Gastritis and Gastric cancer Flashcards
Name the 5 parts of the stomach
cardia, fundus, body, antrum and pylorus.
What does the pylori’s of the stomach connect to?
duodenum
What type of cancer are most gastric cancers?
90% of gastric cancers are adenocarcinoma
What are the 2 histological subtypes of gastric adenocarcinomas?
Intestinal-type: most common, gland-forming. Further divided into papillary, tubular or mucinous adenocarcinomas.
Diffuse-type: less common, composed of discohesive cells. Classically signet cells see on histology. Can lead to extensive infiltration of the stomach and more likely to have a familial element.
If an upper GI cancer involves the GOJ, it may be classified and treated as an oesophageal or gastric cancer. How is this classified?
Epicentre of the tumour ≤2 cm from the GOJ: oesophageal cancer
Epicentre of the tumour >2cm from the GOJ: gastric cancer
If the tumour is HER2 positive, what can it be treated with?
trastuzumab
Which mutation is linked to hereditary diffuse gastric cancer?
CDH1
Which bacteria is associated with gastric caner? Which type of gastric cancer is it associated with?
Helicobacter pylori
89% of non-cardia gastric cancers.
Distal cancers
Which Patient-related factors are associated with the risk of gastric caner?
Genetic polymorphisms (i.e. unique mutations that increase risk of gastric cancer),
pernicious anaemia (autoantibodies directed against parietal cells leading to vitamin B12 deficiency) and
Menetrier’s disease (rare condition associated with overgrowth of glandular mucous cells).
What are the signs and symptoms of gastric cancer
Symptoms Constitutional symptoms: fevers, anorexia, lethargy, weight loss Dysphagia: if involvement of gastric cardia Indigestion Dyspepsia Nausea/vomiting Haematemesis/melaena Post-prandial fullness
Signs
Usually absent unless late presentation with distant spread
Pallor
Cachexia
Lymphadenopathy
Virchow node: left supraclavicular node
Metastatic lesions
Hepatomegaly
Sister Mary Joseph nodule: periumbilical metastasis
Gatric outlet obstruction due to a fibrotic stricture of obstructing tumour. Causes reduced gastric emptying. Succession splash may be heard - sloshing sound when patient moves due to full stomach
Which Paraneoplastic syndromes are associated with gastric cancer?
Acanthosis nigricans: velvety hyperpigmentation of the skin, usually in skin folds (e.g. axilla)
Dermatomyositis: inflammatory myopathy characterised by a helicotropic rash (purple rash around the eyes) and Gottron’s papules (red areas over the knuckles).
Erythema gyratum repens: erythematous rash with an annular (ring-shaped) appearance. Usually involves limbs and trunk.
What are the indications for an urgent 2 week cancer referal?
Upper abdominal mass consistent with gastric cancer, or
Dysphagia, OR > 55 years with weight loss and one of the following: Upper abdominal pain Reflux Dyspepsia
What are the indications for a non urgent cancer referral?
Haematemesis, OR
> 55 years with treatment resistant dyspepsia, OR
> 55 years with upper abdominal pain and anaemia, OR
Thrombocytosis with one of the following: Nausea/vomiting Weight loss Reflux Dyspepsia Upper abdominal pain
Nausea/vomiting with one of the following: Weight loss Reflux Dyspepsia Upper abdominal pain
How is gastric cancer definitively diagnosed?
upper GI endoscopy (Gastroscopy) and biopsies of suspected lesions.
Which imaging tests are used in gastric cancer. What is the purpose of these tests?
CT chest/abdomen/pelvis - stage the cancer
Abdominal ultrasound - liver metastasis
PET-CT: offered to patients with potentially resectable disease (i.e. candidates for surgery) to assess for distant disease
Endoscopic ultrasound (EUS): performed at time of endoscopy. Sometimes completed to help more accurately stage gastric cancer if it will change management
Diagnostic laparoscopy: can be offered to more accurately stage gastric cancer. Particularly important if the disease is locally advanced but potentially resectable.
