Gastric Cancers

Question 1

definition of gastric cancer

Answer 1

neoplasms that can develop in any portion of the stomach and can spread to other lymph nodes and other organs

Question 2

what’s the most common type of gastric cancer

Answer 2

adenocarcinoma

Question 3

rarer types of gastric cancer

Answer 3

lymphomas, leimyosarcoma and stromal tumours

Question 4

aetiology

Answer 4

mostly unknown; environmental and genetic predisposition

Question 5

risk factors

Answer 5

age, smoking, alcohol, smoked and processed food, diet low in fruit and veg, Helicobacter infection, pernicious anaemia, atrophic gastritis, partial gastroectomy, gastric polyps

Question 6

summarise epidemiology

Answer 6

highest incidence in Asia (esp Japan)
6th most common cancer worldwide
usually presents above 50 years
common cause of death worldwide

Question 7

presenting symptoms

Answer 7

at the early stages, its usually asymptomatic
systemic symptoms; weight loss, nausea, anorexia
early satiety, epigastric discomfort
dysphagia
symptoms of metastatic disease

Question 8

what info about location of the cancer does dysphagia present

Answer 8

cancer could be in the gastric cardia

Question 9

metastatic disease symptoms

Answer 9

jaundice and ascites

Question 10

physical examination

Answer 10

epigastric mass, abdo tenderness, ascites, signs of anaemia (DO A FBC), Virchows node (troisers sign - palpable left supraclavicular node), Sister Mary Josephs nodule (metastatic nodule on umbilicus)
krukenbergs tumour (ovarian metastates)

Question 11

investigations

Answer 11

Upper GI endoscopy and biopsy
Bloods (FBC- ANAEMIA and LFTs)
CT/MRI for staging
endoscopic USS to assess depth of gastric invasion and lymph node involvement

Question 12

management algorithm

Answer 12

if patient is fit, localised mass; surgery resection
if patient unfit but localised; chemoradiation
if metastases; chemoradiation OR chemotherapy with immunotherapy