Gastro - Carcinoma of the stomach

Question 1

Epidemiology of Gastric cancer

Answer 1

6th most common cancer and 4th in cancer related death worldwide
Most commonly seen in Central and South America, China, Japan, Korea and Eastern Europe

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Question 2

Risk factors of Gastric cancer

Answer 2

Age – above 50 (median age of Dx is 70)
Sex: 2:1 M:F
H. Pylori infection – 60% of cases
Smoking
Alcohol
Obesity
Diet rich in pickled, cured or processed food
Family Hx (10% of cases, 1% having defect in CDH-1 gene)
Pernicious anemia
Gastritis

Question 3

WHO classification of Gastric cancer? Which ones are most common etc?

Answer 3

Adenocarcinoma (95%)
5% lymphoma. Squamous cell, carcinoid etc

Question 4

Which are the most common locations for gastric cancer?

Answer 4

Typically, in the lower parts of the stomach. Most common locations:
1. Pyloric antrum
2. Lesser curvature
3. Cardia
4. Fundus
5. Body

Question 5

Sx of Gastric cancer

Answer 5

Often asymptomatic or non specific
Weight loss
Dyspepsia
Heartburn
Fatigue
Bloating
Nausea and vomiting

As disease progresses:
haematemesis
Melena
Anaemia
Dysphagia: if cancer involves cardia of stomach

Question 6

Dx of Gastric cancer

Answer 6

Endoscopy and biopsy are gold standard
7 biopsies from ulcer has >98% sensitivity

CT for staging of cancer
CXR metastasis

Tumour markers: CEA, CA 19-9, CA 125, CA 72-4

Question 7

Staging of Gastric cancer

Answer 7

Typically use TNM

T0 – carcinoma in situ
T1a – tumour invades lamina propria or muscularis mucosa
T1b – invades submucosa
T2 – invades muscularis propria
T3 – penetrates subserosa connective tissue
T4a – invades visceral peritoneum
T4b – invades adjacent structures

N0 – no regional lymph node metastasis
N1 – 1-2 regional lymph nodes
N2 – 3-6 regional lymph nodes
N3 – 7+ regional lymph nodes

MOST STOMACH CANCER IS Dx IN STAGE 3

Question 8

Prevention and Tx of Gastric cancer

Answer 8

Prevention:
Diet rich in fruit and veg.
Risk factor control (stop smoking, alcohol)
H. Pylori eradication.

Endoscopic mucosal resection in early stages
Late stages would be partial\ total gastrectomy.
Chemotherapy

Immunotherapy
Trastuzumab (HER2 inhibitor)
Nivolumab (PD1 inhibitor)

Question 9

Where does Gastric cancer often metastasise to? Which lymph nodes would be involved

Answer 9

Liver and peritoneum
Can also spread to lungs and bones.

perigastric nodes,
Supraclavicular (Virchow’s node)
suprapancreatic nodes
nodes around the celiac artery
para-aortic nodes

Question 10

What is Troisier’s sign?

Answer 10

Sign of hard enlarged left supraclavicular node (Virchow’s node) which is a sign of metastatic abdominal malignancy

Question 11

What tumour markers are used for gastric cancer?

Answer 11

Tumour markers: CEA, CA 19-9, CA 125, CA 72-4