Stomach Cancer ☺️ Flashcards
(7 cards)
Epidemiology
Risk factors
Decreasing in incidence
Common in Japan, China, Finland, Colombia
Male, older age
SMOKING Salty, spicy, nitrate rich foods HPylori Pernicious anemia (AI attack on parietal cells => release IF) Gastric polyps
Presentation
Difficulty swallowing N+V Anorexia, weight loss Weight loss, fatigue Persistent indigestion Feeling full quickly Melena, hematemesis
Investigation
Diagnosis - endoscopy + biopsy (OGD)
Staging - CT/endoscopic US of chest, abdo, pelvis for mets
Laparoscopy for peritoneal disease
May also consider
Blood tests
-FBC - Fe def anemia
-U&E, LFT - renal, kidney involvement
Management
-surgical
Surgical
- if limited to mucosa/submucosa => endoscopic submucosal resection
- if 5-10cm from OG junction - subtotal gastrectomy
- if U5cm from OG junction - total gastrectomy
- if extending into esophagus - esophagogastrectomy
Pre/postop chemotherapy
Lymphadenectomy
What are the types of surgery possible
Cancer in lower stomach Roux en Y jejunal anastomosis -remove lower stomach -reattach jejunum to upper stomach -reattach duodenum to jejunum and BD
Gastrojejunal anastomosis
- remove lower stomach
- reattach jejunum to upper stomach only
Cancer in upper stomach
Esophagogastric anastomosis
-remove upper stomach
-reattach duodenum to lower esophagus
Cancer in whole stomach
Esophagojejunal anastomosis
-like Roux en Y but whole stomach removed
TNM staging for stomach cancer
T
T1 - submucosa
T2 - muscularis propria
T3 - serosa
T4 - left stomach, nearby structures
TNM staging for stomach cancer
N
N0 - no LN spread
N1 - U2 LN
N2 - 3+
N3 - 7+
M0 - no organ mets
M1 - organ mets
