GI: Gastric cancer Flashcards
What is the most common cause of gastric adenocarcinoma?
H. Pylori
What are risk factors for the development of gastric carcinoma?
- 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
Which sex is gastric carcinoma more common in?
Males
Development of cancer
Normal,
Atrophic/chronic gastritis,
Intestinal metaplasia
Dysplasia
Gastric cancer
(90% of gastric cancers are adenocarcinoma - remainder are mixture of connective tissue, lymphoid, neuroendocrine)
What are symptoms of gastric carcinoma?
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
What signs might be present in someone with gastric cancer?
- General inspection - anorexia
- Epigastric mass
- Virchow’s node - LN in supraclavicular region
- Hepatomegaly - sign of mets
- Jaundice
- Ascites - sign of metastases
- Acanthosis nigricans
- Dermatomyositis
How does H. pylori cause gastric cancer?
Acute gastritis -> Chronic gastritis -> Atrophic Gastritis -> intestinal metaplasia
How can pernicious anaemia cause gastric carcinoma?
Causes atrophic gastritis
What is early gastric carcinoma defined as?
Confined to mucosa/submucosa, regardless of lymph node spread
What investigations would you perform in someone with suspected gastric carcinoma?
-
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
- Biopsies can be sent for
- 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
How many biopsy samples should be taken from a suspicious lesion?
8-10
What is CT/MRI used for in gastric cancer?
Staging
What is EUS useful for when investigating gastric cancer?
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.
How would you managee gastric carcinoma?
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
Gastrectomy complications
Anaemia (B12 defieciency due to no IF)
Malnutrition
Dumpting syndrome
Early satiety
Diarrhoea
What are gastrointestinal stromal tumours?
Subset of GI mesenchymal tumours of varying differentation. Classified as GI leiomyomas/Leiomyosarcomas, leiomyoblastoma or schwannoma
What is a mucosa associated lymphatic tissue lymphoma?
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
What is the 5 year survival of somoene with gastric adenocarcinoma?
<10% - although better for early gastric carcinoma
What are the 5 A’s of gastric malignancy?
- Anaemia
- Anorexia
- Asthenia - abnormal physical weakness or lack of energy.
- Acanthosis nigrans
- A blood group
Route of spread of gastric cancer
Direct
Lymphatic
Blood
Transcoelomic - across peritoneal cavity
Routes of spread of gastric cancer
Direct
Lymphatic
Blood
Transcoelomic - across peritoneal cavity
DDx gastric cancer
Peptic ulcer disease
GORD
Gallstone
Pancreatic cancer
