5. Gastric Cancer, Zollinger-Ellison Syndrome, & Pyloric Stenosis – Flashcards
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What is the 5 year survival rate for localized stomach cancer?
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67%
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How does gastric cancer spread?
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Direct extension through the GASTRIC WALL and LYMPHATICS
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What are the most common type of gastric cancer?
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Adenocarcinoma
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Type of cells in the cardia
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Mucus secreting cells
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Type of cells in the fundus and body of stomach
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Mucoid, Chief, and Parietal Cells
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Cells in the pylori
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Mucus secreting cells and endocrine cells
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30% of gastric cancers originate in the_______stomach, 20% in ________, and 40% in ___________.
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Distal, Mid, Proximal third
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What kind of fungus is a risk factor for gastric cancer?
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Aflatoxin
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What kind of blood type is a risk factor for gastric cancer?
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Group A
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Common symptom of gastric cancer
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Postprandial fullness
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A patient presents with palpable enlarged stomach with succession splash.......
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Gastric Cancer
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Which lymph nodes are generally enlarged in gastric cancer?
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Virchow Nodes, Irish Nodes
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Test used to evaluate the gastric wall, obtain a biopsy and establish lymph node involvement.
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EGD
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If you wanted to assess the tumor stage for preoperation what test would you use?
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EUS
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Metastatic ovarian nodules (tumor).
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Krukenberg's tumor
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Periumbilical nodes (tumor).
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Sister Mary Jospeh node
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Metastasis to the peritoneal cul-de-sac (tumor)
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Blumer's shelf
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What test would you use when obstructive sx are present?
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Double-contrast upper GI series and barium swallows.
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Tests used to evaluate for metastatic lesions.
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Chest RadiographyCT or MRI
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Lab tests for Gastric Cancer
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CBC: id anemia (found in 30% of pt's b/c of bleeding), CMP:used to characterize the patient's clinical state, Carcinoembryonic antigen (CEA): inc. in 45-50% Cancer Antigen 19-9: elevated in 20%, Stool occult blood test
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Tx of gastric adenocarcinoma
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Complete surgical removal of the tumor with RESECTION of adjacent lymph nodes (only chance of survival)
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Cure rate for early lesions limited to the mucosa or submucosa in gastric adenocarcinoma
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>80%
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What additional tx would you give to medically fit patients with potentially resectable tumors?
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Preoperative chemo or chemoradiotherpy followed by surgery
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Tx of choice for pt’s with DISTAL carcinomas.
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Subtotal gastrectomy
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What kind of gastrecomy is required for PROXIMAL tumors?
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TOTAL or NEAR-TOTAL gastrectomy
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What is the best form of palliation?
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Reduction of tumor bulk
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A relatively radioresistant tumor?
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Adenocarcinoma
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What can prolong survival in pt's with adenocarcinoma?
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Combo radiotherapy and 5-fluorouracil (5-FU)
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Probability of survival after 5 yrs for the 25-30% of pt's unable to complete resection is 20% for _________and <10% for _______
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Distal, Proximal
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What reduces the recurrence rate and prolongs survival in pt's with gastric adenocarcinoma?
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Combo chemo before and after surgery along with postoperative chemo with radiation therapy
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What is the most frequent extranodal site for lymphoma?
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Stomach
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The majority of gastric lymphoma's are __________.
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B Cell lymphomas
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S/S of Gastric Lymphoma
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-6th decade, Epigastric pain, Early satiety, Generalized fatigue, Ulcers with a ragged, thickened mucosal pattern
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What do you need to get to diagnose gastric lymphoma?
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DEEP GASTRIC BIOPSY
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Is gastric lymphoma more treatable than adenocarcinoma?
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Yes
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First step in Tx for gastric lymphoma
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Antibiotic tx. For H. Pylori
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If a pt has. a lack of response to antimicrobial treatment during antibiotic tx for gastric lymphoma what would you consider?
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Chromosomal abnormality
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What is a highly effective therapy for gastric lymphoma?
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CHOP + rituximab
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What has led to a 5 yr survival rate of 40-60% in pt's with localized high-grade lymphomas?
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Subtotal gastrectomy with chemo
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Also known as gastrinoma....
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ZES
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A pancreatic neuroendocrine tumor that secretes gastrin:
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ZES
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ZES causes: (2 things)
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Gastric acid hypersecretionGrowth of the gastric mucosa (more parietal and ECL cells)
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Where is ZES usually located?
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Doudenal ulcers
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A pt. presents with duodenal ulcers, a NEGATIVE H. Pylori test and chronic diarrhea......
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ZES
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The high acidity of chyme in intestines from ZES causes______and _______.
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Diarrhea, Malabsorption
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20-25% of pt's with ZES have_______
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MEN 1
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Mutations of the MEN1 tumor suppressor gene at the ________
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11q13 locals
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What should you measure in pt's with ZES?
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MEN1!-plasma ionized calcium, prolactin levels, plasma hormone levels
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A patient presents with abdominal pain and GERD, diarrhea and weight loss. On exam you find epigastric tenderness and note dental caries. Stool samples show steotorrhia with some bleeding.
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ZES
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3 tests for diagnosis ZES
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Fasting Gastrin Level, Basal Gastric Acid Output, Secretin Provocative Test
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Results of Fasting Gastrin Level in ZES
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Inappropriate fasting hypergastrinemia, Gastrin >1000 pg/mL
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Results of Basal gastric acid output in ZES
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Fasting pH< or = to 2 when OFF antisecretory drugs
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Results of secretin provocative test
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Positive-gastrin levels rise 120 pg w/in 15 min of injection
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This test uses radioactive tracers to help locate tumors.
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Somatostatin receptor scintigraphy
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The most sensitive imaging modality for detection of primary or metastatic lesions.
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Somatostatin receptor scintigraphy
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This test is used to locate a tumor and evaluate for metastatic disease (less sensitive).
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CT
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What test would you use if you wanted to look for duodenal ulceration and hypertrophy of gastric folds in pt's with ZES?
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EGD
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What test would use if you wanted to localize the gastrinoma?
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EU
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Tx for ZES
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PPIH2 B 12 may be needed
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Successful resection of gastrinoma results in :
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Dec/ chance of liver metastasis.Inc. disease-related survival rate.
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What must you do in tx. for pt's with MEN1 and ZES?
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Must treat hyperparathyroidism for antisecretory drugs BEFORE MEDS
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5-yr survival rate for pt's WITH metastatic gastrinoma to the LIVER is _______with 10 yr_______
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20%, 10%
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Newborn has projectile postprandial vomiting.
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Pyloric Stenosis
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Age that vomiting begins in pyloric stenosis
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Between 2-4 weeks
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Risk factors for Pyloric Stenosis
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Male, Caucasian, Premature, Family Hx, Smoking during pregnancy, Erythromycin
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What type of alkalosis do you see in pyloric stenosis?
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Hypochloremic, hypokalemic, metabolic alkalosis
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You see peristaltic waves from left to right and an oval mass on RIGHT UPPER abdomen?
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Pyloric stenosis
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The diagnostic tool of choice for pyloric stenosis?
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Ultrasonography
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What would you expect to find an ultrasound of a pt with pyloric stenosis?
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Hypoechoic muscle ring > 4 mm with hyper dense center and a pyloric channel length >15mm
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Immediate tx for pyloric stenosis.
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Need to correct fluid looks, electrolytes and acid-base imbalance.
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What kind of surgery is common in the tx pyloric stenosis?
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RAMSTEDT pyloromyotomy
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When can infants feed after recovery from anesthesia during surgery for pyloric stenosis?
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4-8 hrs
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Is it normal for pt's to regurgitate after surgery for pyloric stenosis?
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YES, worrisome if 5 days after
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Pt's with pyloric stenosis have 4x greater risk for developing_______
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Chronic abdominal pain
