GI: Gastric cancer Flashcards

1
Q

What is the most common cause of gastric adenocarcinoma?

A

H. Pylori

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2
Q

What are risk factors for the development of gastric carcinoma?

A
  • Pernicious anaemia
  • Blood group A
  • H. pylori
  • Atrophic gastritis
  • Adenomatous polyps
  • Lower social class
  • Smoking
  • Diet - high nitrate, high salt, pickling, low vitamin C
  • Nitrosamine exposure

More common in Japan now than western world

5th most common cancer globally

Male and increase age increase risk

FH

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3
Q

Which sex is gastric carcinoma more common in?

A

Males

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4
Q

Development of cancer

A

Normal,

Atrophic/chronic gastritis,

Intestinal metaplasia

Dysplasia

Gastric cancer

(90% of gastric cancers are adenocarcinoma - remainder are mixture of connective tissue, lymphoid, neuroendocrine)

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5
Q

What are symptoms of gastric carcinoma?

A

Often non-specific

  • Dyspepsia
    • ​Epigastric pain
    • Similar to peptic ulcer pain
    • Leads to early satiety
  • Weight los - late stage marker
  • Vomiting
  • Dysphagia
  • Anaemia - late stage marker
  • Haematemesis/malaena
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6
Q

What signs might be present in someone with gastric cancer?

A
  • General inspection - anorexia
  • Epigastric mass
  • Virchow’s node - LN in supraclavicular region
  • Hepatomegaly - sign of mets
  • Jaundice
  • Ascites - sign of metastases
  • Acanthosis nigricans
  • Dermatomyositis
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7
Q

How does H. pylori cause gastric cancer?

A

Acute gastritis -> Chronic gastritis -> Atrophic Gastritis -> intestinal metaplasia

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8
Q

How can pernicious anaemia cause gastric carcinoma?

A

Causes atrophic gastritis

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9
Q

What is early gastric carcinoma defined as?

A

Confined to mucosa/submucosa, regardless of lymph node spread

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10
Q

What investigations would you perform in someone with suspected gastric carcinoma?

A
  • Gastroscopy - plus multiple ulcer edge biopsies: GOLD STANDARD
    • Biopsies can be sent for
      Histology - for classification and grading
      CLO test - presence of H. Pylori
      HER2/new protein expression
  • CEA blood test - carcinoembryonic antigen is a marker of gastric cancer
  • EUS
  • CT/MRI abdo/pelvis
  • Consider CXR
  • Consider peritoneal washing cytology
  • Consider PET scan
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11
Q

How many biopsy samples should be taken from a suspicious lesion?

A

8-10

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12
Q

What is CT/MRI used for in gastric cancer?

A

Staging

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13
Q

What is EUS useful for when investigating gastric cancer?

A

Useful for local staging to demonstrate the depth of penetration of the cancer through the gastric wall and extension into local lymph nodes.

It complements CT and ultrasound but is most relevant to confirm a cancer is confined to the superficial mucosa, before endoscopic resection.

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14
Q

How would you managee gastric carcinoma?

A

Surgery

  • Early disease - endoscopic mucosal resection
  • Advanced distal - partial gastrectomy
  • Advanced proximal - Total gastrectomy and roux en y reconstruction
  • Palliative surgery may be required

Chemotherapy - advanced disease

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15
Q

Gastrectomy complications

A

Anaemia (B12 defieciency due to no IF)

Malnutrition

Dumpting syndrome

Early satiety

Diarrhoea

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16
Q

What are gastrointestinal stromal tumours?

A

Subset of GI mesenchymal tumours of varying differentation. Classified as GI leiomyomas/Leiomyosarcomas, leiomyoblastoma or schwannoma

17
Q

What is a mucosa associated lymphatic tissue lymphoma?

A

MALT lymphoma

Indolent B cell marginal zone lymphomas primarily involved sites other than lymph nodes e.g. GI tract, thyroid, breast or skin. They constitute about 10% of NHLs

18
Q

What is the 5 year survival of somoene with gastric adenocarcinoma?

A

<10% - although better for early gastric carcinoma

19
Q

What are the 5 A’s of gastric malignancy?

A
  • Anaemia
  • Anorexia
  • Asthenia - abnormal physical weakness or lack of energy.
  • Acanthosis nigrans
  • A blood group
20
Q

Route of spread of gastric cancer

A

Direct

Lymphatic

Blood

Transcoelomic - across peritoneal cavity

21
Q

Routes of spread of gastric cancer

A

Direct

Lymphatic

Blood

Transcoelomic - across peritoneal cavity

22
Q

DDx gastric cancer

A

Peptic ulcer disease

GORD

Gallstone

Pancreatic cancer