Gastric tumours Flashcards
Name the 4 layers of the stomach
Mucosa
Submucosa
Muscularis
Serosa
Name types of gastric polyps
Fundic glands
Hyperplastic polyps
Adenomatous polyps
Give the characteristics of fundic gland polyps
47% of all polyps
2-3mm
No malignant potential
Correlation with colorectal neoplasms
Give the characteristics of hyperplastic gastric polyps
Due to chronic atrophic gastritis (H.pylori)
<1.5cm
2% malignant potential
Give the characteristics of adenomatous gastric polyps
Antral, sessile, villous
Significant malignant risk >2cm
Name the most common gastric cancers
- Adenocarcinoma
- Lymphoma
- GIST
- Neuroendocrine
What is the epidemiology of gastric adenocarcinoma?
M:F 2:1
7th decade peak
Decreasing incidence globally
Name risk factors for gastric adenocarcinoma
Salted meats High nitrates Poor food preparation Lack of refrigeration Smoking Low SES Prior gastric surgery H.pylori infection Gastritis Gastric atrophy Adenomatous polyps
How are gastric adenocarcinomas classified macroscopically?
Bormann classification
Discuss the Bormann’s classification
- Polypoid/fungating
- Ulcerating w/ elevated border
- Ulcer w/ infiltration of surrounding wall
- Diffusely infiltrating w/ contracted gastric volume and early satiety
How are gastric adenocarcinomas classified histologically?
Lauren histological classification
Discuss the Lauren histologic classification
Intestinal type - most common - classic risk factors Diffuse type - familial tendency - younger females - aggressive w/ poorer outcome
Discuss the presentation of gastric tumours
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
How do proximal gastric tumours present vs distal gastric tumours?
Proximal - dysphagia
Distal - GOO
Name investigations for diagnosis of gastric tumour
Gastroscopy Biopsy CXR CT abdomen Endoscopic ultrasound
Discuss the T values for TNM staging of gastric carcinoma
T1 - invades lamina propria/submucosa
T2 - invades muscularis propria/subserosa
T3 - penetrates serosa without invasion
T4 - invades adjacent structures
Discuss the N values for TNM staging of gastric carcinoma
N1 - 1-6 LN
N2 - 7-15 LN
N3 - >15LN
Which TNM findings are stage 0?
T1s N0
Which TNM findings are stage 1A?
T1 N0
Which TNM findings are stage 1B?
T1 N1
T2 N0
Which TNM findings are stage 2?
T1 N2
T2 N1
T3 N0
Which TNM findings are stage 3A?
T2 N2
T3 N1
T4
Which TNM findings are stage 3B?
T3 N2
Which TNM findings are stage 4?
T4 N1-3
T1-3 N3
M1
Discuss treatment of gastric carcinoma
Surgery Chemotherapy Radiotherapy Analgesia Palliation
What is the overall survival rate of gastric carcinoma?
10-15%
Which gastric lymphoma is most common?
B cell lymphoma
MALT
Name predisposing factors for gastric lymphoma
HIV
H. pylori
Which cells do GIST come from?
Cells of Cajal
Which treatment is used specifically for GIST?
Imitanib (tyrosine kinase inhibitor)
