GI - Gastric Cancer Flashcards Preview

Year 3- Surgery > GI - Gastric Cancer > Flashcards

Flashcards in GI - Gastric Cancer Deck (14)
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1
Q

Gastric cancer: epidemiology

A
  • Age: 50’s
  • Incidence: 23/100 000
  • M>F
  • Geographical: increased in Japan, Eastern Europe, China and South America
2
Q

Gastric cancer: risk factors

A
  • Atrophic gastritis (leads to intestinal metaplasia), associated with pernicious anaemia and H pylori
  • Diet: high in nitrates (smoked, pickled, salted), nitrates turn into carcinogenic nitrosamines in GIT
  • Smoking
  • Blood group A
  • Low SEC
  • Familial: E Catherine abnormality
  • Partial Gastric to my
3
Q

Gastric cancer: pathology

A
  • Mainly adenocarcinomas
  • usually in gastric antrum
  • H pylori may lead to a Maltoma
4
Q

Gastric cancer: depth of invasion

A
  • Early gastric Ca: mucosa or submucosa

- Late Gastric Ca: muscularis propria is breached

5
Q

Gastric cancer: name and classification breakdown

A

Bormann classification

  1. Polypoid/fungating
  2. Excavating
  3. Ulcerative and raised edge
  4. Linitis plastic: leather-both like thickening with flat rugae
6
Q

Gastric cancer: symptoms

A
  • Usually presents late
  • Wt loss + anorexia
  • Dyspepsia: epigastric or retrosternal pain/discomfort
  • Dysphagia
  • N + V
7
Q

Gastric cancer: signs

A
  • Anaemia
  • epigastric mass
  • jaundice
  • as cites
  • hepatomegaly
  • Virchow’s node (Troisier’s sign)
  • Achanthosis nigricans
8
Q

Gastric cancer: complications

A
  • Perf
  • Upper GI bleed: haematemesis, melaena
  • Gastric outlet obstruction —> succession splash
9
Q

Gastric cancer: spread

A
  • Can be within stomach: linitis plastics
  • Direct invasion: pancreas
  • Lymphatic: Virchow’s node
  • Blood: liver and lung
  • transcoelomic (can spread to ovaries with Krukenberg tumour or to umbellicus with sister Mary Joseph nodule)
10
Q

Gastric cancer: Ix (blood, imaging and staging)

A
  • Bloods: FBC (anaemia), LFTs and clotting (liver mets)
  • Diagnosis: endoscopy with biopsy
  • Staging: CT or endoscopic US (US has recently been shown to be superior to CT)
11
Q

Gastric cancer: Mx - medical palliative

A
  • Analgesia (eg fentanyl patch)
  • PPI
  • Secretion control
  • Chemo
  • Palliative care team package
12
Q

Gastric cancer: Mx - Surgical palliation

A
  • Pyloric stenting

- Bypass procedures

13
Q

Gastric cancer: Mx - curative surgery

A
  • Disease greater than 5-10cm from OG junction: sub total gastrectomy
  • Tumours extending into oesophagus: eosophagogastrectmy
  • Early gastric cancer confined within mucosa: endoscopic sub mucosal resection
  • Lymphadenectomy normally performed
  • Most pts receive chemo either pre or post op
14
Q

Gastric cancer: prognosis

A
  • Very poor
  • Overall: <10% 5 year survival
  • Pts who undergo surgery: 20-50% 5 year survival

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