Malignant Gastric Tumours Flashcards
Types of Tumour?
Carcinomas (adenocarcinomas)
Lymphomas
Gastric Stromal Tumours (GISTs)
Journey to adenocarcinoma?
H. Pylori infection > Acute gastritis > Chronic gastritis > Atrophic gastritis > Intestinal metaplasia > Dysplasia and gastric cancer
Describe the intestinal type of adenocarcinoma?
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.
Most common location for adenocarcinomas?
Distal stomach
Types of adencarcinomas?
Intestinal type
Diffuse type
Describe the diffuse type of adenocarcinoma?
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
Who gets gastric adenocarcinoma?
Men > women Patients with genetic disposition H. Pylori infection (distal) High salt/nitrate intake Smokers Pernicious anaemia Parietal gastrectomy
How does early gastric adenocarcinoma present?
Often no symptoms so presents late
How does adenocarcinoma present?
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)
How is adenocarcinoma diagnosed?
Gastroscopy CT scan of chest and abdomen Endoscopic US (local staging) Laproscopy PET & CT/PET scan )for exact cancer location) TNM classification
What TNM stage are most patients at when presenting with adenocarcinoma?
Stage 3 or 4
How is gastric adenocarcinoma treated?
Non ulcerated mucosal lesions can be endoscopically removed
Surgery (most effective)
Chemoradiotherapy to support surgery
Diffuse types cancer has better prognosis than intestinal. True or false?
FALSE
Intestinal is a better prognosis
Where does gastric adenocarcinoma commonly spread to?
Lymph nodes Liver Malignant ascites Bone Brain Lung
What is gastric lymphoma?
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
Who gets gastric lymphoma?
Associated with H. Pylori infection
Chromosome abnormality also associated
Patients in their 60s
How does gastric lymphoma present?
Stomach pain
Ulcers
Localized symptoms
Rarely: fatigue, fever & other systemic effects
How is gastric lymphoma diagnosed?
Biopsy of lymph nodes
How is gastric lymphoma treated?
Eradicate the H. Pylori
Stage 3/4 disease is treated with surgery/chemo +/- radiation
Prognosis for gastric lymphoma?
90% 5 year survival rate
What are GIST?
Gastrointestinal stromal tumours
Subset of GI mesenchymal tumours of varying differentiation
Stromal in origin and share common ancestry with the ICCs
How do GIST’s present?
Often asymptomatic
Can ulcerate and bleed
Diagnosis of GIST?
Endoscope and biopsy
How are GISTs treated?
Surgery
Imatinib - tyrosine kinase inhibitor (for unresectable metastatic disease)
Sunitinab: alternative to imatinib in patients who are resistant
Which cancer is most associated with H. Pylori?
Adenocarcinoma
Another term for gastric lymphoma?
MALT tumour
What type of tumour is a GIST?
Sarcoma
