Stomach Cancer

Question 1

What is a typical stomach cancer patient (age and gender)

Answer 1

Men >75

Question 2

Which lymph node is usually enlarged in stomach cancer?

Answer 2

Virchow’s node

Question 3

What are risk factors for stomach cancer?

Answer 3

• Diet (lifestyle factors)
• Pernicious anaemia
• H. pylori infection
• Blood type A (more likely to be infected with H pylori)
• Trousseau’s sign - migratory thrombophlebitis

Question 4

What are the symptoms of stomach cancer?

Answer 4

1) Dysphagia
2) Weight loss
3) Dyspepsia (persistent ingestion)
4) Feeling full after eating small amounts
5) Sickness and vomiting
6) Malaena/haematemesis
7) Iron deficiency anaemia

Question 5

What are the symptoms of iron deficiency anaemia?

Answer 5

• Fatigue
• Breathless
• Pallor

Question 6

What do you need to investigate in a pt presenting with IDA?

Answer 6

• Need to investigate both the stomach and colon with endoscopy and colonoscopy
• Bc IDA can also be caused by colon cancer esp. cancer of the caecum

Question 7

How do you diagnose stomach cancer?

Answer 7

Gastroscopy (OGD) + multiple biopsies

Question 8

What investigations would you do for stomach cancer?

Answer 8

• OGD
• Blood tests (FBC, U&E, LFTs) - check for anaemia and metastasis
• EUS (endoscopic ultrasound)
• CAP CT/MRI - staging

Question 9

What is stage 0 stomach cancer?

Answer 9

High grade dysplasia or carcinoma in situ

Question 10

How do you treat stage 0 stomach cancer?

Answer 10

1) Endoscopic mucosa resection (EMR) or

2) Endoscopic submucosal dissection of the tumour (ESD)

Question 11

What is on the outside of muscle in the GI tract?

Answer 11

Serosa (fascia)

Question 12

What are the layers of the GI wall?

Answer 12

Mucosa, submucosa, inner circular muscle, outer longitudinal muscle, serosa

Question 13

What is the treatment for stage 1 cancer?

Answer 13

• Gastrectomy (surgery)
• ESD or EMR if tumour confined to mucosa without any spread
• Chemotherapy before and after to reduce risk of recurrence

Question 14

How is the type of chemotherapy treatment decided?

Answer 14

Histological staging (grading)

Question 15

What is the treatment for stage 2 stomach cancer?

Answer 15

• Gastrectomy
• Chemotherapy before and after surgery
• Possible chemoradiotherapy post-op

Question 16

What is the treatment for stage 3 cancer?

Answer 16

• Gastrectomy
• Chemotherapy before surgery
• 3 courses of chemotherapy post-op
• Maybe post-op chemoradiation

Question 17

What is stage 4 stomach cancer?

Answer 17

Distant metastases

Question 18

How do you treat stage 4 cancer?

Answer 18

• Chemotherapy
• Palliative surgery for symptom control e.g. if outflow obstruction from stomach to duodenum, join jejunum to upper part of stomach not affected by cancer
• Herceptin (trastuzumab) if adenocarcinoma expresses HER2 protein

Question 19

What are the 4 types of gastrectomy?

Answer 19

1) Roux-en-Y gastro-jejunal anastomosis - if lower half of stomach involved and resected
2) Billroth - gastro-jejunal anastomosis - lower half of stomach resected
3) Oesophago-gastric anastomosis - if upper part of stomach/distal oesophagus involved and resected
4) Total gastrectomy - oesophago-jejunal anastomosis - like Roux-en-Y but connect jejunum to lower oesophagus

Question 20

What is a complication of stomach cancer?

Answer 20

Post-operative bleeding

Question 21

What would you see on histology for stomach cancer?

Answer 21

Signet ring

Question 22

What is the most common type of gastric cancer?

Answer 22

Adenocarcinoma (GOJ)

Question 23

What is curative treatment for stomach caner?

Answer 23

• Surgery (endoscopic mucosal resection, gastrectomy) _ chemo (combination, adjuvant)

Question 24

What is palliative treatment for stomach cancer?

Answer 24

Surgery (gastrectomy) + chemo + targeted - trastuzumab

Question 25

When would you give trastuzumab as a treatment for stomach cancer?

Answer 25

If the pt is HER2 positive