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Charis & Ellie vs GI > Malignant Gastric Tumours > Flashcards

Malignant Gastric Tumours Flashcards

1
Q

Types of Tumour?

A

Carcinomas (adenocarcinomas)
Lymphomas
Gastric Stromal Tumours (GISTs)

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2
Q

Journey to adenocarcinoma?

A

H. Pylori infection > Acute gastritis > Chronic gastritis > Atrophic gastritis > Intestinal metaplasia > Dysplasia and gastric cancer

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3
Q

Describe the intestinal type of adenocarcinoma?

A

Well formed glandular structures. Differentiated cells. Polypoid or ulcerating tumours surrounded by intestinal metaplasia. Often H. Pylori is present, distal stomach is the most common location. Strong environmental component.

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4
Q

Most common location for adenocarcinomas?

A

Distal stomach

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5
Q

Types of adencarcinomas?

A

Intestinal type

Diffuse type

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6
Q

Describe the diffuse type of adenocarcinoma?

A

Poorly cohesive undifferentiated cells, tendency to infiltrate the gastric wall.
Can involve any part of the stomach especially at the cardia.
Loss of expression of the cell adhesion molecule E Cadherin is the key event in the carcinogenesis
Less of an environmental component, more likely any age/younger demographic

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7
Q

Who gets gastric adenocarcinoma?

A 
Men > women 
Patients with genetic disposition 
H. Pylori infection (distal)
High salt/nitrate intake 
Smokers 
Pernicious anaemia 
Parietal gastrectomy
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8
Q

How does early gastric adenocarcinoma present?

A

Often no symptoms so presents late

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9
Q

How does adenocarcinoma present?

A 
Epigastric pain: maybe relieved by food and antacids
Nausea 
Anorexia 
Weight loss 
Vomiting 
Dysphagia (tumour involving fundus)
Anaemia (from blood loss)
Jaundice (liver mets)
Malignant ascites 
Gross haematemesis (unlikely)
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10
Q

How is adenocarcinoma diagnosed?

A 
Gastroscopy 
CT scan of chest and abdomen 
Endoscopic US (local staging)
Laproscopy 
PET & CT/PET scan )for exact cancer location)
TNM classification
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11
Q

What TNM stage are most patients at when presenting with adenocarcinoma?

A

Stage 3 or 4

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12
Q

How is gastric adenocarcinoma treated?

A

Non ulcerated mucosal lesions can be endoscopically removed
Surgery (most effective)
Chemoradiotherapy to support surgery

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13
Q

Diffuse types cancer has better prognosis than intestinal. True or false?

A

FALSE

Intestinal is a better prognosis

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14
Q

Where does gastric adenocarcinoma commonly spread to?

A 
Lymph nodes 
Liver 
Malignant ascites 
Bone 
Brain 
Lung
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15
Q

What is gastric lymphoma?

A

Cancer derived from associated lymphoid tissue (MALT), continuous inflammation induces an evolution into clonal B cell proliferation- low grade lymphoma.
If unchecked it evolves into High grade B cell lymphoma

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16
Q

Who gets gastric lymphoma?

A

Associated with H. Pylori infection
Chromosome abnormality also associated
Patients in their 60s

17
Q

How does gastric lymphoma present?

A

Stomach pain
Ulcers
Localized symptoms
Rarely: fatigue, fever & other systemic effects

18
Q

How is gastric lymphoma diagnosed?

A

Biopsy of lymph nodes

19
Q

How is gastric lymphoma treated?

A

Eradicate the H. Pylori

Stage 3/4 disease is treated with surgery/chemo +/- radiation

20
Q

Prognosis for gastric lymphoma?

A

90% 5 year survival rate

21
Q

What are GIST?

A

Gastrointestinal stromal tumours
Subset of GI mesenchymal tumours of varying differentiation
Stromal in origin and share common ancestry with the ICCs

22
Q

How do GIST’s present?

A

Often asymptomatic

Can ulcerate and bleed

23
Q

Diagnosis of GIST?

A

Endoscope and biopsy

24
Q

How are GISTs treated?

A

Surgery
Imatinib - tyrosine kinase inhibitor (for unresectable metastatic disease)
Sunitinab: alternative to imatinib in patients who are resistant

25
Q

Which cancer is most associated with H. Pylori?

A

Adenocarcinoma

26
Q

Another term for gastric lymphoma?

A

MALT tumour

27
Q

What type of tumour is a GIST?

A

Sarcoma

Charis & Ellie vs GI (120 decks)

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