Gastric Cancer Flashcards
What is the definition of gastric cancer?
When cancer develops from the lining of the stomach
Represents the 4th most common cancer worldwide
What is the median age of onset?
45-60 years of age
What are the etiological factors of gastric cancer?
Genetic factors - blood group A more frequent. First degree relatives of those with gastric cancer 2-x more likely to develop gastric cancer.
Environmental factors - starch, pickled vegetables, salted fish and meat and smoked foods more likely to cause gastric cancer. Common cause is increased salt intake. Nitrates and nitrites
What are some possible precancerous conditions?
Gastric ulcers
Gastric atrophy
Adenomatous polyps or gastric polyposis
Menetrier’s hypertrophic gastritis
Gastrectomy
What are the 5 patterns of spread of gastric cancer?
- Direct spread of distal carcinoma into duodenum or proximal carcinomas into oesophagus
- Direct local extension to adjacent viscera such as transverse colon, pancreas, spleen and omentum]
- Spread through lymphatics to local or more distant lymph nodes
- Hematogenous spread to the liver, peritoneum and omentum, lung and adrenal, CNS and bone
- Intraperitoneal seeding
What are the 2 classifications of gastric cancer?
- Early gastric cancer
- Advanced gastric cancer
What is the definition of early gastric cancer?
Disease in which the depth of invasion is limited to mucosa or submucosa regardless of lymph node involvement
Where can early gastric cancer occur?
Middle or lower third of stomach
What are the 3 macroscopical types of early gastric cancer?
Type 1 - protruded
Type 2 - superficial
Type 3 - excavative
What is the definition of advanced gastric cancer?
Disease that has penetrated the muscular layer. Usually associated with distant or contiguous (sharing borders with) spread of tumour and thus is rarely curable
What are the clinical features of gastric cancer?
Epigastralgia
Dyspepsia
Pyrosis (heartburn)
Vomiting that does not relieve the pain
What are the manifestations given by cancer complications?
Super digestive bleeding
Gastric stenosis
Dysphagia
Perforations
Fistulas
Chronic diarrhoea
What are the extra digestive symptoms of gastric cancer?
Total anorexia
Selective anorexias for meat, bread and fats
Anemia
Alteration of general status
Weight loss
Long loss ting unexplained fever
Paraneoplastic syndromes - deep or superficial phlebitis (vein inflammation)
What will you find on the physical examination of gastric cancer?
Tumoural mass with epigasstric localisation, firm consistency, irregular contour with various sensibility on palpation
Firm irregular hepatomegaly
Ascites for which rivalta reaction is positive
Enlarged node in supraclavicular area (virchow’s sign)
Rectal examination will reveal prerectal adenopathies (Strauss sign)
Gynecological exam - krukenberg’s tumours
Which paraclinical examinations can be done for gastric cancer?
Endoscopy shows macroscopic aspect of tumour
Gastric X-ray
Gastric secretion (gastric cancer is followed by Achlorhydria)
ESR increased
Positive tests for occult haemorrhages
Hypoproteinemia
Anaemia
