STOMACH CANCERS AND NEOPLASIAS Flashcards Preview

ONCOLOGY AND PALLIATIVE CARE > STOMACH CANCERS AND NEOPLASIAS > Flashcards

Flashcards in STOMACH CANCERS AND NEOPLASIAS Deck (32):
1

What are the two types of gastric polyp and which is more common?

Adenomatous polyps - 5%
Hyperplastic or cystic fundal polyps - very common

2

How are most gastric polyps discovered?

Through endoscopy. Most of them are asymptomatic so will not be picked up until they develop into something more sinister.

3

Which group of patients might develop polyps in the stomach fundus which turn out to be carcinoid tumours?

Pernicious anaemia patients

4

What are the complications of gastric polyps?

Bleeding
Malignant change

5

What are the treatment options for someone found to have a gastric polyp?

Surgical resection
Hyperplastic polyps are often left alone unless symptomatic

6

What are gastrointestinal stromal tumours (GIST)?

Most common mesenchymal neoplasms of the gastrointestinal tract. GISTs arise in the smooth muscle pacemaker interstitial cell of Cajal, or similar cells. They are in the walls of the stomach and therefore the overlying mucosa can be intact.

7

What proportion of GI tract malignancies are made up of gastrointestinal stromal tumours (GIST)?

Rare - only 3%

8

What are the clinical features of gastrointestinal stromal tumours (GIST)?

Asymptomatic if small
GI blood loss if they ulcerate and bleed
Abdominal pain
Palpable mass

9

What drug can be used in patients with a gastrointestinal stromal tumour that is not resectable?

Imatinib - anti-tyrosine kinase receptor monoclonal antibody

10

What is Menetrier's disease?

Normal gastric mucosa is replaced by hypertrophied epithelium producing a characteristic appearance of thickened mucosal folds. There is excessive protein loss through the gastric mucosa. It is not a true neoplasia. Possibly pre-malignant but risk is poorly characterised.

11

How is Menetrier's disease (thickening of the mucosal folds) treated?

Antisecretory medication - PPI
Partial gastrectomy - may be required to reduce protein loss

12

What type of carcinoma are most gastric cancers?

Glandular adenocarcinomas (90%)

13

Where is the world has a 5 times greater incidence of gastric cancer than the UK?

Japan
(China also increased but not quite as high)

14

What types of food increase the risk of developing gastric cancer?

Nitrates from salted or smoked foods

15

What are the risk factors for developing gastric carcinoma?

Chronic H. pylori infection
Diet - neutral/high pH
Pernicious anaemia
Blood group A
Previous partial gastrectomy
Lower SEC
Adenomatous gastric polyps

16

How might someone with gastric carcinoma present?

Epigastric pain (similar to peptic ulcers)
Weight loss
Nausea, vomiting
Loss of apetite
Fatigue
Malaise
Symptoms of metastases

17

On examination, what signs might you pick up in someone with suspected gastric carcinoma?

Conjunctival pallor
Palpable mass
Lymphadenopathy (Virchow's node)
Jaundice - mets
Ascites

18

What investigations would you do in someone with suspected gastric carcinoma?

Endoscopy
Barium meal
CT
PET
LFTs, U&Es

19

What might you expect to find during endoscopy of someone with gastric carcinoma?

You could find a tumour, but more likely you would find an ulcer which would need biopsy and further investigation to check that it wasn't malignant

20

What might a barium meal reveal in someone with gastric carcinoma?

May show gastric ulcer
If diffuse infiltrative type of gastric cancer then barium meal may reveal a rigid, contracted stomach.

21

What are the most common sites for gastric cancer?

Antrum - 50%
Body/Fundus - 25%
Cardia (oesophageal opening) - 25%

22

Why would you do LFTs and U&Es in someone with gastric cancer?

This is to look for signs of metastases ie liver and bone (hypercalcaemia).

23

What is the prognosis for someone diagnosed with gastric carcinoma?

Those confined to the mucosa have a 90% 5 year survival rate
However, those with invasive lesions have more like 10% 5 year survival rate.
Screening programs have now been set up in Japan due to high rates.

24

How is someone diagnosed with gastric carcinoma managed?

MDT
Options include:
Surgery - only curative option
Chemo and radiotherapy are actually rarely used but may help with control of symptoms due to tumour bulk.
Symptom control with analgesia and antiemetics

25

What percentage of gastric malignancies does gastric lymphoma make up?

5-10%

26

What type of lymphoma are gastric lymphomas?

Non-Hodgkin B cell type arising from MALT (mucosal-associated lymphoid tissue), rather than primary lymph nodes.

27

Are gastric lymphomas associated with H. pylori infection?

Yes

28

What are the clinical features of gastric lymphoma?

Epigastric pain (similar to peptic ulcers)
Weight loss
Night sweats
Nausea, vomiting
Loss of apetite
Fatigue
Malaise
Symptoms of metastases

29

What are the treatment options for someone diagnosed with gastric lymphoma?

MDT
Eradication of H. pylori
Chemotherapy and radiotherapy
Surgical resection of the tumour
Endoscopic surveillance

30

What is the prognosis for someone diagnosed with gastric lymphoma?

Very good
80-90% survival depending on the type of lymphoma. Complete excision can be curative.

31

What are the two main types of gastric adenocarcinoma as defined by the Lauren Classification?

Intestinal type (58%)
Diffuse type (33%)

32

What is the different between intestinal type and diffuse type of gastric adenocarcinoma?

Intestinal type gastric carcinomas are associated with Helicobacter pylori associated chronic gastritis, atrophy, and intestinal metaplasia, which are thought to be precursors of the dysplastic changes that evolve into this type of carcinoma.

Gastric carcinomas of the diffuse type are also associated with H pylori infection, but not with atrophy and intestinal metaplasia; they are usually less well differentiated, characterised by sheets of cells without gland formation, with the occasional presence of signet ring cells and mucin, and are associated with a poor prognosis compared with the intestinal type of tumour.