Gastric Cancer

• Risk factors for gastric cancer

  • Old age - 70yrs
  • Male - x2 more likely
  • H. Pylori - 60% of cases
  • Gastritis
  • Smoking
  • Alcohol
  • Obesity
  • Diet - pickled/cured/processed foods
  • Family History - 10% of cases
  • Pernicious anaemia
• What is HDGC?

  • Autosomal dominant gene mutation that increases risk of the more severe diffuse gastric cancer
  • CDH-1 gene mutation which encodes E-cadherin, cells become less cohesive promoting cancer development
  • 50% chance of passing it on increasing gastric cancer risk to 70-80% at aged 80
  • Also increases risk for lobular breast cancer to 40%
• Gastric cancer is the 6th most common cancer worldwide
• The most common location of gastric cancer is the pyloric antrum followed by the lesser curvature, cardia, fundus and body of the stomach

  
• Signs and symptoms of gastric cancer can include

  • Weight loss
  • Fatigue
  • Bleeding - haematemesis or melena or anaemia
  • Nausea and vomiting
  • Dyspepsia
  • Bloating
  • Dysphagia if cancer affects cardia of stomach
• Troisier's sign aka Virchow's node

  • A palpable left supraclavicular lymph node
  • Indicates abdominal malignancy
• Gold standard diagnostic test for gastric cancer is endoscopy with biopsy
• CT scans are used to asses TNM stage 0-4, which involves

  1. Tumour size and local tissue involvement
  2. Lymph Node involvement
  3. Metastasis
• 5 year survival for gastric cancer is 30%, improves to 90% if caught in the earliest stage
• Gastric cancer is managed with

  1. Endoscopic mucosal resection in early stage
  2. Partial/total gastrectomy in late stage
  3. Chemotherapy
  4. Immunotherapy
• Adjuvant chemotherapy is given after surgery to prevent recurrence

  Neoadjuvant chemotherapy is given before surgery to shrink or stop the spread of cancer
• Immunotherapy options for gastric cancer:

  Trastuzumab - a HER2 inhibitor, 25% of gastric cancer cases are HER2 positive

  Nivolumab - a monocloncal antibody that inhibits PD1 receptor, increasing antitumor response