Gastric tumours

Question 1

Name the 4 layers of the stomach

Answer 1

Mucosa
Submucosa
Muscularis
Serosa

Question 2

Name types of gastric polyps

Answer 2

Fundic glands
Hyperplastic polyps
Adenomatous polyps

Question 3

Give the characteristics of fundic gland polyps

Answer 3

47% of all polyps
2-3mm
No malignant potential
Correlation with colorectal neoplasms

Question 4

Give the characteristics of hyperplastic gastric polyps

Answer 4

Due to chronic atrophic gastritis (H.pylori)
<1.5cm
2% malignant potential

Question 5

Give the characteristics of adenomatous gastric polyps

Answer 5

Antral, sessile, villous

Significant malignant risk >2cm

Question 6

Name the most common gastric cancers

Answer 6

1. Adenocarcinoma
2. Lymphoma
3. GIST
4. Neuroendocrine

Question 7

What is the epidemiology of gastric adenocarcinoma?

Answer 7

M:F 2:1
7th decade peak
Decreasing incidence globally

Question 8

Name risk factors for gastric adenocarcinoma

Answer 8

Salted meats
High nitrates
Poor food preparation
Lack of refrigeration
Smoking
Low SES 
Prior gastric surgery
H.pylori infection
Gastritis
Gastric atrophy
Adenomatous polyps

Question 9

How are gastric adenocarcinomas classified macroscopically?

Answer 9

Bormann classification

Question 10

Discuss the Bormann’s classification

Answer 10

1. Polypoid/fungating
2. Ulcerating w/ elevated border
3. Ulcer w/ infiltration of surrounding wall
4. Diffusely infiltrating w/ contracted gastric volume and early satiety

Question 11

How are gastric adenocarcinomas classified histologically?

Answer 11

Lauren histological classification

Question 12

Discuss the Lauren histologic classification

Answer 12

Intestinal type 
- most common
- classic risk factors
Diffuse type
- familial tendency
- younger females
- aggressive w/ poorer outcome

Question 13

Discuss the presentation of gastric tumours

Answer 13

Epigastric discomfort
Indigestion
Early satiety
Dyspepsia
Weight less
Fatigue
Vomiting
Anemia of Fe deficiency 

Palpable epigastric mass 
Hepatomegaly
Virchow's
Sister Mary Joseph 
Bloomer's shelf
Krukenberg's

Question 14

How do proximal gastric tumours present vs distal gastric tumours?

Answer 14

Proximal - dysphagia

Distal - GOO

Question 15

Name investigations for diagnosis of gastric tumour

Answer 15

Gastroscopy 
Biopsy
CXR
CT abdomen 
Endoscopic ultrasound

Question 16

Discuss the T values for TNM staging of gastric carcinoma

Answer 16

T1 - invades lamina propria/submucosa
T2 - invades muscularis propria/subserosa
T3 - penetrates serosa without invasion
T4 - invades adjacent structures

Question 17

Discuss the N values for TNM staging of gastric carcinoma

Answer 17

N1 - 1-6 LN
N2 - 7-15 LN
N3 - >15LN

Question 18

Which TNM findings are stage 0?

Answer 18

T1s N0

Question 19

Which TNM findings are stage 1A?

Answer 19

T1 N0

Question 20

Which TNM findings are stage 1B?

Answer 20

T1 N1

T2 N0

Question 21

Which TNM findings are stage 2?

Answer 21

T1 N2
T2 N1
T3 N0

Question 22

Which TNM findings are stage 3A?

Answer 22

T2 N2
T3 N1
T4

Question 23

Which TNM findings are stage 3B?

Answer 23

T3 N2

Question 24

Which TNM findings are stage 4?

Answer 24

T4 N1-3
T1-3 N3
M1

Question 25

Discuss treatment of gastric carcinoma

Answer 25

Surgery
Chemotherapy
Radiotherapy 
Analgesia
Palliation

Question 26

What is the overall survival rate of gastric carcinoma?

Answer 26

10-15%

Question 27

Which gastric lymphoma is most common?

Answer 27

B cell lymphoma

MALT

Question 28

Name predisposing factors for gastric lymphoma

Answer 28

HIV

H. pylori

Question 29

Which cells do GIST come from?

Answer 29

Cells of Cajal

Question 30

Which treatment is used specifically for GIST?

Answer 30

Imitanib (tyrosine kinase inhibitor)