Gastric Tumours Flashcards
What are the different types of gastric tumour?
Adenocarcinoma
Gastrointestinal Stromal Tumours (GISTs)
Primary gastric lymphoma
Gastric Polyps
What are the risk factors for gastric adenocarcinoma?
H. pylori infection High salt intake Tobacco smoking Family history Pernicious anaemia Partial gastrectomy
What are the two types of gastric adenocarcinoma?
Intestinal (type 1)
Diffuse (type 2)
Describe intestinal (type 1) gastric adenocarcinomas
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
Describe diffuse (type 2) gastric adenocarcinomas
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
In gastric adenocarcinomas, is cancer diagnosed usually early or late?
Late
What is the most common symptom of gastric adenocarcinoma?
Epigastric pain
What are the symptoms of gastric adenocarcinoma?
Epigastric pain Nausea, anorexia, weight loss Vomiting Gross haematemesis (unusual) Anaemia
What is linitis plastics?
Brinton’s disease
Widespread submucosal gastric cancer causing diffuse thickening and rigidity of the stomach wall
What are common metastasis sites for gastric adenocarcinoma?
Liver
Bone
Brain
Lung
What are signs of gastric adenocarcinoma?
Weight loss
Palpable epigastric mass with abdominal tenderness
Palpable lymph node in supraclavicular fossa
Associated with dermatomyositis and acanthus nigricans
What investigation is done to diagnose gastric adenocarcinoma?
Gastroscopy
Why should 8-10 biopsies be taken from suspicious lesions in a gastroscopy for gastric adenocarcinoma?
Negative biopsy does not necessarily rule it out
What is done so that diffuse type infiltrates in the submucosa don’t go undetected?
Multiple deep biopsies
What investigations are done for staging of gastric adenocarcinoma?
CT scan of chest and abdomen
Endoscopic ultrasound
Laparoscopy
PET and CT/PET
What is the management for gastric adenocarcinomas?
Endoscopic removal for early lesions (mucosal resection or submucosal dissection)
Surgery
What are gastrointestinal stromal tumours?
A subset of gastrointestinal mesenchymal tumours
What issues can gastrointestinal stromal tumours cause?
Can ulcerate and bleed
Who do gastrointestinal stromal tumours mostly affect?
People between 55 and 65
Which mutations often cause gastrointestinal stromal tumours?
Mutations occurring in the oncogene KIT
What is the management for gastrointestinal stromal tumours?
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
What are primary gastric lymphomas often?
Mucosa-associated lymphatic tissue (MALT) lymphomas
What is the aetiology of gastric MALT lymphomas?
90% due to H. pylori infection
Chromosome abnormalities also
Who are mostly diagnosed with gastric MALT lymphomas?
People in their 60s with stage 1 or 2 disease outside the lymph nodes
What are the symptoms of gastric MALT lymphomas?
Stomach pain
Ulcers
Other localised symptoms
Rarely systemic complains such as fatigue or fever
What is the management of gastric MALT lymphomas?
H. pylori eradication
Chemotherapy for stage 3 or 4 disease
What are the symptoms of gastric polyps?
Rare to have symptoms but larger ones can result in anaemia or haematemesis
How is the diagnosis made for gastric polyps?
Endoscopic biopsy
What is the treatment for gastric polyps?
Possible polypectomy based on histological finding
Large ones may need surgery
What are the different types of gastric polyp?
Hyperplastic polyps
Adenomatous polyps
Cystic gland polyps
Inflammatory thyroid polyps
What are the features of hyperplastic polyps?
Most common
Most <2cm
Rarely pre-malignant but may be accompanied by pre-malignant atrophic glands
What are the features of adenomatous polyps?
Usually solitary lesions in the antrum
Larger ones can progress to cancer but this is not common
What are the features of cystic gland polyps?
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
What are inflammatory thyroid polyps?
Benign spindle cell tumours
Infiltrated by eosinophils
Excision is indicated as they commonly enlarge and cause obstruction
