GI - Gastric Cancer

Question 1

Gastric cancer: epidemiology

Answer 1

• Age: 50’s
• Incidence: 23/100 000
• M>F
• Geographical: increased in Japan, Eastern Europe, China and South America

Question 2

Gastric cancer: risk factors

Answer 2

• Atrophic gastritis (leads to intestinal metaplasia), associated with pernicious anaemia and H pylori
• Diet: high in nitrates (smoked, pickled, salted), nitrates turn into carcinogenic nitrosamines in GIT
• Smoking
• Blood group A
• Low SEC
• Familial: E Catherine abnormality
• Partial Gastric to my

Question 3

Gastric cancer: pathology

Answer 3

• Mainly adenocarcinomas
• usually in gastric antrum
• H pylori may lead to a Maltoma

Question 4

Gastric cancer: depth of invasion

Answer 4

• Early gastric Ca: mucosa or submucosa

- Late Gastric Ca: muscularis propria is breached

Question 5

Gastric cancer: name and classification breakdown

Answer 5

Bormann classification

1. Polypoid/fungating
2. Excavating
3. Ulcerative and raised edge
4. Linitis plastic: leather-both like thickening with flat rugae

Question 6

Gastric cancer: symptoms

Answer 6

• Usually presents late
• Wt loss + anorexia
• Dyspepsia: epigastric or retrosternal pain/discomfort
• Dysphagia
• N + V

Question 7

Gastric cancer: signs

Answer 7

• Anaemia
• epigastric mass
• jaundice
• as cites
• hepatomegaly
• Virchow’s node (Troisier’s sign)
• Achanthosis nigricans

Question 8

Gastric cancer: complications

Answer 8

• Perf
• Upper GI bleed: haematemesis, melaena
• Gastric outlet obstruction —> succession splash

Question 9

Gastric cancer: spread

Answer 9

• Can be within stomach: linitis plastics
• Direct invasion: pancreas
• Lymphatic: Virchow’s node
• Blood: liver and lung
• transcoelomic (can spread to ovaries with Krukenberg tumour or to umbellicus with sister Mary Joseph nodule)

Question 10

Gastric cancer: Ix (blood, imaging and staging)

Answer 10

• Bloods: FBC (anaemia), LFTs and clotting (liver mets)
• Diagnosis: endoscopy with biopsy
• Staging: CT or endoscopic US (US has recently been shown to be superior to CT)

Question 11

Gastric cancer: Mx - medical palliative

Answer 11

• Analgesia (eg fentanyl patch)
• PPI
• Secretion control
• Chemo
• Palliative care team package

Question 12

Gastric cancer: Mx - Surgical palliation

Answer 12

• Pyloric stenting

- Bypass procedures

Question 13

Gastric cancer: Mx - curative surgery

Answer 13

• Disease greater than 5-10cm from OG junction: sub total gastrectomy
• Tumours extending into oesophagus: eosophagogastrectmy
• Early gastric cancer confined within mucosa: endoscopic sub mucosal resection
• Lymphadenectomy normally performed
• Most pts receive chemo either pre or post op

Question 14

Gastric cancer: prognosis

Answer 14

• Very poor
• Overall: <10% 5 year survival
• Pts who undergo surgery: 20-50% 5 year survival