Gastric cancer

Question 1

True or false: gastric cancer is twice as common in men than in women

Answer 1

True

Question 2

What are 4 risk factors for gastric cancer?

Answer 2

1) H. pylori infection
2) tobacco smoking
3) high salt diet
4) genetic abnormalities

Question 3

Explain how H. pylori infection can cause gastric cancer:

Answer 3

it can cause gastritis which can promote metaplasia

Question 4

Name 2 tumour suppressor genes that often lose their heterozygosity in gastric cancer?

Answer 4

1) p53
2) APC

Question 5

What are the two types of gastric cancer?

Answer 5

1) intestinal
2) diffuse

Question 6

A mutation of what cell adhesion molecule is seen in diffuse gastric cancers?

Answer 6

E-cadherin

Question 7

Describe the differentiation of intestinal (type 1) gastric cancers:

Answer 7

well-differentiated cancers

Question 8

Describe the differentiation of diffuse (type 2) gastric cancers:

Answer 8

poorly differentiated cancers

Question 9

Which type of gastric cancer tends to infiltrate the gastric wall?

Answer 9

Diffuse

Question 10

Where do intestinal gastric cancers mainly occur?

Answer 10

distal stomach

Question 11

Where do diffuse gastric cancers mainly occur?

Answer 11

anywhere in stomach but especially in the cardia

Question 12

Which type of gastric cancer has the worse prognosis?

Answer 12

Diffuse

Question 13

Describe the appearance of an intestinal gastric cancer:

Answer 13

ulcerating lesion with rolled edges

Question 14

What type of gastric cancer is associated with H. pylori and chronic gastritis?

Answer 14

intestinal

Question 15

Give 3 symptoms associated with gastric cancer:

Answer 15

1) epigastric pain
2) weight loss and anorexia
3) nausea

Question 16

True or false: gastric cancer is mostly asymptomatic and so diagnosis occurs at an advanced stage of disease

Answer 16

True

Question 17

What is linitus plastica?

Answer 17

where a widely spreading submucosal gastric cancer causes diffuse thickening and rigidity of the stomach

Question 18

What specific symptom may a patient present with if the tumour is in the pylorus?

Answer 18

Vomiting

Question 19

What specific symptom may a patient present with if the gastric tumour is in the fundus?

Answer 19

dysphagia (A condition with difficulty in swallowing food or liquid. This may interfere in a person’s ability to eat and drink.)

Question 20

What lymph node may be palpable in gastric cancer?

Answer 20

Virchow’s node (supraclavicular fossa, left side)

Question 21

What abdominal palpation sign is associated with gastric cancer?

Answer 21

palpable epigastric mass with abdominal tenderness

Question 22

What is the main diagnostic investigation for gastric cancer?

Answer 22

gastroscopy and biopsy

Question 23

How many biopsies should be taken during a gastroscopy for gastric cancer?

Answer 23

8-10

Question 24

What staging system is used in gastric cancer?

Answer 24

TNM (tumour, node, metastasis)

Question 25

Give two investigations used to help stage a gastric cancer:

Answer 25

1) CT chest and abdomen (check for gastric wall thickening, lymphadenopathy and liver and lung metastasis)
2) endoscopic ultrasound (investigating depth of penetration through the gastric wall)

Question 26

What is the most common form of management for gastric cancer?

Answer 26

surgery often with chemotherapy

Question 27

What are gastrointestinal stromal tumours?

Answer 27

a subset of GI mesenchymal tumours including leiomyomas and leiomyoblastomas

Question 28

Name two treatments for gastrointestinal stromal tumours:

Answer 28

1) surgery
2) imatinib (used in metastasis)

Question 29

What is the mechanism of imatinib?

Answer 29

tyrosine kinase inhibitor