Gastric cancer

Question 1

Define

Answer 1

DEFINITION: cancer of the stomach. Most commonly adenocarcinoma

Rarer causes of gastric cancer:

• Lymphoma
• Leiomyosarcoma
• Stromal tumours

Question 2

Cause

Answer 2

UNKNOWN

Environment and genetics

Question 3

Risk factors

Answer 3

Smoked and processed foods

Smoking

Alcohol

Helicobacter pylori infection

Atrophic gastritis

Pernicious anaemia

Partial gastrectomy

Gastric polyps

Question 4

Epidemiology

Answer 4

COMMON cause of cancer death worldwide

Highest incidence in JAPAN (and Asia in general)

6th most common cancer in the UK

Usual age of presentation: > 50 yrs

Question 5

Symptoms

Answer 5

Often asymptomatic early

Early satiety

Epigastric discomfort

Systemic symptoms: weight loss, anorexia, nausea/vomiting

Dysphagia (in tumours of the gastric cardia)

Symptoms of metastases (e.g. ascites, jaundice)

Question 6

Signs

Answer 6

Epigastric mass

Abdominal tenderness

Ascites

Signs of anaemia

Virchow’s Node (aka Troisier’s sign)

Sister Mary Joseph’s Nodule (metastatic node on the umbilicus)

Krukenberg’s Tumour (ovarian metastases)

Question 7

Investigations

Answer 7

Upper GI endoscopy

Bloods - FBC (check for anaemia), LFTs

CT/MRI - for staging

Endoscopic USS - assess depth of gastric invasion and lymph node involvement