Gen Surg: gastric cancer

Question 1

What is the most common type of gastric cancer?

Answer 1

Adenocarcinoma

Question 2

What are 4 risk factors for developing gastric cancer?

Answer 2

Any 4 of male, H. pylori infection, increasing age, smoking, positive fhx, alcohol consumption, increased dietary salt, pernicious anaemia

Question 3

How would a patient with gastric cancer present?

Answer 3

Specific: Dyspepsia, early satiety, vomiting and dysphagia.

General cancer sx: anorexia, weight loss, anaemia

Question 4

What is trosiers sign?

Answer 4

Presence of palpable left supraclavicular node- sign of metastatic abdominal cancer (usually gastric)

Question 5

A 43 year old patient presents with early satiety, what are your differentials?

Answer 5

Ovarian cancer, GORD, gastritis, peptic/duodenal ulcer, gastric cancer

Question 6

Why is gastric cancer so hard to diagnose?

Answer 6

Vague and non-specific symptoms

Question 7

What are differentials to consider when meeting a patient with dyspepsia, early satiety, anorexia and vomiting?

Answer 7

Gastric cancer, peptic ulcer disease, gallstone disease, pancreatic cancer

Question 8

As well as trosier’s sign, what are other signs of metastatic gastric cancer?

Answer 8

Hepatomegaly, ascites, jaundice, acanthosis nigricans

Question 9

What imaging would you do in a patient with a suspected gastric cancer?

Answer 9

Upper GI endoscopy (OGD) with anyone who has new onset dysphagia or >55yrs with weight loss and either: upper abdo pain, reflux or dyspepsia

Question 10

Why do you perform an OGD in a patient with suspected gastric cancer?

Answer 10

For visualisation and biopsy

Question 11

On histology what would the appearance of cells be for a patient with gastric cancer?

Answer 11

Signet ring cells

Question 12

What is the purpose of CT abdo-pelvis and laparoscopy in a patient with confirmed gastric cancer?

Answer 12

CT is used to make the treatment plan and the laparoscopy is used for staging

Question 13

How do you treat early gastric tumour?

Answer 13

T1a- endoscopic mucosal resection is used

Question 14

What is the curative management of gastric cancer?

Answer 14

Surgery- offered to fit enough patient, with peri-operative chemo.

Proximal gastric cancer- total gastrectomy
Distal gastric cancer- subtotal gastrectomy

Question 15

What are the palliative treatment options for gastric cancer?

Answer 15

May incl chemo, best supportive care and stenting
Palliative surgery can be used when stenting fails

Question 17

Complications of gastrectomy? (stomach removal for stomach cancer)

Answer 17

B12 deficiency (need 3 month B12 injections)
dumping syndrome
re-operation
Death
Anastamotic leak