Gastric Cancers Flashcards
What is the most common type of gastric cancer
More than 90% are adenocarcinomas
In which locations is gastric cancer more common
Far Eastern countries such as Japan and Korea
what are the risk factors for developing gastric cancers
Male H-pylori Increasing age Smoking Alcohol FH Pernicious anaemia Salt in diet
How does H pylori survive the acidic environment of the stomach
H-pylori virulence factor - urease enzyme which breaks down urea into Co2 and ammonia which neutralises stomach acid
what are the clinical features of gastric cancer
Dyspepsia ( not responding to PPI) Dysphagia Early satiety Vomiting Malena
Non specific sx => weight loss, anaemia
What are the differential diagnosis
PUD
GORD
Gall stones
Pancreatic malignancy
What lab tests would you order to investigate gastric cancer
Routine bloods
LFT
what imaging modalities will be used to investigate Gastric cancer
Urgent OGD + biopsy taken if mass is seen
Biopsies should be sent for:
- histology - classification
- CLO test - test for H-pylori ( risk factor for gastric cancer)
- HER2/neu protein expression
How would you stage gastric cancer
CT CAP
Staging laparoscopy
( can’t do PET as do not take up radioactive glucose well enough )
What are the surgical options for patients who are fit enough for surgery
Proximal gastric cancers - total gastrectomy
Distal gastric cancers - subtotal gastrectomy
Patients fit enough for surgery should be given peri-operative chemotherapy. What is this
3 cycles of Neoadjuvant
3 cycles of adjuvant
what is the aim of the surgery
Removal of tumor + regional lymph nodes
What is the roux-en-y reconstruction
Stomach is bypassed as the small bowel is connected to the base of the oesophagus and the duodenum is connected to the small bowel.
what interventions are available for patients with smaller tumors
EMR
what are the complications of gastrectomy
Death
Anastomoses leak
Reoperation
Dumping syndrome
B12 deficiency - patients will need a 3
months b12 injection
