Upper GI Oncology - Stomach Flashcards
What major organs make up the upper gastrointestinal tract?
Stomach Liver Pancreas Oesophagus Gallbladder
Where is the stomach located?
Left hypochondriac region, epigastric region,
Left upper quadrant
Lies directly inferior to the diaphragm
What is the stomachs function?
secretes mixture of acid, mucus and digestive enzymes.
Functions as a mixing chamber and holding reservoir
What are the regions of the stomach
cardia, body and pyloric antrum
What are the major regional nodes of the stomach?
coeliac axis nodes, splenic hilar, porta hepatis, gastroduodenal & suprapancreatic nodal groups
(venous drainage is primarily through the portal venous system into liver)
What organs are in close proximity to the stomach?
liver, spleen, kidney and inferior vena cava
What are the diet risk factors of stomach cancer?
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
What are the lifestyle risk factors of stomach cancer?
?Alcohol & tobacco
Poor nutrition
Low socioeconomic status
(also working in an area with industrial dust exposure)
What are the biological risk factors of stomach cancer?
Helicobacter pylori infection (they secrete ammonia which can lead to gastric cancer)
Anaemia due to B12 def (6x risk)
Genetic – Blood group A
What are common presenting symptoms of stomach cancer?
Vague epigastric discomfort
Loss of appetite
Weight loss
Nausea, vomiting
Palpable epigastric mass
Ascites (fluid in peritoneal cavity)
Left supraclavicular adenopathy
Jaundice
Left axillary and supraclavicular adenopathy
haematemesis (vomiting blood)
What are common patterns of spread of disease?
(1/3 of all cases are metastatic)
Local spread:
- omentum, pancreas
- regional lymph and blood channels in submucosa, subserosa
Blood:
- Liver and lung via portal venous system
Lymphatics:
- Nodes in the left gastric chain
- Then splenic, coeliac plexus (axis), & hepatic
What is the pathology of stomach cancers?
90-95% are Adenocarcinoma
5% are Lymphoma
Gastrointestinal stromal tumours (GISTS)
Carcinoids
What is the common staging technique for stomach cancer
TNM
Read Walter and Millers Cancer and its management - pg 403 AND 264
READ IT
How is stomach cancer managed clinically
There is a multidisciplinary approach
Surgery, neoadjuvant & adjuvant chemo, palliative chemotherapy and radiation
primarily resection
- Only 25-30% suitable for curative surgery
What is classified as ‘upper GI’
digestives above the small bowel (small intestine)
What is classified as ‘lower GI’
digestives below the small bowel
What types of adjuvant treatments are available
Chemo and RT
For RT the high toxicity to organs at risk (as the stomach is surrounded by many radiosensitive organs) is what limits the dose prescribed.
(E.G. abdomen small intestine, liver, spinal cord and kidneys)
post operative chmo/RT is for good performance and helps improve survival/
What are palliative therapies for stomach cancer?
RT and chemo
RT - Inoperable local control for symptoms, Dysphagia, haemorrhage, pain
Chemo- Inoperable metastatic disease
What areas should be included in the CTV for gastric cancers
the gastric/tumour bed, gastric remnant, nodal stations along the lesser & greater curvature of the stomach, coeliac axis, suprapancreatic, porta hepatis & splenic groups
What OAR should be contoured?
The liver, kidneys, lungs and heart are contoured as OAR.
What is the conventional dose given to treat gastric cancer?
Adjuvant radiotherapy - 45 Gy in 25 daily fractions of 1.8 Gy given in 5 weeks (25#)
with concomitant 5FU and Leucovorin (& 2 cycles chemo post RT)
What are some OAR tissue tolerances?
the liver V30 should be below 60 per cent and two thirds of one kidney (and ideally both) should be below 20 Gy.
What are some steps to ensure patient care?
Monitored carefully
Weekly full blood counts (spleen produces red blood cells and helps with immune system thus doing blood counts also shows if it is affected)
Biochemistry
Dietetic assessments – including weight
Adequate measures for gastrointestinal toxicity (nausea, vomiting and diarrhoea)
