Flashcards in Gastric Tumours Deck (28)
what are the benign gastric tumours? 2
cystic fundic gland polyps
what are the malignant tumours of the stomach? 3
carcinomas (most are adenocarcinomas unsurprisingly)
gastrointestinal stromal tumours (GIST) - distinct group of mesenchymal tumours
In the UK proximal adenocarcinoma tumours of the cardia/GOJ are ____ and distal tumours are _____
In the UK proximal tumours of the cardia/GOJ are increasing and distal tumours are decreasing
what are the two major histological types of adenocarcinoma?
intestinal and diffuse
intestinal : ____ /____ mass
diffuse: ___ /____ stomach wall
Intestinal : exophytic/polypoid mass- this is more resectable. These are well formed glandular structures
Diffuse: expands/infiltrates stomach wall
benign peptic ulcers ___ adenocarcinoma but they are more ___ __ and lack a ___ ___ ___
mimic, punched out and lack a raised rolled edge
what is the aetiology of adenocarcinoma? 5
H Pylori infection important
other premalignant conditions
- pernicious anaemia
- partial gastrectomy
- HNPCC/lynch syndrome
- menetrier's disease
how do adenocarcinomas spread? 3
local spread into other organs
what is an important site for local invasion?
ovaries - kruckenburg syndrome
what is the node that is a sign of gastric cancer?
virchows node - left clavicular
why is early liver metastases common?
the venous drainage from the stomach is straight to the liver
what is gastric lymphoma derived from?
the mucosa associated lymphoid tissue
lymphoma is associated with _____ infection
lymphoma involves continuous ______ which induces an evolution into a ___ ___ cell- proliferation - this is a __ grade lymphoma
If left unchecked it evolves into a ___ grade lymphoma
It involves continuous inflammation which induces an evolution into a clonal B cell- proliferation - this is a low grade lymphoma
If left unchecked it evolves into a high grade lymphoma
where is the commonest site for lymphoma in the GI tract and why?
The stomach is the commonest site for lymphoma in the GI tract because of the large amount of lymphoid tissue
what does lymphoma look like histologically ?
small round lymphoid cells
most people that have lymphoma will be ______
what are the signs of gastric cancer?
- Abdominal mass
- Paraneoplastic syndrome
- Weight loss
what are the symptoms?
dyspepsia - abdominal pain, emesis, anorexia, dysphagia, early satiety
upper GI haemorrhage
what is picked up on physical examination?
weight loss, lymph nodes - large virchow's, abdominal masses
how is it diagnosed?
upper GI endoscopy and biopsy
what imaging techniques are done
- CT (MRI) scan
what are the treatment options?
For palliation of symptoms and for improved survival
Can remove involved adjacent organs
what are the contraindications of surgery? 3
- Widely metastatic disease
- Malignant ascites
- Brief life expectancy
- ____- gastrectomy for proximal lesions
- ___ gastrectomy for distal lesions
Total gastrectomy for proximal lesions
Partial gastrectomy for distal lesions
when is chemotherapy done?
in advanced and metastatic disease