Gastric Tumours/Cancers

Question 1

What are risk factors for gastric tumour/cancers?

Answer 1

Age
Male 
H. pylori
Poort diet
Smoking 
FHx

Question 2

The majority of gastric tumours/cancers are caused by?

Answer 2

H. pylori

Question 3

What are examples of benign gastric tumours?

Answer 3

Hyperplastic polyps

Cystic fundi gland polyps

Question 4

What are examples of malignant gastric tumours?

Answer 4

Carcinomas
Lmphomas
GISTs

Question 5

What are GISTs?

Answer 5

Gastro-intestinatal stromal tumours

Question 6

How can gastric adenomas become malignant?

Answer 6

H. pylori - chronic gastritis - atrophy - intestinal metaplasia - dysplasia - neoplasia

Question 7

What are examples, besides gastric adenomas, of premalignant conditions?

Answer 7

Pernicious anaemia
Partial gastrectomy
HNPCC or Lynch syndrome
Méneiér’s Disease

Question 8

What are subtypes of gastric adenomas?

Answer 8

Intestinal

Diffuse

Question 9

What are features of intestinal gastric adenomas?

Answer 9

Tends to produce exophytic polypoid mass

Question 10

What are features of diffuse gastric adenomas?

Answer 10

Expands

Infiltrates stomach wall

Question 11

What are the subtypes of diffuse gastric adenomas?

Answer 11

Linitis plastica

Signet right type

Question 12

What is characteristic features of linitis plastica?

Answer 12

every layer of stomach is invaded

Question 13

How do gastric adenomas spread?

Answer 13

Local (other organs, peritoneal cavity, ovaries)
Lymph nodes
Haematogenous (to liver)

Question 14

What is the name of a gastric adenoma that spreads to the ovaries?

Answer 14

Krudenberg tumour

Question 15

What is a gastric MALT lymphoma?

Answer 15

Derived from mucosa-associated lymphoid tissue (MALT) and is associated with H. pylori infection

Question 16

What is the pathophysiology of Gastric MALT Lymphoma?

Answer 16

Continuous inflammation induces clonal B cell proliferation = low grade lymphoma
If untreated –> high-grade B-cell lymphoma

Question 17

How do you treat Gastric MALT Lymphoma?

Answer 17

PPI + Antibiotics to eradicate H. pylori (may stop cancer if early enough)

Question 18

How do gastric tumours/cancers present?

Answer 18

Non-specific

Late signs: indigestion, fatigue, bloating, abode pain, weight loss, vomiting, dysphagia, anaemia

Question 19

When do you refer?

Answer 19

Acute GI bleeding 
Dyspepsia + chronic GI bleed
Progressive dysphagia
Progressive unintentional weight loss
Persistent vomiting 
Epigastric mass

Question 20

What are signs/symptoms specific to MALT Lymphoma?

Answer 20

Dyspepsia
Epigastric discomfort
Gastric bleeding
Fatigue 
Low grade fevers
Nausea
Constipation
Weight loss
Anaemia
Recurrent RTIs

Question 21

How do investigate gastric tumours/cancers?

Answer 21

Endoscopy

FBC, LFTs, U+Es, LFTs, Endoscopy, Biopsy (WCC will be off)

Question 22

How do you treat gastric cancer/tumours?

Answer 22

Surgery
Nutritional support
Symptom control

Question 23

What are the theories behind how H. Pylori stops gastric acid secretion?

Answer 23

Direct effect of bacterial products /ammonia, Cave’s factor / a-methyl histamine)
Effect of body inflammation induced by H.P; IL 1B - increase gastritis = powerful acid secretion inhibitor?