stomach Flashcards
What are risk factors for stomach cancer
Smoking
H. pylori - increases risk by 3-6x
Barrett’s oesophagitis - for proximal tumours
Pernicious anaemia
CDH1 mutation
What is the commonest histology for gastric cancer
Adenocarcinoma, but also the commonest site of GI lymphoma
Rarely can have lobular breast mets to the stomach
How should a potential gastric cancer be investigated
OGD and biopsy
HER2 status in metastatic disease
Staging CT
EUS if GOJ lesion
Laparoscopy to exclude peritoneal mets
When is surgery only an appropriate management for gastric cancer
Stage 1A (T1N0), and grade 1-2, <2cm, non-ulcerated
When is Neo-adjuvant chemotherapy indicated for gastric cancer
And what regimen
> T1 or node positive
4x FLOT followed by surgery and 4x FLOT adjuvant chemoW
When is there no benefit to adjuvant chemotherapy
MSI-H disease, post radical resection
What chemo regimen is used for those who did not receive NACT
doublet with fluoropyrimidine and oxali/docetaxel
FolFox / CapOx, or 5-FU/capecitabine with docetaxel
Treatment for 6mths - 6% survival benefit
What surgery is recommended for a T1 gastric cancer
And for a >T2 tumour
T1 - Partial gastrectomy with D1 LN dissection (perigastric nodes within 3cm of the tumour)
> T2 - complete gastrectomy, distal pancreatectomy and splenectomy with D2 LN dissection (L gastric, hepatic artery and splenic hilar nodes)
When is chemoRT indicated for gastric cancer
And at what dose
In those who haven’t received NACT, and have an R1 resection or non-D2 resection, can consider adjuvant CRT
45Gy/25# with concurrent 5FU or cape
What is the management of metastatic gastric cancer
Doublet chemotherapy with Pt and fluoropyridime - cisplatin/capecitabine (5FU-irini if Pt-intolerant)
+ trastuzumab if HER2+
+ nivolumab if PDL1+
What is used 2nd line metastatic gastric cancer
Ramicurimab-paclitaxel if no contraindications to either
MSI-H or dMMR - single agent pembro (2nd line only)
What is the prognosis for stomach cancer
5 year OS for all stages = 22% (but for T1 patients = 70%)
