Gastric Cancer
Reference: OHCM 508, Lec Not Onc 90, Sur
Talk 109
Epidemiology
Increasing at GOJ, decreasing at distal/body. Common. 5th biggest
killer in UK.
Risk Factors
-
Predisposing conditions
-
Pernicious anaemia, atrophic gastritis, previous gastric
resection, chronic peptic ulcer, polyps
-
Environmental
-
H Pylori
-
↓socio-economic
-
smoking,
-
Genetic: Blood group C, HNPCC
Pathology
95% adenocarcinoma. Early are confined to mucosa/submucosa.
Macroscopic appearances:
-
Malignant ulcer w raised everted edges
-
Polypoid proliferating in to stomach lumen
-
Colloid: massive gelatinous growth
-
Leather bottle stomach (linitus plastica): anaplastic
Clinical
Symptoms
Often non-specific.
Dyspepsia: (abdominal pain, epigastric, worse with meals), anorexia,
vomiting, dysphagia, anaemia
Incurable
signs: Epigastric mass, hepatomegaly, jaundice, ascites, Virchows node
(=Troissier's sign), acanthosis nigricans (pigmented warty axillary
skin)
Differential
Another cancer, pernicious anaemia, uraemia
Investigations
-
General: FBC, LFT, CXR
-
Screening: faecal occult blood
-
Diagnostic: Gastroscopy + multiple liver biopsies
-
Staging: endoscopic USS, CT/MRI
Spread
Local:
e.g.
oesophagus, duodenum, pancreas
Lymphatic:
classically
Virchow's
Blood:
via
portal vein to liver
Transcoelomic:
e.g.
to ovaries = Krukenberg tumour
Management
-
Radical Surgery + lymphadenectomy. Gastrectomy: equal
survival for total/subtotal.
-
Palliative: Chemotherapy, pyloric stenting
Prognosis
Most present w mets so 30% 5YS. If caught early (rare) then good
prognosis.
