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A. Block E Oncology > Gastric Cancer > Flashcards

Gastric Cancer Flashcards

1
Q

What is the incidence of gastric cancer?

1 - 1.2 cases per 100,000
2 - 12 cases per 100,000
3 - 120 cases per 100,000
4 - 1200 cases per 100,000

A

2 - 12 cases per 100,000
>1 million cases worldwide

5th most common cancer

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2
Q

What age group are most likely to develop gastric cancer?

1 - >20 y/o
2 - >40 y/o
3 - >65 y/o
4 - >70 y/o

A

4 - >70 y/o

  • rare before the age of 50 y/o
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3
Q

Are men or women more likely to develop gastric cancer?

A
  • men
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4
Q

All of the factors below are risk factors for developing gastritis, inflammation and ultimately cancer. Which of the following is the most common risk factor?

1 - age
2 - helicobacter pylori
3 - diet (salt, nitrosamines)
4 - smoking and alcohol
5 - gastric polyps
6 - genetics
7 - pernicious anaemia and atrophic gastritis

A

2 - helicobacter pylori

Accounts for 75% of gastric cancers

  • increases risk by x8
  • generally risk factors causes gastritis which is the first step to developing gastric cancer
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5
Q

Gastric polyps is a risk factor for developing gastric cancer. What is the genetic condition that increases the risk of polyps in the stomach?

1 - klinefelter syndrome
2 - peutz-jeghers
3 - turner syndrome
4 - ankylosing spondylitis

A

2 - peutz-jeghers

  • also causes clubbing and brown spots on the lips
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6
Q

There are a wide variety of different types of cancers that can form in the stomach. Which of the following accounts for 90% of gastric cancers?

1 - adenosquamous
2 - lymphoma
3 - small cell
4 - neuroendocrine tumours
5 - adenocarcinomas
6 - gastrointestinal stromal tumours

A

5 - adenocarcinomas

  • columnar glandular epithelium
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7
Q

There are 5 main parts to the stomach. What is the name of the most superior aspect which includes the lower oesophageal sphincter?

1 - pyloric sphincter
2 - pyloric antrum (pylorus)
3 - cardia
4 - fundus
5 - body

A

3 - cardia

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8
Q

There are 5 main parts to the stomach. What is the name of the most superior aspect next to the cardia?

1 - pyloric sphincter
2 - pyloric antrum (pylorus)
3 - cardia
4 - fundus
5 - body

A

4 - fundus
- latin for part of hollow organ furthest from the opening (pyloric sphincter)

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9
Q

There are 5 main parts to the stomach. What is the name of the largest part of the stomach?

1 - pyloric sphincter
2 - pyloric antrum (pylorus)
3 - cardia
4 - fundus
5 - body

A

5 - body

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10
Q

There are 5 main parts to the stomach. What is the name of the lowest part of the stomach?

1 - pyloric sphincter
2 - pyloric antrum (pylorus)
3 - cardia
4 - fundus
5 - body

A

2 - pyloric antrum (pylorus)

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11
Q

The stomach has multiple layers, one of these is the mucosa. Which of the following is NOT one of the 3 layers of the mucosa?

1 - serosa
2 - epithelial layer
3 - muscularis propria
4 - lamina preopria

A

1 - serosa

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12
Q

Put the layers of the stomach in order from inside out:

1 - submucosa
2 - muscular layer
3 - mucosa
4 - adventitia serosa

A

1 - mucosa
2 - submucosa
3 - muscular layer
4 - adventitia serosa

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13
Q

Does gastric cancer always present with symptoms early on in the diagnosis?

A
  • no
  • can be asymptomatic
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14
Q

What is the most common symptom patients present with early on in gastric cancer?

1 - dyspepsia
2 - dysphagia
3 - abdominal pain
4 - weight loss

A

1 - dyspepsia

Indigestion

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15
Q

Symptoms are more common when gastric cancer has progressed. Which of the following is NOT a common symptom?

1 - dyspepsia
2 - haemoptysis
3 - abdominal pain
4 - weight loss

A

2 - haemoptysis

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16
Q

The following are symptoms that can occur with advanced cancer:

  • dysphagia in proximal cancers
  • nausea and vomiting
  • GI bleeds
  • anaemia due to loss of blood
  • obstruction
  • early satiety
A
17
Q

Which 2 of the following patients would be referred through a 2-week referral for suspected gastric cancer?

1 - aged >55, dysphagia and weight loss
2 - aged >55 with dysphagia
3 - aged >55 with weight loss, dyspepsia and abdo pain
4 - aged >55 with dyspepsia and reflux

A

1 - aged >55, dysphagia and weight loss

3 - aged >55 with weight loss, dyspepsia and abdo pain

NICE guidelines:

with dysphagia or
aged 55 and over with weight loss and any of the following:
upper abdominal pain
reflux
dyspepsia.

18
Q

What is the primary method for diagnosing gastric cancers?

1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - MRI
4 - endoscopic ultrasound

A

1 - Oesophago-Gastro-Duodenoscopy

  • biopsies can also be taken for histology
19
Q

Following a Oesophago-Gastro-Duodenoscopy, biopsies can be taken. What is a common sign in gastric cancer that can be seen on histlogy?

MCV = median cell volume

1 - signet ring cells
2 - hyperchromatism
3 - increased MCV
4 - multiple polyps

A

1 - signet ring cells

  • increased vaculoles push nucleus to the end of the cells
20
Q

The following are all methods for diagnosing gastric cancer, where the chest and abdomen are commonly scanned. What is often the primary method for staging gastric cancers once they have been diagnosed?

1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - CT-PET
4 - endoscopic ultrasound
5 - staging laparoscopy

A

2 - CT (chest and abdo)
- CT-PET can also be useful

  • all of these methods can be used, it just depends on what the staging
21
Q

In a patient with a T1/2 (as part of the TNM staging) gastric cancer staging, what would be the most appropriate surgery?

1 - palliative care, chemo, stents, radiotherapy, bypass surgery
2 - neoadjuvant chemo+surgery or adjuvant with no surgery (if unfit for surgery)
3 - chemoradiotherapy
4 - local resection or radical resection

A

4 - local resection or radical resection

  • resection of the tumour
    -removal of lymph nodes where appropriate
22
Q

In a patient with a T2/3 (as part of the TNM staging) gastric cancer staging, what would be the most appropriate surgery?

1 - palliative care, chemo, stents, radiotherapy, bypass surgery
2 - neoadjuvant chemo+surgery or adjuvant with no surgery (if unfit for surgery)
3 - chemoradiotherapy
4 - local resection or radical resection

A

2 - neoadjuvant chemo+surgery or adjuvant with no surgery (if unfit for surgery)

23
Q

In a patient with a T4/mets (as part of the TNM staging) gastric cancer staging, what would be the most appropriate surgery?

1 - palliative care, chemo, stents, radiotherapy, bypass surgery
2 - neoadjuvant chemo+surgery or adjuvant with no surgery (if unfit for surgery)
3 - chemoradiotherapy
4 - local resection or radical resection

A

1 - palliative care, chemo, stents, radiotherapy, bypass surgery

24
Q

If a radical gastrectomy is required there are specific procedures that are performed. Which of the following is NOT commonly performed?

1 - sleeve gastrectomy
2 - billroth I
3 - billroth II
4 - roux-en-y

A

1 - sleeve gastrectomy

  • radical lymphadenectomy is also performed
25
Q

What is the overall 5 year survival of gastric cancer?

1 - 0.2%
2 - 2%
3 - 20%
4 - 40%

A

3 - 20%

  • 50% if tumour is resectable
  • 8-10 months if metastasis are detected
26
Q

Early satiety is a long term complication of gastric surgery. Why is this?

1 - stress to the body
2 - modulates hormone levels in the body
3 - stomach will be smaller
4 - stomach innervation can be damaged during surgery

A

3 - stomach will be smaller

27
Q

Nutritional deficiencies are a long term complication of gastric surgery. Why is this?

1 - stress to the body
2 - modulates hormone levels in the body
3 - stomach will be smaller
4 - fewer parietal cells

A

4 - fewer parietal cells

  • parietal cells secrete intrinsic factor which binds to B12 for digestion
28
Q

Early dumping syndrome is a long term complication of gastric surgery for gastric cancer, which is when undigested food it dumped into the small intestines early. Why can this cause symptoms such as abdominal pain, bloating, nausea, vomiting and diarrhoea?

1 - excessive digesta cannot be digested effectively
2 - digesta causes hyperosmolar conditions
3 - gall bladder cannot secrete bile quickly enough
4 - pancreas cannot secret sufficient fluids quickly enough

A

2 - digesta causes hyperosmolar conditions

  • duodenum will secrete fluids to dilute, causing problems
29
Q

How can we treat dumping syndrome?

1 - surgery
2 - medication
3 - lifestyle advice
4 - clear up on its own

A

3 - lifestyle advice

30
Q

Which of the following lymph nodes is commonly associated with gastric cancer?

1 - submandibular node
2 - supraclavicular node
3 - submental
4 - deep cervical

A

2 - supraclavicular node

  • called virchows node and referred to as Troisier sign on examination
31
Q

A patient has had chemotherapy, radical gastrectomy and lymphadenectomy and is recovering well. However, he presents to A&E with flushing and light headed 2 hours after eating. What is this patient experiencing?

1 - reoccurrence of gastric cancer
2 - pancreatic failure
3 - cholelithiasis
4 - dumping syndrome

A

4 - dumping syndrome

Undigested, calorie rich food is dumped into the SI causing fluid to be pumped into lumen to dilute.

This is what causes the flushing and light headedness

32
Q

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count?

1 -dexamethasone
2 - granulocyte colony stimulating factors (GCSF)
3 - blood transfusion
4 - frozen WBCs

A

2 - granulocyte colony stimulating factors (GCSF)

A. Block E Oncology (17 decks)

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