Upper GI Oncology

Question 1

Stomach orientation

Answer 1

Lies directly inferior to diagram

Connects oesophagus to duodenum

Question 2

3 parts of stomach + sphincter

Answer 2

cardia (fundus)
body
pyloric antrum
pyloric sphincter

Question 3

Blood supply to stomach

Answer 3

branches of coeliac trunk
L&R gastric arteries
L&R epigastric arteries

Question 4

Venous drainage of stomach

Answer 4

portal venous system
Gastric veins
Epigastric veins

Question 5

lymphatic drainage of stomach

Answer 5

Regional lymphatics -coeliac axis nodes, splenic hilar, porta hepatis, gastroduodenal & suprapancreatic nodal groups

Question 6

Stomach Aetiology & Epidemiology (Diet)

Answer 6

Low intake of animal fats and proteins 
High intake of carbs 
(grains and starchy roots) 
High salt intake 
Low intake of fruits and vegetables 
Diet rich in smoked foodstuffs 
Diet high in nitrates

Question 7

Stomach Aetiology & Epidemiology (Lifestyle)

Answer 7

Alcohol & tobacco
Poor nutrition
Low socioeconomic status

Question 8

Stomach Aetiology & Epidemiology

Answer 8

Occupation:
Industrial dust exposure
Medical:
Helicobacter pylori infection 
Anaemia due to B12 def (6x risk) 
Genetic – Blood group A

Question 9

Stomach Signs & Symptoms

Answer 9

Stomach
Vague epigastric discomfort 
Loss of appetite 
Weight loss 
Nausea, vomiting 
Palpable epigastric mass 
Ascites (fluid in peritoneal cavity) 
Left supraclavicular adenopathy 
Jaundice 
Left axillary adenopathy

Question 10

Stomach Patterns of spread

Answer 10

Stomach 
~ 1/3 metastatic at presentation 
Local spread: 
Many adjacent organs, omenta, pancreas
Regional lymph and blood channels in submucosa, subserosa 
Blood: 
Liver & lung via portal system 
Lymphatics: 
Nodes in the left gastric chain
Then splenic, coeliac, & hepatic

Question 11

Stomach Pathology and Staging

Answer 11

Stomach
Adenocarcinoma (90-95%) 
Lymphoma (~5%) 
Carcinoids
Gastrointestinal stromal tumours (GISTS)
 Staging: 
TNM

Question 12

Stomach Clinical Management 1

Answer 12

Multi-disciplinary approach
Surgery, neoadjuvant & adjuvant chemo, palliative chemotherapy and radiation
Primarily resection
Only 25-30% suitable for curative surgery

Question 13

Stomach Clinical Management 2

Answer 13

Adjuvant therapy: 
RT - Pre or Post Op 
High toxicity is dose-limiting 
Post-op for good performance for positive margins 
Chemo 
Chemo/RT post-op improves survival