Gastric Cancer

    Cards (9)

    • Gastric cancer epidemiology:
      • More common in people above 75 years of age
      • More common in the male gender
    • Gastric cancer types:
      • Adenocarcinoma (most common)
      • GISTs
      • Lymphoid
      • Neuroendocrine
    • Gastric cancer risk factors:
      • Heliobacter Pylori
      • Pernicious anemia
      • Diet - salt, nitrates, alcohol
      • Ethnicity - Japan, China
      • Smoking
      • Blood group A
    • H. pylori infection can cause acute gastritis, which may progress to chronic gastritis, which can progress to metaplasia, then dysplasia and then cancer
    • Gastric Cancer Clinical features:
      • Epigastric pain
      • Dyspepsia
      • Dysphagia
      • Weight loss
      • Nausea and vomiting
      • Lymphatic spread - left supraclavicular node (Virchow's node), periumbilical nodule (Sister Mary Joseph's node)
    • Gastric cancer investigations:
      • OGD with biopsy - sample should be sent for histology to look for signet ring cells, CLO test for H. pylori and HER2/neu protein expression for targeted monoclonal therapies
      • CT - chest, abdomen and pelvis to assess metastasis
      • PET scan is rarely used in gastric cancers as they do not take up the tracer well
    • Gastric cancer management
      • Proximal cancers - total gastrectomy
      • Distal cancers (in the antrum or pylorus) - subtotal gastrectomy
      • Chemotherapy
      • EMR or ESD (for early T1a tumors)
    • Gastrectomy complications:
      • Death
      • Anastomotic leak
      • Duodenal stump leak
      • Re-operation
      • Dumping syndrome
      • Vitamin B12 deficiency
    • Current NICE guidelines recommend referring for an urgent OGD for any patients presenting with new-onset dysphagia or aged >55 years presenting with weight loss and either upper abdominal painreflux, or dyspepsia.
    See similar decks