Stomach Cancer

Question 1

How does stomach cancer develop?

Answer 1

Develop through phases of intestinal metaplasia and dysplasia

Question 2

What type of cancer is stomach cancer?

Answer 2

Adenocarcinoma

Question 3

What are the risk factors for stomach cancer?

Answer 3

Previous h. pylori infection
Alcohol
Smoking
Excessive consumption salted fish, pickled vegetables and cured meats
Family history (majority are sporadic with no demonstrable inherited component)

Question 4

How do patients with stomach cancer present?

Answer 4

Dyspepsia
Weight loss
Nausea + vomiting
Early satiety
GI bleeding: melaena / haematemesis
Iron deficiency anaemia
Gastric outlet obstruction

Question 5

How is stomach cancer diagnosed?

Answer 5

Endoscopy (gastroscopy) + biopsy
Endoscopic ultrasound can evaluate depth of invasion
CT/MRI chest/abdomen helps staging
Staging laparoscopy is recommended for locally advanced tumours

Question 6

What is the prognosis?

Answer 6

5-year survival rate less than 20% (tends to present late)

Question 7

What is the treatment/management?

Answer 7

Endoscopic mucosal resection
Partial gastrectomy may suffice for more advanced distal tumours (gastroduodenal re-anastomoses): laparoscopic surgery
If proximal, total gastrectomy may be needed (and Roux en Y reconstruction): open surgery
Chemotherapy is given post operatively: improves survival
In locally advanced and metastatic disease, chemotherapy increases quality of life and survival

Question 8

What are the complications of stomach cancer?

Answer 8

Spread: direct (to surrounding tissues), lymphatic (spread to regional lymph nodes), blood (liver), transcoelomic (spread within peritoneal cavity)