Gastric Cancer Flashcards
What is the definition of gastric cancer?
cancer (malignant neoplasm) developing in the stomach
malignant neoplasm is a neoplasm that has the potential to metastasize elsewhere around the body and kill the patient
gastric cancer can occur anywhere in the stomach from the gastro-oesophageal junction to the point where the stomach becomes the duodenum
What is the epidemiology of gastric cancer like?
How common is it?
- 16th most common cancer in the UK (6,700 per year)
- more common with aging (>50% are > 75 years)
- more common in males with a ratio of 2:1
- wide geographical variation
- higher rates in Eastern Asia, Andean regions of South America, Eastern Europe
What is the aetiology of gastric cancer like?
What is it predominantly linked to?
lifestyle is linked to 75% of gastric cancers:
- diet (smoked/cured meat or fish, pickled vegetables)
- smoking & alcohol
- overweight or obese
helicobacter pylori infection is implicated in 30% of gastric cancers
bile reflux / low levels of stomach acid play a role
1% have a hereditary component
What is the underlying cause (pathogenesis) of gastric cancer dependent on?
the underlying cause depends on the site of the tumour
What is a carcinoma of the gastro-oesophageal junction associated with?
Who is more likely to get this type of gastric cancer?
- more common in caucasian males (white males)
- association with gastro-oesophageal reflux disease
- NO association with H. pylori / diet
- increased incidence in recent years
What factors are associated with carcinoma of the gastric body / antrum?
- association with H. pylori infection
- association with diet (high salt, low fruit & vegetables)
- NO association with gastro-oesophageal reflux
- decreased incidence in recent years
What are the 2 distinct types of gastric cancer when looking down the microscope?
How can they be recognised?
intestinal type:
- glands are arranged in a similar fashion to normal glands
- well or moderately differentiated
- may undergo intestinal metaplasia and adenoma steps
diffuse type:
- poorly differentiated sheets or individual cells (do not form glandular structures)
- scattered growth
- cadherin loss / mutation
What are the clinical symptoms associated with gastric cancer?
- difficulty swallowing (dysphagia) in polypoidal tumours
- weight loss
- indigestion
- feeling full after eating small amounts
- vomiting
- bleeding / melaena in ulcerated tumours
How is a diagnosis of gastric cancer made?
How is it treated based on severity?
upper intestinal endoscopy
if the tumour is small and early stage it can be removed using a local excision technique
if the tumour is more advanced, surgeons will perform a partial / total gastrectomy to remove part/whole stomach
if the tumour has spread outside the operative field then chemotherapy is given
What are the outcomes for gastric cancer like?
outcomes depend on the stage at diagnosis
currently only 20% live for 5 years after diagnosis
