Stomach

Question 1

Aetiology

Answer 1

• Prior infections: H-Pylori
• Diet: high red meat intake
• Exposure: asbestos
• Smoking
• Obesity

Question 2

Epidemiology

Answer 2

Incidences will decrease by 17% by 2035, with a peak rate at 85-89 years

Question 3

Presentation

Answer 3

Weight-loss
Dysphagia
Vomiting
Bleeding
Pain

Question 4

Diagnosis

Answer 4

CT/MRI
Endoscopy
PET/CT: track the lymphatic system
Barium Swallow: identifies any blockage
Blood tests: LFT
Biopsy = Her2 status

Question 5

What is the most common pathology

Answer 5

Adenocarcinoma (95%)

Question 6

What other pathology is found in the stomach?

Answer 6

Leiosarcomas, lymphomas and sarcomas

Question 7

What type of spread is uncommon

Answer 7

Distant spread

Question 8

Where does local spread travel to?

Answer 8

Liver (most common), oesophagus, small bowel via duodenum

Question 9

Where does lymphatic spread travel to?

Answer 9

mesenteric, coeliac nodes, pancreaticoduodenal then cisterns cyhli

Question 10

What are the types of treatment

Answer 10

Surgery
Immunotherapy
Chemo
RT (palliative)

Question 11

What immunotherapy drug used

Answer 11

Nivolumab

Question 12

What sensitivity is the stomach

Answer 12

It is extremely chemo sensitive

Question 13

Describe chemo to the stomach

Answer 13

Can be used as a single agent or combined

Question 14

What is the NICE for chemo

Answer 14

Cape for inoperable advanced tumours with cis-platin
If the patient is HER 2 +, transtizumab in combination with cape, cisplatin or 5-FU

Question 15

Describe RT

Answer 15

ant + post fields
20Gy in 5, 8Gy in 1 or 30Gy in 10 (high dose palliative)
Adjuvant chemoradiation (45Gy in 25 fractions with 5-FU) with 10 weeks of surgery
Intra-operable

Question 16

SE of RT

Answer 16

nausea, vomiting, fatigue, diarrhoea, skin