Gastric tumours

Question 1

Gastric tumours types

Answer 1

• may arise from the tissues of the mucosa (adenocarcinoma),
• connective tissue of the stomach wall (previously known as leiomyoma)
• the neuroendocrine tissue (carcinoid tumours)
• lymphoid tissue (lymphoma)

Question 2

Commonest type

Answer 2

adenocarcinoma >50y

Question 3

risk factors

Answer 3

• H pylori
• autoimmune gastritis
• genetic
• racial - much more common in certain populations e.g japanese
• smoking

Question 4

Symptoms

Answer 4

• Dyspesia - any new onset over the age of 45 should be concincered to be carcinoma until proven other wise
• Weight loss, anorexia, lethargy
• Anaemia (iron deficency due to chronic blood loss)
• occasionaly presents as Upper GI bleeding
• Dysphagia uncommon unless involving the proximal fundus and gastro=-oesophageal junction

Question 5

Signs

Answer 5

• weight loss
• palpable epigastric mass
• palpable supraclavicular lymph node (troisers sign) suggests disseminate disease

Question 6

Diagnosis and investigation

Answer 6

• upper GI gastroscopy (barium meal if contraindicated)
• Staging
  
  • CT- chest/abdo- disseminated metastases and local lymphadenopathy
  • endoscopic ultrasound- local disease
  • laparoscopy - for patient considered for potential resection
  • PET scan

Question 7

Which staging system is used to stage gastric carcinoma

Answer 7

TMN staging

Question 8

Surgery for gastric carcinoma

Answer 8

• surgery- gastrctomy with regional lymph node excision
• chemotherapy- locally advanced disease or palliative
• palliative surgery to relieve obstruction
• endoscopic laser treatment to bleeding tumour