Stomach_Gastric_Adeno

Question 1

When was gastric cancer the leading cause of cancer mortality in the US and Europe?

Answer 1

1930s. It has falen dramatically since then…

Question 2

What are known risk factors for gastric cancer?

Answer 2

H. pylori infection, gastric polyps, nitrosamines, smoking, previous gastric surgery, pernicious anemia, family hx.

Question 3

What countries/regions have the highest incidence of gastric cancer?

Answer 3

Japan, Korea and areas of South America - more distal stomach lesions

Question 4

What countries/regions have the lowest incidence of gastric cancer?

Answer 4

North America, Australia and portions of N. Africa -

Question 5

What are the 2 different kinds of gastric adenocarcinoma?

Answer 5

Intestinal (well-differentiated) and diffuse (poorly differentiated)

Question 6

Intestinal-type gastric adenocarcinoma is more common in what population?

Answer 6

High-risk populations and older patients

Question 7

Diffuse-type gastric adenocarcinoma is more common in what population?

Answer 7

Women and younger patients

Question 8

Diffuse-type gastric adenocarcinoma is thought to arise from what structure?

Answer 8

Lamina propria and spreads via submucosal infiltration

Question 9

In Western countries what kind of gastric adenocarcinoma is increasing?

Answer 9

Proximally located and diffuse-type tumors

Question 10

What lymph node findings are often present on gastric adenocarcinoma presentation?

Answer 10

Sister Mary Joseph periumbilical), Virchow (left supraclavicular) and Blumer’s shelf (prerectal met on rectal exam) lymph node enlargement

Question 11

What is the examination of choice when working up potential gastric adenoca?

Answer 11

Endoscopy - can use EUS to determine depth or lymph node involvement. Accuracy 80% and 50% respectively.

Question 12

Why should peritoneal washings be collected during diagnostic laparoscopy?

Answer 12

Prognosis. Pts. without visible metastatic disease and neg. peritoneal washings had 98.5 mean month survival compared to 14.8 months with positive cytology.

Question 13

How many lymph nodes are needed from the surgical specimen for accurate staging?

Answer 13

15

Question 14

What is the cornerstone of curative therapy for gastric CA?

Answer 14

Surgical excision

Question 15

What kind of gastrectomy yeilds the best survival for gastric CA?

Answer 15

Subtotal or total gastrectomy- no difference in survival

Question 16

What gross margins are preferred for gastric CA?

Answer 16

5 cm

Question 17

Describe a D0 lymphadenectomy

Answer 17

No effort is made to resect nodes

Question 18

Describe a D1 lymphadenectomy

Answer 18

Excision of perigastric nodes

Question 19

Describe a D2 lymphadenectomy

Answer 19

D1 + LN along the main trunks of the celiac axis

Question 20

What is the controversy surrounding D1 vs D2 resections?

Answer 20

Japan has shown a difference in survival for D2 resections, but no other country (other than single-center institutions) have replicated the results.

Question 21

Describe the results of the Intergroup 0116 trial for gastric adenoCA

Answer 21

5-FU + leucovorin + XRT had improvement in overall survival and relapse-free survival compared to pts who were only observed.

Question 22

What is the criticism of the Intergroup 0116 trial?

Answer 22

Most patients only received a D0 resection (52%) instead of a D2 lymphadenectomy(10%), D2 recommended by the trial, only 64% pts completed chemo.

Question 23

What are th results of the MAGIC trial?

Answer 23

Neoadjuvent epirubicin, cisplatin, and 5-FU to surgery alone demonstrated improved overall and progression-free survival and improved resectability.

Question 24

When is neoadjuvent therapy recommended for gastric adenoCA?

Answer 24

T2 and higher.

Question 25

Is there a post-op nomogram for predicting gastric adenoCA survival?

Answer 25

Yes. Better than AJCC staging. From Memorial Sloan-Kettering. Has been validated by other centers.