GI cancer: Gastric cancer (CDH-1 Mutation)

Question 1

Majority of gastric cancer are…

Answer 1

Adenocarcinomas

Question 2

Types of gastric carcinomas

Answer 2

Intestinal = usually exophytic or ulcerating
Diffuse = flat, causing linitus plastica with signet ring cells

Question 3

Risk factors

Answer 3

Modifiable
- H. pylori
- Smoking
- Alcohol
- Diet
- Obesity
Non modifiable
- Male gender
- Increasing age
- Pernicious anaemia
- Blood type A
- CDH-1 mutation and FHx
- LYNCH SYNDROME

Question 4

Aetiology

Answer 4

H.pylori
Smoking
CDH-1 mutation
Pernicious anaemia

Question 5

Signs

Answer 5

Iron deficiency anaemia
Progressive dysphagia
Palpable mass
Melaena
Acanthosis nigricans

Question 6

Symptoms

Answer 6

Severe epigastric pain (same as gastritis but worse)
Wt loss
TATT
Difficulty swallowing

Question 7

Mets signs

Answer 7

Jaundice = liver mets
Krukenburg tumour = ovarian mets from gastric cancer

Question 8

Lymph node spread

Answer 8

Virchows node = supraclavicular
Sister Mary Joseph Node = umbilical

Question 9

Diagnosis

Answer 9

GOLD STANDARD = Gastroscopy + biopsy
CT/MRI for staging, PET, to ID mets

Question 10

Staging

Answer 10

TNM staging
- Type 1 = carcinoma of the distal oesophagus associated with Barrett’s oesophagus which infiltrates the GOJ from above = well differentiated better prognosis = MC
- Type 2 = Junctional carcinoma of the cardia = undifferentiated “signet ring carcinoma” = worse prognosis = typically at proximal stomach

Question 11

Treatment

Answer 11

Surgery + “ECF” chemo regimen, if resectable
* CHEMO OFFERED TO ALL PATIENTS *

Question 12

Complications

Answer 12

Bleeding
Gastric outlet obstruction
Perforation
Metastasis