

Answer 10

Generally poor.

Better prognosis in asian people, and in countries such as Japan due to screening.

5 year survival is between 8-20% depending on age. (better prognosis in younger patients)