Gastric cancer Flashcards
What is the most common cause of gastric adenocarcinoma?
H. Pylori
What are risk factors for the development of gastric carcinoma?
- Pernicious anaemia
- Blood group A
- H. pylori
- Atrophic gastritis
- Adenomatous polyps
- Lower social class
- Smoking
- Diet - high nitrate, high salt, pickling, low vitamin C
- Nitrosamine exposure
Which sex is gastric carcinoma more common in?
Males
What are symptoms of gastric carcinoma?
Often non-specific
- Dyspepsia
- Weight loss
- Vomiting
- Dysphagia
- Anaemia
What signs might be present in someone with gastric cancer?
- Epigastric mass
- Hepatomegaly
- Jaundice
- Ascites
- Virchow’s node
- Acanthosis nigricans
- Dermatomyositis
How does H. pylori cause gastric cancer?
Acute gastritis -> Chronic gastritis -> Atrophic Gastritis -> intestinal metaplasia
How can pernicious anaemia cause gastric carcinoma?
Causes atrophic gastritis
What is early gastric carcinoma defined as?
Confined to mucosa/submucosa, regardless of lymph node spread
What investigations would you perform in someone with suspected gastric carcinoma?
- Gastroscopy - plus multiple ulcer edge biopsies
- EUS
- CT/MRI abdo/pelvis
- Consider CXR
- Consider peritoneal washing cytology
- Consider PET scan
How many biopsy samples should be taken from a suspicious lesion?
8-10
What is CT/MRI used for in gastric cancer?
Staging
What is EUS useful for when investigating gastric cancer?
Useful for local staging to demonstrate the depth of penetration of the cancer through the gastric wall and extension into local lymph nodes.
It complements CT and ultrasound but is most relevant to confirm a cancer is confined to the superficial mucosa, before endoscopic resection.
How would you managee gastric carcinoma?
Surgery
- Early disease - endoscopic mucosal resection
- Advanced distal - partial gastrectomy
- Advanced proximal - Total gastrectomy
- Palliative surgery may be required
Chemotherapy - advanced disease
What are gastrointestinal stromal tumours?
Subset of GI mesenchymal tumours of varying differentation. Classified as GI leiomyomas/Leiomyosarcomas, leiomyoblastoma or schwannoma
What is a mucosa associated lymphatic tissue lymphoma?
MALT lymphoma
Indolent B cell marginal zone lymphomas primarily involved sites other than lymph nodes e.g. GI tract, thyroid, breast or skin. They constitute about 10% of NHLs
