Stomach cancer Flashcards
Types?
1) Intestinal:
- -> lesser curvature (most common)
- -> assoc w/ H.pylori, smoking, achlorhydia and chronic gastritis
2) diffuse:
- -> NOT assoc w/ H. Pylori
- -> assoc w/ signet cells
Risk factors?
1) smoking
2) pernicious anaemia
3) H.Pylori !! x6
4) High alcohol intake (>6 units/day0
5) Nitrosamines –> fishies
6) atrophic gastritis
7) Adenomatous polyps
8) Achlorydia
9) blood group A
NB. GORD increases risk of duodenal carcinoma
Presentation?
- anaemia
- weight loss
- melaena/haematemesis
- dysphagia
- early satiety
Urgent referral (2ww) for OGD?
LEARN
1) Dysphagia - any age
2) >55 w/ weight loss AND:
- -> upper abdo pain/ dyspepsia/ reflux
- -> upper abdo mass consistent with stomach (left) cancer (usually non-tender)
Non-urgent (6ww) referral for OGD?
LEARN
1) Haematemesis - any age
2) >55 w/ any of:
- -> Rx resistant dyspepsia
- -> upper abdo pain + low Hb
- -> raised platelets + 1 of: (nausea, vomiting, reflux, weight loss, dyspepsia, epigastric pain)
- -> N&V + 1 of: (relux, weight loss, dyspepsia, epigastric pain)
1st line investigation post-endoscopy (staging)?
CT chest, abdo, pelvis
Investigation to identify spread to liver?
MRI
Management of locally invasive disease?
- Total gastrectomy
- Partial gastrectomy
- (EMR possible)
Other treatment options?
- Chemotherapy (neoadjuvant)
- Chemoradiotherapy (non-surgical candidate)
Metastatic is inoperable
Palliative options for advanced disease?
1) surgery (relieve obstruction/haemorrhage)
2) chemo (improve QOL)
Buzz word after endoscopy?
SIGNET RINGS CELLS = gastric adenocarcinoma
What is Virchow’s node?
Left sided supraclavicular lymph node –> supplied by the intra-abdo lymph systemic = Trosier’s sign
What is Trosier’s sign highly suggestive of?
Gastric malignancy
Investigation for enlarged left supraclavicular lymph node?
Upper GI endoscopy (OGD)
What’s a Krukenburg tumour?
Development of mets in the ovary from the stomach
