Gastric Tumours

Question 1

What are the different types of gastric tumour?

Answer 1

Adenocarcinoma
Gastrointestinal Stromal Tumours (GISTs)
Primary gastric lymphoma
Gastric Polyps

Question 2

What are the risk factors for gastric adenocarcinoma?

Answer 2

H. pylori infection
High salt intake
Tobacco smoking
Family history
Pernicious anaemia
Partial gastrectomy

Question 3

What are the two types of gastric adenocarcinoma?

Answer 3

Intestinal (type 1)

Diffuse (type 2)

Question 4

Describe intestinal (type 1) gastric adenocarcinomas

Answer 4

Well formed glandular structures (well differentiated)
Lesions are polypoid or ulcerating
Intestinal metaplasia is seen
More likely to be distal stomach
Likely in patients with atrophic gastritis

Question 5

Describe diffuse (type 2) gastric adenocarcinomas

Answer 5

Poorly cohesive cells (poorly differentiated)
Tend to infiltrate gastric wall
Ant part of stomach but especially the cardia
Worse prognosis than intestinal
Loss of expression of the cell adhesion molecule E-cadherin

Question 6

In gastric adenocarcinomas, is cancer diagnosed usually early or late?

Answer 6

Late

Question 7

What is the most common symptom of gastric adenocarcinoma?

Answer 7

Epigastric pain

Question 8

What are the symptoms of gastric adenocarcinoma?

Answer 8

Epigastric pain
Nausea, anorexia, weight loss
Vomiting
Gross haematemesis (unusual)
Anaemia

Question 9

What is linitis plastics?

Answer 9

Brinton’s disease

Widespread submucosal gastric cancer causing diffuse thickening and rigidity of the stomach wall

Question 10

What are common metastasis sites for gastric adenocarcinoma?

Answer 10

Liver
Bone
Brain
Lung

Question 11

What are signs of gastric adenocarcinoma?

Answer 11

Weight loss
Palpable epigastric mass with abdominal tenderness
Palpable lymph node in supraclavicular fossa
Associated with dermatomyositis and acanthus nigricans

Question 12

What investigation is done to diagnose gastric adenocarcinoma?

Answer 12

Gastroscopy

Question 13

Why should 8-10 biopsies be taken from suspicious lesions in a gastroscopy for gastric adenocarcinoma?

Answer 13

Negative biopsy does not necessarily rule it out

Question 14

What is done so that diffuse type infiltrates in the submucosa don’t go undetected?

Answer 14

Multiple deep biopsies

Question 15

What investigations are done for staging of gastric adenocarcinoma?

Answer 15

CT scan of chest and abdomen
Endoscopic ultrasound
Laparoscopy
PET and CT/PET

Question 16

What is the management for gastric adenocarcinomas?

Answer 16

Endoscopic removal for early lesions (mucosal resection or submucosal dissection)
Surgery

Question 17

What are gastrointestinal stromal tumours?

Answer 17

A subset of gastrointestinal mesenchymal tumours

Question 18

What issues can gastrointestinal stromal tumours cause?

Answer 18

Can ulcerate and bleed

Question 19

Who do gastrointestinal stromal tumours mostly affect?

Answer 19

People between 55 and 65

Question 20

Which mutations often cause gastrointestinal stromal tumours?

Answer 20

Mutations occurring in the oncogene KIT

Question 21

What is the management for gastrointestinal stromal tumours?

Answer 21

Surgery
Imatinib for unresectable or metastatic disease, or as adjuvant therapy after surgery in the absence of metastases
If resistive to imatinib, sunitinib can be used for a short time period

Question 22

What are primary gastric lymphomas often?

Answer 22

Mucosa-associated lymphatic tissue (MALT) lymphomas

Question 23

What is the aetiology of gastric MALT lymphomas?

Answer 23

90% due to H. pylori infection

Chromosome abnormalities also

Question 24

Who are mostly diagnosed with gastric MALT lymphomas?

Answer 24

People in their 60s with stage 1 or 2 disease outside the lymph nodes

Question 25

What are the symptoms of gastric MALT lymphomas?

Answer 25

Stomach pain
Ulcers
Other localised symptoms
Rarely systemic complains such as fatigue or fever

Question 26

What is the management of gastric MALT lymphomas?

Answer 26

H. pylori eradication

Chemotherapy for stage 3 or 4 disease

Question 27

What are the symptoms of gastric polyps?

Answer 27

Rare to have symptoms but larger ones can result in anaemia or haematemesis

Question 28

How is the diagnosis made for gastric polyps?

Answer 28

Endoscopic biopsy

Question 29

What is the treatment for gastric polyps?

Answer 29

Possible polypectomy based on histological finding

Large ones may need surgery

Question 30

What are the different types of gastric polyp?

Answer 30

Hyperplastic polyps
Adenomatous polyps
Cystic gland polyps
Inflammatory thyroid polyps

Question 31

What are the features of hyperplastic polyps?

Answer 31

Most common
Most <2cm
Rarely pre-malignant but may be accompanied by pre-malignant atrophic glands

Question 32

What are the features of adenomatous polyps?

Answer 32

Usually solitary lesions in the antrum

Larger ones can progress to cancer but this is not common

Question 33

What are the features of cystic gland polyps?

Answer 33

Contain micro cysts lined by parietal cells and chief cells
Located in fundus and body
Common in familial polyposis syndromes and patients of PPIs
Usually low grade but high grade in the presence of familial adenomatous polyposis

Question 34

What are inflammatory thyroid polyps?

Answer 34

Benign spindle cell tumours
Infiltrated by eosinophils
Excision is indicated as they commonly enlarge and cause obstruction