Stomach Cancer ☺️

Question 1

Epidemiology

Risk factors

Answer 1

Decreasing in incidence

Common in Japan, China, Finland, Colombia
Male, older age

SMOKING
Salty, spicy, nitrate rich foods
HPylori
Pernicious anemia (AI attack on parietal cells => release IF)
Gastric polyps

Question 2

Presentation

Answer 2

Difficulty swallowing
N+V
Anorexia, weight loss
Weight loss, fatigue 
Persistent indigestion
Feeling full quickly
Melena, hematemesis

Question 3

Investigation

Answer 3

Diagnosis - endoscopy + biopsy (OGD)

Staging - CT/endoscopic US of chest, abdo, pelvis for mets
Laparoscopy for peritoneal disease

May also consider
Blood tests
-FBC - Fe def anemia
-U&E, LFT - renal, kidney involvement

Question 4

Management

-surgical

Answer 4

Surgical

• if limited to mucosa/submucosa => endoscopic submucosal resection
• if 5-10cm from OG junction - subtotal gastrectomy
• if U5cm from OG junction - total gastrectomy
• if extending into esophagus - esophagogastrectomy

Pre/postop chemotherapy

Lymphadenectomy

Question 5

What are the types of surgery possible

Answer 5

Cancer in lower stomach
Roux en Y jejunal anastomosis
-remove lower stomach
-reattach jejunum to upper stomach
-reattach duodenum to jejunum and BD

Gastrojejunal anastomosis

• remove lower stomach
• reattach jejunum to upper stomach only

Cancer in upper stomach
Esophagogastric anastomosis
-remove upper stomach
-reattach duodenum to lower esophagus

Cancer in whole stomach
Esophagojejunal anastomosis
-like Roux en Y but whole stomach removed

Question 6

TNM staging for stomach cancer

T

Answer 6

T1 - submucosa
T2 - muscularis propria
T3 - serosa
T4 - left stomach, nearby structures

Question 7

TNM staging for stomach cancer

N

Answer 7

N0 - no LN spread
N1 - U2 LN
N2 - 3+
N3 - 7+

M0 - no organ mets
M1 - organ mets