Gastric carcinoma (brief)

Question 1

How common is it?

Answer 1

Adenocarcinoma: Commonest age of incidence >50 M:F 3:1

Question 2

What causes it/what risk factors are there?

Answer 2

Helicobacter pylori (H. Pylori)

Rubber production

Tobacco smoking

X-radiation, gamma-radiation

Body fatness

Diet rich in nitrosamines

Chronic atrophic gastritis

Question 3

How does it present?

Answer 3

Dyspepsia

Weight loss, anorexia and lethargy

Anaemia (iron deficient)

Occasionally presents as upper GI bleeding

Dysphagia uncommon unless involving the proximal fundus and gastro-oesophageal junction

Question 4

Signs on examination?

Answer 4

Weight loss

Palpable epigastric mass

Palpable supraclavicular lymph node (Troisiers sign or Virchow’s node) suggests disseminated disease

Question 5

Investigations

Answer 5

Diagnosis usually by gastroscopy. Barium meal by be required if gastroscopy is contraindicated. Staging investigations include US and thoraco-abdominal CT.

Question 6

Treatment

Answer 6

Vast majority are metastatic or unresectable due to local extension. Treatment mainly directed at symptoms and palliation.

If early gastric cancer (T1 or 2, N0/1, H0 (H for liver mets)): Surgical resection if patient well enough. Simple or radical gastrectomy. Local resection or ablation has an uncertain place in treatment.

Advanced gastric cancer: Surgery only for palliative treatment. Local ablation for symptom control occasionally possible. Palliative chemo occasionally effective.

Question 7

Conditions that would present similarly:

Answer 7

Acute Gastritis

Atrophic Gastritis

Bacterial Gastroenteritis

Chronic Gastritis

Esophageal Cancer

Esophageal Stricture

Esophagitis

Malignant Neoplasms of the Small Intestine

Non-Hodgkin Lymphoma

Peptic Ulcer Disease

Viral Gastroenteritis