stomach cancer

Question 1

What is the gender bias in gastric cancer?

Answer 1

Men: women -> 2:1

Question 2

What are the most common sites for gastric cancer in most Western countries?

Answer 2

The proximal lesser curvature, cardiac and oesophagogastric junction are the most common sites in Western countries

Question 3

What are the risk factors for gastric cancer?

Answer 3

1. Increasing age
2. Poor SES
3. H. pylori
4. Diet
5. Smoking
6. Atrophic gastritis, pernicious anaemia, post-gastrectomy, Ménétrier’s disease.
7. Familial risk

Question 4

What is the presentation associated with gastric cancer?

Answer 4

Dyspepsia, weight loss, vomiting, dysphagia, abdominal discomforts, loss of apetite and anaemia

An upper abdominal mass

Treatment with antisecretory drugs may delay diagnosis or result in a misdiagnosis on first endoscopy

Question 5

When would you consider referral for gastric cancer?

Answer 5

Refer people who have an upper abdominal mass consistent with stomach cancer

Urgent referral to those with dysphagia OR 55 > and weight loss and pain/erflux/dyspepsia

Question 6

What investigations would you do for gastric cancer?

Answer 6

1. FBC (anaemia)
2. Rapid-access video endoscopy and endoscopic biopsy remain the investigations of choice
3. Biopsy gastric ulcer

Question 7

What is Krukenberg’s tumour?

Answer 7

Spread of gastric cancer to the ovaries

Question 8

How would you manage gastric cancer?

Answer 8

Nutritional support

1. Endoscopic surgery is the mainstay of treatment for early gastric cancers
2. Proximal or distal partial resection is appropriate with limited lymphadenectomy

Perioperative combination chemotherapy

Question 9

What is the most common type of gastric cancer?

Answer 9

Adenocarcinomas (90%)

Question 10

What is the most common cause of gastric cancer?

Answer 10

H pylori

Question 11

What cutaneous conditions are associated with gastric cancer?

Answer 11

A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as acanthosis nigricans, is associated with intra-abdominal cancers such as gastric cancer

Question 12

Where do gastric adenocarcinomas originate?

Answer 12

Glandular epithelium of the gastric mucosa

Question 13

What is a characteristic of adenocarcinomas?

Answer 13

Adenocarcinomas tend to aggressively invade the gastric wall, infiltrating the muscularis mucosae, the submucosa and then the muscularis propria

Question 14

What is the prognosis of gastric cancer?

Answer 14

The prognosis of stomach cancer is generally poor, because the tumor has often metastasized by the time of discovery, and most people with the condition are elderly (median age is between 70 and 75 years) at presentation