The Stomach - Gastric Carcinoma

Question 1

Epidemiology of Gastric Cancer.

Answer 1

1. 50% of cases are above 75.

2. Males (2:1).

Question 2

Types of Gastric Cancer (2).

Answer 2

1. Intestinal.

2. Diffuse.

Question 3

Associations of Gastric Cancer (7).

Answer 3

1. H. pylori (in Intestinal mainly).
2. Smoking.
3. Achlorhydria.
4. Chronic (Atrophic) Gastritis.
5. Diet rich in Nitrates and Salt-Preserved Foods.
6. EBV (in Diffuse mainly).
7. FAP.

Question 4

What type of cells are associated with Diffuse Gastric Cancer?

Answer 4

Signet cells - contain a large vacuole of mucin that displaces the nucleus to one side; higher number = poorer prognosis.

Question 5

Clinical Features of Gastric Carcinoma (4).

Answer 5

1. Vague Epigastric Pain.
2. Dyspepsia.
3. Constitutional Symptoms.
4. Dysphagia (if Proximal).

Question 6

Relevant Lymph Nodes of Gastric Carcinoma (2).

Answer 6

1. Left Supraclavicular Lymph Node (Virchow’s Node) : Troisier’s Sign.
2. Periumbilical Nodule (Sister Mary Joseph’s Node) - associated with Intestinal Gastric Carcinoma.

Question 7

Investigations of Gastric Carcinoma (2).

Answer 7

1. Diagnosis : Endoscopy with Biopsy.

2. Staging : CT Scan.

Question 8

Management of Gastric Carcinoma (2).

Answer 8

1. Surgical Options : Endoscopic Mucosal Resection, Gastrectomy (Partial or Total).
2. Chemotherapy.

Question 9

Complications of a Gastrectomy (6).

Answer 9

1. Dumping Syndrome.
2. Weight Loss & Early Satiety.
3. Iron-Deficiency Anaemia.
4. Osteoporosis/Osteomalacia.
5. Vitamin B12 Deficiency.
6. Increased Risk of Gallstones and Gastric Cancer.

Question 10

Prognosis of Gastric Carcinoma (2).

Answer 10

1. 5 year survival is approximately 20%.

2. Intestinal Prognosis > Diffuse Prognosis.

Question 11

What is Dumping Syndrome?

Answer 11

1. Early : Food of High Osmotic Potential moves into the small intestine to cause a fluid shift.
2. Late : Rebound Hypoglycaemia - a surge of insulin follows food of high glucose value in the small intestine; 2-3 hours later the insulin ‘overshoots’ to cause hypoglycaemia.