Stomach Cancer

Question 1

What are risk factors for gastric cancer?

Answer 1

Pernicious anemia
Blood group A
H.pylori
Atrophic gastritis
Adenomatous polyps
Lower social class
Smoking
Diet - high salt, spicy, nitrates

Question 2

What is histology of gastric cancer

Answer 2

Adenocarinoma

Signet ring cell - large vacuole of mucin which displaces nucleus to one side

Question 3

What are clinical features of gastric cancer?

Answer 3

Dyspepsia
Nausea and vomiting
Anorexia and weight loss
Dysphagia

Epigastric mass
Hepatomegaly
Jaundice
Ascites
Large Virchow's node - left supraclavicular)
Acanthosis nigricans

Question 4

What referral criteria for upper GI cancer?

Answer 4

> =55 with weight loss and treatment refractory symptoms

Question 5

How does gastric cancer spread

Answer 5

Local
Lymphatic
Blood
Transcoelomic e.g. to ovaries

Question 6

What investigations for gastric cancer?

Answer 6

Gastroscopy +multiple ulcer edge biopsies
Staging: Endoscopic US can evaluate depth of invations
CT CAP

Staging laparscopy for locally advanced tumours
Cytology of peritoneal washings to identify peritoneal metastasis

Question 7

What Mx for gastric cancer that is distally sited > 5-10cm from the OG junction

Answer 7

Subtotal gastrectomy

Question 8

Mx for tumour < 5cm from OG junction

Answer 8

Total gastrectomy

Question 9

What Other Mx for gastric cancer?

Answer 9

Curative:
Chemotherapy adjuvant

Plliative:
Laser therapy
Analgesia
Stent
EtOH injection
Radiotherpay