Gastric Cancer Lecture – Flashcards
Unlock all answers in this set
Unlock answersquestion
occurs when cancerous cells develop in any part of the stomach
answer
stomach cancer a.k.a. gastric cancer
question
cancer is classified based on the layer it originates, which one is the most common?
answer
adenocarcinomas; from the inner/mucosal layer of the stomach
question
What is the anatomy of the stomach from anterior to posterior
answer
esophagus -> cardia/cardial notch -> fundus -> body -> pyloric antrum - > / angular inclosure / ->pyloric canal - > pylorus - > duodenum
question
What are the 3 major fx of the stomach
answer
Stores food (1500mL) mixes food with Gastric secretions controls rate of delivery of chyme to the sm intestine
question
How many units of blood can be stored in the stomach before you vomit?
answer
4 units
question
men or women get gastric cancer more often? older or younger?
answer
men 2:1 female older b/c get more mutations r/t exposure to carcinogenic substances and impaired repairing mechanisms
question
True or False cancer is essentially a genetic disease?
answer
TRUE b/c of mutations in the cell DNA that changes the apoptosis gene regulation and allows unlimited proliferation
question
Gastric cancer ranks _____ among all causes of cancer world wide
answer
2nd
question
What are predisposing risk factors r/t gastric cancer?
answer
H.pylori pernicious anemia gastric atrophy gastric polyps PUD/surgery intestinal metaplasia cigarette smoking ETOH excessive NaCL intake antioxidant deficiency
question
What does H.pylori do to the stomach?
answer
read text
question
LT consequences from bariatric surgery
answer
removal of the lower part of the stomach causes B12 insufficiency b/c the part that produces B12 is gone
question
Why does Japan have so much gastric cancer?
answer
soya salts cured fish cured meats
question
List other risk factors for gastric cancer
answer
Exposure to N-nitroso (nitrite) Obesity Familial hypogammaglobulinaemia Blood group type A Barrett's esophagus Radiation tx Genetic factors
question
What are the main two types of gastric cancer
answer
intestinal gastric cancer diffuse gastric cancer * lower survival rate
question
intestinal gastric cancer tumors form
answer
polypoid tumors or ulcers arise in area of intestinal metaplasia
question
cancer follows anatomy if venous goes if arterial goes if lymph goes
answer
venous = liver arterial = everywhere lymph = spreads through abd cavity
question
how do you classify a tumor?
answer
T and N system
question
True or False diffuse gastric cancer forms obvious mass lesions
answer
FALSE infiltrates deeply into stomach and spreads widely in the gastric wall
question
What occurs with the inactivation of p53?
answer
tumor supressor gene, if knocked out allows cancer cells to proliferate w/o regulation
question
Define direct spread of cancer
answer
penetrates the muscularis - > serosa -> adjacent organs such as pancreas, colon, liver
question
True or False Diet for preventing gastric cancer is the same recommended diet for DM
answer
TRUE
question
____________ cancer the tumor resembles carcinomas found elsewhere in the tubular GI tract and fomrs polypoid tumors or ulcers, probably arising in areas of intestinal metaplasia
answer
Intestinal gastric cancer
question
___________ cancer infiltrates deeply into the stomach w/o fomring obvious mass lesions but spreads widely in the gastric wall
answer
Gastric cancer
question
Gastric cancer is divided into two categories
answer
Early gastric cancer advanced gastric cancer
question
limited to mucosa and submucosa w/ or w/o lymph node involvement, can be protruding, superficial or excavated
answer
Early gastric cancer
question
what cancer involves the muscularis?
answer
advanced gastric cancer
question
inactivation of p53 does what?
answer
p53 is a tumor supressor gene so w/o it tumors can grow unchecked and is in about 30% of both intestinal and diffuse gastric cancers
question
mutation or loss of heterzygosity of the ______ gene is found in 50% of gastric cancer
answer
APC gene
question
mutation or loss of heterozygosity of the coding for ________ is found in 30% of gastric cancers
answer
b-catenin
question
MSI
answer
microsatellite instability which is a result of errors in DNA replication has been found in 15% of gastric cancer cases and is not specific to either intestinal or diffuse types of cancer
question
What growth factors receptors are overexpressed/amplified in gastric cancer?
answer
c-Met k-Sam cErbB2
question
What growth factors are overexpressed?
answer
TGFa EGF VEGF (vascular endothelial growth factor)
question
loss of heterozygosity in ________ gene which is an inhibitor of apoptosis is associated with intestinal type gastric cancer
answer
BCL2
question
tumor that penetrates the muscularis, serosa and ultimatley adjacent organs such as pancreas, colon and liver
answer
Direct spread
question
tumor spreads by both permeation and emboli to affected tiers of nodes, can be extensive
answer
Lymphatic spread
question
tumor appearing in the supraclavicular nodes
answer
Troisier's sign
question
metasteses that occurs first to the liver and subsequently to other organs including lung and bone
answer
blood-borne metasteses
question
common mode of spread once the tumor has reached the serosa of the stomach and indicates incurability
answer
transperitoneal spread
question
In what stage of gastric cancer do the following clinical manifestations occur? indigestion/heartburn loss of appetite, esp for meat abd discomfort/irritation
answer
Stage I - early
question
What are the clinical manifestations of Stage II - middle for gastric cancer?
answer
weakenss/fatigue bloating of stomach, usually after meals
question
Abd pain in upper abd N/v diarrhea or constipation weight loss bleeding possible anemia r/t bleeding dysphagia
answer
Stage III - late gastric cancer
question
What sx's indicate bleeding in stage III?
answer
hematoemisis blood in stool = black stool
question
What does the sx of dsyphagia indicate specifically?
answer
tumor in cardia or extension of gastric tumor into the esophagus
question
what stage is it if the tumor involves lamina propia
answer
T1
question
T2 means
answer
tumor involves muscularis or subserosa
question
tumor involves serosa
answer
T3
question
tumor invades adjacent organs
answer
T4
question
NO
answer
No lymph node involvement
question
N1
answer
metastasis in 1-6 regional nodes
question
metastasis in 7-15 regional nodes
answer
N2
question
N3
answer
Metastasis in 15+ regional nodes
question
No distant metastasis
answer
M0
question
M1
answer
distant metastsis including peritoneum and distant lymph nodes
question
Stage I includes
answer
T1N0M0 T1N1M0 T2N0M0
question
T1N2M0 T2N1M0 T3N0M0
answer
Stage II
question
Stage III includes
answer
T2N2M0 T3N1M0 T4N0M0 T3N2M0
question
T4N1-3M0 T1-3N3M0 AnyT AnyN M1
answer
Stage IV
question
What is the gold standard for gastric cancer diagnosis?
answer
gastroscopy biopsy cytology
question
What provides the best overall method of diagnosing gastric cancer?
answer
Gastrointestinal endosocpy
question
The more biopsies obtained ___________
answer
the higher the diagnostic yeild
question
How many biopsy specimens should be obtained from each separate lesion for histology?
answer
4-6
question
If you can't do a GI endoscopy what can we do?
answer
Bariu meal-double contrast with air Shows: lack of distnesibility of stomach ulcerated mass/mass surrounding ulcer mass in any portion of stomach enlarged gastric folds
question
Combines endoscopy and ultrasonography to produce detailed images of the stomach wall allowing an accurate assessment of depth of tumor invasion
answer
endoscopic ultrasonography
question
more accurate in assessing depth of cancer invasion and more accurate in determining cancer spread to regional lymph nodes
answer
endoscpic ultrasonography
question
Used to evaluate gastric wall thickness, direct extension of tumor into adjacent organs, regional and retroperitoneal lymph node enlargement, ascites, and liver metastases thus stage the tumor
answer
CT
question
What is CT mainly used for?
answer
predict which patients can undergo curative surgery and which tumors are unresectable
question
What can we see with an abd U/s?
answer
seeding of peritoneum in females the Krunkenburg tumors can be seen
question
What do we do a laprascopy for?
answer
Stage the turmor assess lymph node involvement biopsy peritoneal washout for cytolgoy check operability of tumor
question
What diagnostic labs do we do for gastric cancer?
answer
Hgb Urea Electrolytes Carcinoembryonic antigen Guiac for occult blood in stool
question
How do we treat gastric cancer?
answer
Surgery Chemo Radiation Multimodal tx
question
how can we prevent gastric cancer?
answer
Eat more fruits & veggies Reduce salty/smoked food STOP SMOKING Get info about risk of gastric cancer
question
What predicts the prognosis of gastric cancer?
answer
Stage of cancer at time of diagnosis location of tumor type of surgery that can/can't be performed
question
What is the overall 5-yr survival rate of gastric cancer?
answer
22%
question
What is the 5yr survival rate for stage 0
answer
89%
question
5yr surivival rate for Stage I
answer
58-78%
question
34% 5yr survival rate
answer
Stage II
question
Stage II survival rate
answer
8-20%
question
Stage IV survival rate
answer
7%
