Week Ten - Case One Flashcards
what is the second most common cancer worldwide
gastric adenocarcinoma
what is the male to female ratio of gastric adenocarcinoma
2:!
what is the cause of gastric adenocarcinoma thought to be
the combination of genetic factors and nitrates in the diet, with increased risk on smokers and those with h pylori infection
what is diagnosis usually a combination of
usually a combination of an endoscopy and CT +/- USS
what is staging of gastric adenocarcinoma done using
the TNM scale
what are gastric tumours almost always
almost always an adenocarcinoma of the mucous secreting cells of gastric pits. the most common mutation is that of tumour suppressor gene p53
what is the 5 year syrivival rate of stomach cancer
about 10%
what are the two other types of tumours that affect the stomach
Gastric lymphoma (MALT) – accounts for 1-2% of gastric carcinomas.
H pylori is again a large precipitating factor. Presentation often similar to gastric adenina carcinoma and thus may be difficult to differentiate from GORD or gastric ulcer
Oesophageal carcinoma – almost always occurs in the presence of Barrett’s oesophagus, and is basically just an adenocarcinoma of the new columnar epithelium – i.e. it is similar historically to gastric carcinoma. Likely to present with dysphagia
what sort of diets can predispose you to gastric adenocarcinoma
smoked fish, pickled foods, salt and nitrates
what foods have a beneficial benefit
fresh fruit and vegetables, particular those containing vitamin C and A
what is thought to be responsible for 60-70% of gastric adenocarcinoma s
h pylori
you are at greater risk of you get the infection when you are young, and if you are one of the people who goes hypocholorohydric when they get it
H pylori will often cause inflammation, leading to gastritis, leading to gastric atrophy, which leads to gastric carcinoma
what are the other risks for developing gastric adenocarcinoma
Smoking
Gastric polyps
FAP (familial adenomatous polyposis)
Genetic factors – e.g. HDC-1 mutations
Resection of the stomach
what are the symptoms of gastric adenocarcinoma
History of recent dyspepsia.(50%) This pain will be very similar to that of peptic ulcer disease, and can often be relieved by antacids.
Loss of appetite / anorexia (35%)
Bloating / fullness
Weight loss (72%)
Vomiting/nausea (40%)
Iron-deficiency anaemia due to occult bleeding
Dysphagia (22%)
Melaena (20%)
Mass (17%)
Haematemesis is unusual
what are the red flag symptoms
patients of any age, with dyspepsia, AND
- chronic GI bleeding
- dysphagia
- progressive wright loss
- iron deficiency anaemia
- perisitent vomtiing
- epigastric mass
- suspicious barium meal result
OR
patients > 55
- with sudden onset dyspepsia
what are the tests done to confirm gastric adenocarcinoma
essentially all you need to do is a gastroscopy and routine FBC, and LFTs
what is the most common genetic factor for gastric adenocarcinoma
loss of the TSG p53 which occurs in about 70% of gastric cancersw
where are early gastric cancers confined to
the mucosa and the submucosa, whilst more advanced cancers can penetrate the muscular proproria, and may become ulcerating
what is the prognosis for early gastric cancer
90%
how can the cancers be described
as either intestinal or diffuse
intestinal ones have histology representative of internal epithelium, whilst diffuse ones arise form normal gastric mucosa
who do diffuse cancers tend to occur in
younger patients
what is the pattern of the disease
initially there will be chronic gastritis leading to atrophy, then onto metaplasia, and premalignant dysplasia, finally ending up at malignancy
where can gastric cancer spread lymphatic ally to
the Virchow’s node, and can spread via venous blood to the liver and ovaries
what are Krukenburg tumours
spread of cancer via the venous blood to the liver and ovaries
what will a CT show
liver metastasis, but not lymph node involvement. will also show gastric wall thickening
what will an endoscopic ultrasound show
how far the tumour has progressed through the gastric wall and lymph node involvement
what is the other way to stage gastric tumours apart from TNM
UICC score