Gastric cancer Flashcards
1
Q
Most common type of gastric cancer
A
- Adenocarcinoma
- Rest are connective tissue eg GIST, lymphoid, neuroendocrine malignancy
2
Q
Where is gastric cancer common?
A
- Rates fallen in many countries due to improved diet and treatment of h-pylori
- More common in far east eg Japan and Korea
3
Q
RF for gastric cancer
A
- Male
- H-pylori
- Increasing age
- Smoking
- Alcohol consumption
4
Q
Why does h-pylori increase risk?
A
- Acute gastritis
- –> metaplasia
- –> dysplasia
- –> malignancy
5
Q
Symptoms of gastric cancer
A
- VAGUE - present late
- Dyspepsia (new onset, not responsive to PPI)
- Dysphagia
- Early satiety
- Vomitting
- Melena
- Anorexia, weight loss or anaemia are markers of late stage
6
Q
Examination findings of gastric cancer
A
- Epigastric mass - late stage
- Troisier sign - palpable left supraclavicular node (Virchows node) - sign of metastatic abdominal malignancy
- Hepatomegaly, ascites, jaundice or acanthosis nigricans
7
Q
Bedside and bloods for ?gastric cancer
A
- Urgent bloods - FBC, LFT, clotting, group and save if bleeding presentation
8
Q
Imaging for gastric cancer
A
- Upper GI endoscopy - OGD with biopsies
9
Q
What should biopsies suspecting gastric cancer be sent for?
A
- Histology - classification and grading
- CLO test - h-pylori present? (rapid urease test)
- HER2/neu protein expression - targetted monoclonal therapies if present
10
Q
Problem with CT for gastric cancer
A
- May show thickening of gastric wall but does not allow direct visualisation or biopsy
- OGD is only definitive means
11
Q
Staging for gastric cancer
A
- CT chest abdomen pelvis
- Staging laparoscopy - peritoneal mets?
- PET scans rarely used due to the gastric cancers not being very ‘PET avid’ - don’t take up tracer well
12
Q
General management gastric cancer
A
- MDT
- Adequate nutrition - dietician, may need NG tube or RIG pre and post treatment
13
Q
Curative treatment for gastric cancer
A
- Peri-operative chemotherapy - 3 cycles neo, 3 cycles adjuvant
- Remove tumour and local lymph nodes - loco-regional control
14
Q
Operation for proximal vs distal gastric cancers
A
- Proximal - total gastrectomy
- Distal (antrum or pylorus) - subtotal gastrectomy
- Spleen and distal pancreas may be removed if there is direct invasion of these organs and still chance of cure
15
Q
How is reconstruction achieved post surgery?
A
- Roux-en Y reconstruction
- Distal oesophagus is end to end anastomosed directly to small bowe
- Small bowel end to end anastomosed to small bowel
