Gastric Cancer + Gastric Outlet Obstruciton Flashcards
(24 cards)
Most common type of gastric cancer
Adenocarcinoma
Where is gastric cancer most commonly found in order?
Cardia
Antrum
Body
Classifications of gastric cancer
Location:
- cardia gastric cancer: similar presentation of oesophageal cancer
- non cardia gastric cancer
.
Type: Laruen classification
- diffuse: more often in younger patients + worse prognosis
- intestinal
- mixed
What types of cancer can you get in the stomach?
- adenocarinoma (most common)
- lymphoma
- leimyosarcoma
- neuroendocrine tumours
Risk factors of gastric cancer
- male
- increasing age
- H. Pylori infection
- family history
- smoking
- alcohol
- pernicious anaemia
- high salt diet
What is H pylori?
Gram negative helical bacterium
Presentation of gastric cancer
- dyspepsia
- dysphagia
- early satiety
- N+V
- anorexia
- weight loss
- Virchow’s node enlargement
What is Troisier sign of malignancy?
Palpable Virchow’s node
(Left node)
Possibly signs of metastasis gastric cancer
- hepatomegaly
- ascites
- jaundice
- acanthosis nigricans
Investigations of gastric cancer
- bloods
- oesophagogastroduodenoscopy + biopsy
- CT CAP + staging laparoscopy for staging
What should biopsies of suspected gastric cancer be sent for?
- histology - signet ring cells
- CLO test (to see presence of H pylori)
- HER2/neu protein expression
Who does nice recommend referral for urgent OGD in?
- new onset dysphagia
- > 55 presenting with weight loss PLUS upper abdomen pain, reflux or dyspepsia
What are PET scans rarely used in gastric cancers?
The cancers do not take up the radioactive tracer well
Management of gastric cancer
- nutritional assessment by dietician
- definitive national support via NG or RIG tube
- peri-operative chemo
- total gastrectomy in proximal gastric cancers
- subtotal gastrectomy in distal gastric cancers (antrum/pylorus)
- Roux-en-Y reconstruction
- endoscopic mucosal resection in superficial tumours confined to muscularis mucosa
- palliative care: chemotherapy, stenting, supportive care
Complications of gastric cancers
- gastric outlet obstruction
- iron deficiency anaemia
- pernicious anaemia
- perforation
- malnutrition
What is a gastric outlet obstruction
Mechanical obstruction in the proximal GI tract between the pylorus + proximal duodenum > inability to empty the stomach
Causes of gastric outlet obstruction
- peptic ulcers > strictures
- gastric or small bowel cancer
- iatrogenic e.g. anastomotic stricture
- pancreatic pseudo cyst
- bouveret syndrome
Presentation of gastric outlet obstruction
- epigastric pain
- postprandial vomiting
- early satiety
- no change in bowel habit
- tender + distended upper abdomen pain
- ‘succession splash’ on auscultation during sudden movement
What is bouveret syndrome?
- Gastric outlet obstruction secondary to gallstone impacted at the pylori’s or proximal duodenum
- due to cholecystoduodenal fistula after recurrent cholecystitis
What is gastroparesis?
Delayed gastric emptying due to neuromuscular dysfunction
Investigations of gastric outlet obstruction
- routine bloods
- abdominal X ray
- CT CAP with IV contrast
- oesophagogastroduodenoscopy
Management of gastric outlet obstruction
- IV fluid resuscitation
- NG tube
- IV PPI
- edndoscopy to dilate structuring or remove luminal obstruction
- surgical intervention - resection or bypass by forming a gastrojejunostomy
Tumour marker for gastric cancer
Bombesin
Management of gastric MALT lymphoma
H pylori eradication
Omeprazole + amoxicillin + clarithromycin
