GOO Flashcards
(120 cards)
1
Q
Q: What is carcinoma of the stomach often referred to as?
A
A: ‘The captain of men of death.’
2
Q
Q: Where is carcinoma of the stomach most common?
A
A: It is most common in Japan, with an incidence of 70 per 100,000 population.
3
Q
Q: Which gender is more affected by gastric carcinoma?
A
A: It is more common in males.
4
Q
Q: How has the incidence of gastric cancer changed in the Western world?
A
A: There has been a decrease in incidence over the last four decades, primarily in distal gastric cancers.
5
Q
Q: What is the trend for proximal gastric cancer in the Western world?
A
A: The incidence of proximal gastric cancer is increasing.
6
Q
Q: Is proximal gastric cancer associated with H. pylori infection?
A
A: No, unlike cancers of the body and distal stomach.
7
Q
Q: What percentage of gastric cancer cases are familial?
A
A: About 10%.
8
Q
Q: Which gene mutation is associated with hereditary diffuse gastric cancer?
A
A: Mutation of the e-cadherin gene.
9
Q
Q: What risk factor is associated with blood group ‘A’?
A
A: Gastric mucosa of people with blood group ‘A’ is more susceptible to carcinogens.
10
Q
Q: How does pernicious anemia affect gastric cancer risk?
A
A: It increases the risk by 6 times.
11
Q
Q: What dietary factors increase the risk of gastric cancer?
A
A: High salt diet and foods with nitrosamines, such as smoked salmon.
12
Q
Q: What protective dietary components can reduce the risk?
A
A: Fruits and vegetables rich in vitamin ‘C’.
13
Q
Q: What type of gastritis is linked to proximal gastric cancer?
A
A: Atrophic autoimmune gastritis.
14
Q
Q: What is the association between smoking and gastric cancer?
A
A: Smoking is a risk factor for gastric carcinoma.
15
Q
Q: How does Helicobacter pylori infection influence gastric cancer risk?
A
A: It increases risk, especially the Cag A strain, leading to a 6-fold increase in incidence.
16
Q
Q: In which socioeconomic group is proximal gastric carcinoma common?
A
A: It is common in young individuals from upper socioeconomic groups.
17
Q
Q: How does the presentation of gastric cancer differ between Western and Asian countries?
A
A: In Western countries, it is more common in the proximal stomach, while in Asia, it remains common in the distal stomach.
18
Q
Q: What is a common type of proximal gastric cancer?
A
A: Signet ring type, which has a poor prognosis.
19
Q
Q: What occupational exposures increase the risk of gastric cancer?
A
A: Exposure among rubber workers and coal workers.
20
Q
Q: What is the commonest precursor lesion for carcinoma stomach?
A
A: Chronic atrophic gastritis, mainly the intestinal subtype.
21
Q
Q: What percentage of atrophic gastritis patients in Japan develop early gastric cancer?
A
A: 95% of patients with atrophic gastritis develop early gastric cancer.
22
Q
Q: In which population is the incidence of atrophic gastritis higher?
A
A: The incidence is higher in the elderly and those with H. pylori infection.
23
Q
Q: What type of gastric polyps are considered a precursor for carcinoma?
A
A: Adenomatous gastric polyps.
24
Q
Q: How does intestinal metaplasia relate to gastric cancer risk?
A
A: The risk depends on the extent of metaplasia in the mucosa; H. pylori eradication is important.
25
Q: What are the two types of intestinal metaplasia?
A: Complete and incomplete metaplasia.
26
Q: What characterizes complete intestinal metaplasia?
A: Glands are completely lined with goblet cells and intestinal absorptive cells indistinguishable from small bowel.
27
Q: What is incomplete intestinal metaplasia?
A: It contains columnar cells and goblet cells but lacks intestinal absorptive cells.
28
Q: What are the three types of incomplete intestinal metaplasia?
A: Type I (mature), Type II (cells at different levels of dedifferentiation), Type III (marked dedifferentiation).
29
Q: What is Menetrier's disease?
A: A condition that can act as a precursor lesion for gastric carcinoma.
30
Q: What is the risk of carcinoma associated with benign gastric ulcers?
A: The risk is 2-5%, but can be as high as 6-23% for giant gastric ulcers.
31
Q: What is ulcer cancer?
A: Cancer developing in a preexisting benign gastric ulcer.
32
Q: What is stump carcinoma?
A: Cancer that can occur in the stomach remnant after procedures like Billroth II gastrojejunostomy.
33
Q: How long does it typically take for stump carcinoma to develop?
A: It can take around 15 years or more to develop.
34
Q: What are the pathogenesis factors for stump carcinoma?
A: Altered acid levels, duodenogastric bile reflux, mucosal metaplasia, and dysplasia.
35
Q: What are common features of stump carcinoma?
A: Loss of appetite, decreased weight, often a palpable mass, and possible liver secondaries or ascites.
36
Q: How is stump carcinoma diagnosed?
A: Diagnosis is confirmed by gastroscopy with biopsy and CT scan.
37
Q: What is the treatment for stump carcinoma?
A: Treatment is gastrectomy with nodal clearance.
38
Q: What environmental factors are associated with gastric cancer?
A: Smoking, alcohol consumption, and obesity.
39
Q: What dietary habits increase the risk of gastric cancer?
A: Low vegetable intake, diets low in vitamin A and C, and consuming red meat, smoked salmon, and nitrosamines.
40
Q: What genetic mutation is linked to diffuse gastric cancers?
A: E-cadherin gene mutation.
41
Q: Which gene mutation is associated with intestinal cancers?
A: Mutation in the APC gene and β-catenin; 50% of cases.
42
Q: What role does the p53 gene play in gastric cancer?
A: Inactivation of the tumor suppressor gene p53 is found in 30% of cases.
43
Q: What is the significance of the BCL2 gene in gastric cancer?
A: Loss of heterozygosity in the BCL2 gene, an inhibitor of apoptosis, is relevant for intestinal type.
44
Q: How does H. pylori infection relate to gastric cancer?
A: It is a precancerous lesion associated with chronic gastritis.
45
Q: What is the risk of gastric cancer in patients with HNPCC?
A: HNPCC carries a 5-10% risk of gastric cancer.
46
Q: What blood group is associated with an increased risk of gastric cancer?
A: Blood group A.
47
Q: How does pernicious anemia affect gastric cancer risk?
A: It is considered a risk factor for gastric cancer.
48
Q: What is the risk associated with adenomatous polyps larger than 2 cm?
A: They are considered precursors to gastric cancer.
49
Q: What is the increased risk for first-degree relatives of gastric cancer patients?
A: They have a 3-6 fold increased risk.
50
Q: How do monozygotic twins compare to dizygotic twins in terms of gastric cancer risk?
A: Monozygotic twins carry more risk than dizygotic twins.
51
Q: What is the risk if both parents have gastric cancer?
A: Siblings are at risk of diffuse proximal gastric cancer.
52
Q: What is FAP and its relation to gastric cancer?
A: Familial Adenomatous Polyposis (FAP) carries a 10-fold increased risk of gastric cancer.
53
Q: What oncogene mutations are associated with gastric cancer?
A: Mutation of the H-ras oncogene and overexpression of the c-erb B2 gene.
54
Q: What is the most common site for gastric cancer?
A: The prepyloric and pyloric region (65%).
55
Q: What percentage of gastric cancers occur in the body of the stomach?
A: 25%.
56
Q: Which other sites can gastric cancer occur?
A: The fundus and the oesophago-gastric (O-G) junction.
57
Q: What is the trend regarding the incidence of gastric cancer near the O-G junction?
A: The incidence of growth in the upper part, near the O-G junction, is increasing.
58
Q: What is the intestinal type of gastric cancer?
A: It constitutes 53% of cases and has a favorable prognosis, commonly associated with H. pylori.
59
Q: What are the characteristics of the intestinal type?
A: Features include gland formation, definite cellular architecture, and types such as polypoid and superficial.
60
Q: What is the prognosis for diffuse type gastric cancer?
A: It has a poor prognosis and comprises 33% of cases.
61
Q: Who is more commonly affected by the diffuse type?
A: It is common in individuals with blood group A, familial types, young people, and females.
62
Q: What are the characteristics of diffuse type gastric cancer?
A: It is usually poorly differentiated, signet ring type, with early gastric wall penetration and lymphatic spread.
63
Q: What is linitis plastica?
A: A common presentation in diffuse type gastric cancer characterized by thickened stomach walls.
64
Q: What percentage of gastric cancers are unclassified?
A: 14% are unclassified.
65
Q: What are the initial clinical features of gastric cancer?
A: Recent onset of loss of appetite and weight, early satiety, and fatigue.
66
Q: What type of anemia is common in gastric cancer patients?
A: Microcytic, hypochromic anemia (iron deficiency).
67
Q: What abdominal symptom is often reported in gastric cancer?
A: Upper abdominal pain.
68
Q: What vomiting signs indicate gastric outlet obstruction?
A: Positive VGP, positive ausculto-percussion test, and positive succussion splash after fasting for 4-6 hours.
69
Q: Describe the characteristics of a mass in the abdomen due to gastric cancer.
A: Mass in the pylorus lies above the umbilicus, is nodular, hard, has impaired resonance, is mobile, and moves with respiration.
70
Q: What is a potential symptom if the mass is in the upper epigastrium?
A: Dysphagia.
71
Q: How may gastric cancer present if it arises from the body of the stomach?
A: It may present as a mass in the abdomen only.
72
Q: What are the signs of liver involvement in gastric cancer?
A: Jaundice, palpable liver with hard, nodular secondaries (50%) and umbilication.
73
Q: What is indicated by a positive Troisier’s sign?
A: It suggests malignant lymphadenopathy, often associated with gastric cancer.
74
Q: What is the significance of recto-vesical secondaries?
A: They can be detected during a per rectal examination (Blumer shelf).
75
Q: What is Trousseau's sign?
A: Migrating thrombophlebitis, also seen in pancreatic carcinoma.
76
Q: What general conditions may present with gastric cancer?
A: Anemia, cachexia, hematemesis, and melaena.
77
Q: How can gastric cancer occasionally present acutely?
A: It can present as perforation (4%).
78
Q: What are Sister Joseph’s nodules?
A: Secondaries in the umbilicus, indicating spread through the ligamentum teres.
79
Q: What are Krukenberg tumors?
A: Secondary tumors in the ovaries resulting from gastric cancer.
80
Q: What initial blood tests are performed in gastric cancer investigations?
A: Hb% and hematocrit.
81
Q: What does a barium meal study reveal in gastric cancer?
A: Irregular filling defect.
82
Q: What is the sensitivity of single contrast barium studies for detecting gastric cancer?
A: 75%.
83
Q: What is the sensitivity of double contrast barium studies?
A: 90-95%, comparable to endoscopy.
84
Q: What are the barium meal findings indicative of carcinoma stomach?
A: Irregular filling defect, loss of rugosity, delayed emptying, and dilatation of the stomach in pylorus.
85
Q: What does decreased stomach capacity indicate in linitis plastica?
A: It shows reduced capacity due to the disease.
86
Q: What is Carman's meniscus sign?
A: The margin of the lesion projects outward from the ulcer into the gastric lumen.
87
Q: How many biopsies are typically taken during a gastroscopy for gastric cancer?
A: 10 targeted biopsies.
88
Q: What is the role of endosonography (EUS) in gastric cancer?
A: It detects involvement of stomach layers, nodal status, and tumor staging with 90% accuracy for T staging.
89
Q: What are the limitations of ultrasound (US) abdomen in gastric cancer?
A: It is less sensitive than EUS and CT scans for detecting liver secondaries, ascites, and nodes.
90
Q: What blood tests assess liver function in gastric cancer patients?
A: Liver function tests and prothrombin time.
91
Q: How can liver secondaries affect liver function?
A: They can cause hepatic dysfunction and liver cell failure, potentially leading to obstructive jaundice.
92
Q: What is often performed on a palpable left supraclavicular lymph node?
A: Fine needle aspiration cytology (FNAC).
93
Q: What is the purpose of laparoscopy in gastric cancer?
A: To stage the disease.
94
Q: What does a CT scan of the abdomen and thorax assess in proximal tumors?
A: Size, extent, infiltration, lymph node status, secondaries, and operability.
95
Q: How does laparoscopy compare to CT in detecting lesions?
A: Laparoscopy is more accurate and sensitive for identifying unresectable or missed lesions.
96
Q: What additional procedures can laparoscopy facilitate?
A: Nodal and peritoneal biopsy.
97
Q: What is the use of combined PET-CT scans in gastric cancer?
A: To evaluate metabolic, physiologic, and functional activity, mainly for identifying recurrent gastric cancer.
98
Q: What is sentinel node biopsy?
A: It involves 99mTc colloid peritumoral injection during gastrectomy.
99
Q: What are the sensitivity and specificity rates of sentinel node biopsy?
A: Sensitivity is 80% and specificity is 100%, but it is not widely used.
100
Q: What are the two types of gastric lymphomas?
A: Primary and secondary.
101
Q: What is primary gastric lymphoma?
A: It is the most common type among gastrointestinal primary lymphomas and the second most common malignant neoplasm of the stomach (5% of gastric malignancies).
102
Q: In which demographic is primary gastric lymphoma most common?
A: It is common in elderly men, particularly in the antrum of the stomach.
103
Q: What are the possible presentations of primary gastric lymphoma?
A: It can be infiltrative, ulcerative, nodular, polypoid, or combined.
104
Q: What type of lymphoma is most commonly seen in the stomach?
A: Non-Hodgkin's lymphoma (NHL), specifically B cell type (98%).
105
Q: What is MALToma?
A: It is primary gastric lymphoma arising from B cells derived from mucosal associated lymphoid tissue (MALT).
106
Q: What is the pathology of gastric lymphoma?
A: It typically involves diffuse mucosal thickening that eventually ulcerates.
107
Q: How long does primary gastric lymphoma typically remain localized?
A: It remains in the stomach for a long time before spreading to the liver and other lymph nodes.
108
Q: What is the association between H. pylori and gastric lymphoma?
A: There is a well-established association; H. pylori infection leads to lymphocyte presence in gastric mucosa.
109
Q: What is the typical presentation of primary gastric lymphoma disease?
A: It is usually localized to the stomach without involvement of other lymph nodes, liver, spleen, or bone marrow.
110
Q: What are common clinical features of gastric lymphoma?
A: Abdominal pain, melaena, and a smooth, firm abdominal mass.
111
Q: What are additional symptoms associated with gastric lymphoma?
A: Loss of weight and loss of appetite.
112
Q: What is secondary gastric lymphoma?
A: It is the most common type of lymphoma occurring in the stomach.
113
Q: How does secondary gastric lymphoma differ from primary gastric lymphoma?
A: It primarily involves systemic lymph nodes first, starting in lymph nodes at different regions before affecting the stomach.
114
Q: What does a peripheral smear typically show in secondary gastric lymphoma?
A: Lymphocytosis.
115
Q: What findings are seen in the bone marrow for secondary gastric lymphoma?
A: Changes indicative of lymphoma.
116
Q: What does a CT scan of the abdomen and chest reveal in secondary gastric lymphoma?
A: Multiple nodal enlargement.
117
Q: What type of disease is secondary gastric lymphoma?
A: It is a systemic disease that extends to the stomach.
118
Q: What are potential complications of secondary gastric lymphoma?
A: Perforation and bleeding.
119
Q: What is the main treatment for secondary gastric lymphoma?
A: Chemotherapy, including regimens like CHOP, ABVD, MOPP, and BACOP.
120
Q: Is surgery commonly performed for secondary gastric lymphoma?
A: Surgery is not done unless local complications occur.
