Stomach

Question 1

Average age of carcinoma stomach

Answer 1

Age 65-74 years

Question 2

Lymph node : N1 Distribution

Answer 2

1. RT paracardial
2. Lt paracardial
3. Lesser curvature
4. Greater curvature
5. Suprapyloric
6. Infra pyloric

Question 3

Lymph node distribution N2

Answer 3

7. Left gastric
8. Common hepatic
9. Celiac
10. Splenic hilar
11. Splenic artery

Question 4

Lymph node distribution: N3

Answer 4

12. Hepatoduodenal
13. Superior mesenteric
14. Middle colic
15. Para colic
16. Portal/ retropharyngeal

Question 5

Risk factors for carcinoma stomach

Answer 5

Diet
H pylori, EBV
Achlorohydria
Chronic gastritis, atrophic gastritis
Tobacco/ smoking
Occupational exposure: coal, rubber, timber, nickel processing
Gastric polyp
Familiar: FAP, HNPCC, Li fraumenia
Peutz jegher

Question 6

Pathological classification of carcinoma stomach

Answer 6

Pathology :
● 95% : Adenocarcinoma
● 5% : Leiomyosarcoma, lymphomas, carcinoid, squamous, GISTS (gastrointestinal stromal tumours) or
others (squamous cell carcinoma, small cell carcinoma).
Histological subtypes (WHO)
1. Adenocarcinoma
2. Papillary adenocarcinoma
3. Tubular adenocarcinoma
4. Mucinous adenocarcinoma
5. Adenosquamous carcinoma
6. Squamous cell carcinoma
7. Signet ring cell carcinoma
8. Small cell carcinoma
9. Undifferentiated carcinoma

Question 7

Carcinoma stomach commonly metastasize to?

Answer 7

*Liver, lung
*Peritoneum (10%)
● Supraclavicular LN (Virchow’s node)
● Left ant. axillary LN (Irish node) [through lower esophageal & intrathoracic lymphatics]
● Umbilicus (Sister Mary Joseph nodule) [tumour spread along falciform ligament]
● Ovary in women (Krukenberg tumour)
● Rectal shelf in men (Blumer shelf)
● Bone mets (Sclerotic type)
● Carcinomatous meningitis.

Question 8

Tumor marker in case of carcinoma stomach

Answer 8

CEA
AFP
CA 19-9
Other biomarkers
MSI-for all
Her2, PDL1- in case of metastatic,recurrent
NGS may be done

Question 9

Common pre operative and peri operative regimen for ca stomach

Answer 9

FLOT
Fluorouracil+ oxaliplatin
FLOT
FU: 2600 mg/m2 IV D1 over 24 hours
Leucovorin 200 mg/m2 D1
Oxaliplatin 85 mg/m2 D1
Docetaxel 50 mg/m2 D1
Give 2 weekly

Repeat every 14 days for 4 cycles prior to surgery and 4 cycles post surgery.
Surgery should take place within 6 weeks after completion of Cycle 4.
Cycle 5 should begin 6-12 weeks after surgery.

Question 10

Differential diagnosis of mass in Rt epigastric region

Answer 10

Benign:
Chronic duodenal ulcer
TB
Hypertrophic pyloric stenosis
Malignant
Carcinoma stomach
Lymphoma
GIST
Sarcoma
Carcinoma head of the pancreas

Question 11

DCF schedule( Nazir sir favrt)

Answer 11

Docetaxel 75mg/m2 iv 1hr infusion D1
Cisplatin 75mg/m2 iv 1-3 hr infusion D1
5 Fu 750 mg/m2 iv cont inf D1-5

Question 12

Pns of stomach

Answer 12

Associated paraneoplastic syndromes –
A. Skin : Acanthosis nigricans (in 55% cases associate with gastric carcinoma) Polymyositis, Dermatomyositis,
Circinate erythemas, Pemphigoid, Acute onset of seborrheic keratosis ( Laser-Trelat sign)
B. Central nervous system : Dementia, Cerebellar ataxia
C. Others : Thrombophlebitis, Microangiopathic hemolytic anemia, Membranous nephropathy, Ectopic
Cushing/ carcinoid syndrome, Hypocalcemia, Acromegaly, Granulocytosis.

Question 13

Borrman classification of stomach

Answer 13

Borrman classification
Divides tumours into five types:
● Type I polypoid or fungating,
● Type II ulcerated with elevated borders,
● Type III ulcerated and invading the gastric wall,
● Type IV diffusely infiltrating (linitus plastica)
● Type V unclassifiable

Question 14

Endoscopy cannot diagnose following tumor

Answer 14

[Endoscopy cannot diagnose the following conditions due to normal gastric mucosa:
● Linitis plastica,
● Gastrointestinal stromal tumor (GIST),
Fundic part tumor

Question 15

Most important marker for stomach cancer

Answer 15

Most important marker for stomach cancer
- CA 72-4