Gastric cancer

Question 1

Risk factors: gastric cancer

Answer 1

• H. pylori
  
  • triggers inflammation of the mucosa → atrophy and intestinal metaplasia
• atrophic gastritis
• diet
  
  • salt and salt-preserved foods
  • nitrates
• smoking
• blood group

Question 2

Clinical presentation of Gastric cancer

Answer 2

• abdominal pain
  
  • typically vague, epigastric pain
  • may present as dyspepsia
• weight loss and anorexia
• nausea and vomiting
• dysphagia: particularly if the cancer arises in the proximal stomach
• overt upper gastrointestinal bleeding is seen only in a minority of patients
• if lymphatic spread:
  
  • left supraclavicular lymph node (Virchow’s node)
  • periumbilical nodule (Sister Mary Joseph’s node)

Question 3

Investigations ?

Answer 3

• diagnosis:oesophago-gastro-duodenoscopy with biopsy
  • signet ring cellsmay be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis
• staging: CT

Question 4

Management: gastric cancer

Answer 4

• surgical options depend on the extent and side but include:
  
  • endoscopic mucosal resection
  • partial gastrectomy
  • total gastrectomy
• chemotherapy