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Flashcards in Gastric Cancer Deck (14)
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1
Q

Gastric Adenocarcinoma

Intestinal Type

Diffuse (linitis plastica)

Cell adhesion
Cell structure
Patho
Pt

A
I- Present
Intestinal metaplasia
Tubular/glandular
Inflam/diet/environment
Older, Males

D- defective, lost ecadherin
Infiltrating, signet ring
Genetic
Young, M + F

2
Q

Intestinal tupe gastric ca results from

area

A

chronic inflamm, H pylori

proximal stomach

3
Q

Pathogenesis

Non-atrophic gastritis
Atrophic
Intestinal metaplasia
Dysplasia
Invasive adeno

H pylori tumorigenesis

A

N- H pylori, w lymphocytic infil w superimposed PMNs
A- loss of gastric glands (parietal, chief, mucus) first neoplastic step
IM- glands at junction of antrum/body, hypoCl
D- cells appear, dont penetrate
IA- ulcerated mass forms

generation of NO- leading to DNA abnormalities

4
Q

Diffuse characteristics

Commonly invade

Infiltration of a broad region of gastric wall occurs, resulting in a

A

rapid, early metastasis

gastric wall, going to esophagus, proximal duodenum

thickened stomach

5
Q

Spread via

Direct extension

Lymphatic

Hematogenous

A
D- pancreas, colon, liver
peritoneal seeding (malignant ascites/mets to ovary, perumbical region SMJ nodes)

L- intra-ab and supraclavicular LN

H- liver

6
Q

Common area for gastric ca

Dietary risks

A

East A, East Europe, South America

salt preserved foods, nitrates

7
Q

CM

Most are ___ with superficial gastric adeno

Progressive sx

Diffuse sx

A

Asx

vague ab pain, anorexia, wl
NV (pyloric area), dysphagia (GE jxn)

Nausea, early satiety (poor stomach distensibilty)

8
Q

Rf

PE findings

A

hx of gastric ulcer, occult bleeding (heme +, Fe def anemia)

Colonic obstruction (extrinsic comp)
Virchows (lymph)
SMJ (peritoneal)
Enlarged ovary (Krukenburg)
Blumers shelf
Malign ascites
9
Q

Test of choice

Visualize

Linitis plastius finding

Endoscopic findings

Suspicious ulcers require

A

upper endoscopy

Gastric ulcer, exophytic/rugal folds

Leather flask, stiff

Ulcer w irregular margins, nodular mucosal folds, lost rugal folds

biopsy

10
Q

Biopsy findings

Intestinal type

Diffuse type

A

bulky, glands with broad cohesive cells, vacuoles, abundant mucin

marked thickened gastric wall, signet rings

11
Q

Mx is targeted at

Localized distal dz

Localized proximal dz

Intestinal more susceptible to

Diffuse more susceptible to

A

resection of tumor/LN

subtotal gastrectomy

total gastrectomy

5FU, oxaliplantin

cisplatin

12
Q

Primary gastric lymphoma

more likely to be

risk increased with

sx

Appearance

Characterstic findings

A

typical extranodal site for lymphoma

H pylori (MALT)

epigastric pain, fullness, satiety, fatigue

ulcerations, thick mucosa

B cells inf gastric wall, well diff (MALT) or poorly diff high grade lymphoma (Large cell)

13
Q

PGL tx

well diff MALT

Localized high grade

A

Ab therapy to eradicate H pylori

subtotal gastrectomy, chemo

14
Q

Gastric sarcoma

types

Rarely

Heme spread

A

leiomyosarcoma/GI stromal tumors

metastasize

Liver/lungs