Stomach Cancer ☺️ Flashcards
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
