Podcast
Questions and Answers
What is the most common symptom associated with gastric cancer?
What is the most common symptom associated with gastric cancer?
Which genetic abnormalities are most common in gastric cancer?
Which genetic abnormalities are most common in gastric cancer?
What is the best method for diagnosing gastric cancer?
What is the best method for diagnosing gastric cancer?
Which site of gastric cancer requires total gastrectomy with D2 lymph node dissection?
Which site of gastric cancer requires total gastrectomy with D2 lymph node dissection?
Signup and view all the answers
Which lymph nodes have a higher propensity for metastasis from proximal stomach tumors?
Which lymph nodes have a higher propensity for metastasis from proximal stomach tumors?
Signup and view all the answers
What is the most common site of metastasis for gastric cancer?
What is the most common site of metastasis for gastric cancer?
Signup and view all the answers
Early satiety in gastric cancer is often a result of what?
Early satiety in gastric cancer is often a result of what?
Signup and view all the answers
What should follow-up for gastric cancer patients include after the first year?
What should follow-up for gastric cancer patients include after the first year?
Signup and view all the answers
Which paraneoplastic syndrome is associated with gastric cancer?
Which paraneoplastic syndrome is associated with gastric cancer?
Signup and view all the answers
What is the common presentation of distal antral tumors in gastric cancer?
What is the common presentation of distal antral tumors in gastric cancer?
Signup and view all the answers
Study Notes
Carcinoma Stomach Incidence and Tumors
- Gastric cancer incidence, particularly distal cancer, is on the decline; distribution shows distal tumors (40%) > middle tumors (30%) > proximal tumors (30%).
- Increasing incidence of gastroesophageal (GE) junction tumors.
- Malignant tumors comprise approximately 90% of all stomach tumors, predominantly gastric adenocarcinoma.
- Common genetic abnormalities include p53 and COX-2 genes.
- Tumor markers associated with gastric cancer: CEA, CA 19-9, CA-125, CA 72-4, and beta-HCG.
Clinical Features
- Major symptoms include abdominal pain (62-91%) and weight loss (22-61%). Pain is typically constant, nonradiating, and unrelieved by eating.
- Dysphagia is common in proximal tumors affecting the gastroesophageal junction; distal antral tumors may cause gastric outlet obstruction.
- Extensive mural involvement by tumor (e.g., linitis plastica) can lead to stomach distensibility issues and early satiety.
- Symptoms of advanced disease may include ascites, jaundice, or palpable masses.
- Malignant spread may lead to fistula formation with the transverse colon and obstruction.
- Notable physical findings: Virchow's lymph node (supraclavicular), Sister Mary Joseph's node (periumbilical), Irish nodes (left axilla), and Krukenberg's tumor (ovarian mass).
- Paraneoplastic syndromes possible: thrombophlebitis (Trousseau's syndrome), neuropathies, nephrotic syndrome, and disseminated intravascular coagulation (DIC).
Lymph Node Metastasis
- Risk of nodal metastases varies according to tumor origin and depth of gastric wall invasion.
- Proximal stomach and GE junction tumors show greater likelihood of mediastinal and pericardial spread.
- Tumors in the stomach body primarily metastasize to nodes along the greater and lesser curvature.
- Distal stomach tumors tend to metastasize to periduodenal, peripancreatic, and porta hepatis nodes.
Diagnosis
- Endoscopy with biopsy is the preferred method for diagnosing gastric cancer.
- Endoscopic ultrasound (EUS) is the ideal choice for early gastric cancer staging.
- Contrast-enhanced computed tomography (CECT) is best for preoperative staging.
Treatment by Site
- Proximal-third: Extended gastrectomy including distal esophagus.
- Middle-third: Total gastrectomy with D2 lymph node dissection.
- Distal-third: Subtotal gastrectomy with D2 lymph node dissection for intestinal-type; total gastrectomy with D2 lymph node dissection for diffuse-type.
Recurrence
- Most recurrences happen within the first three years.
- Highest loco-regional failure rates occurring at anastomosis or stump (25%) followed by stomach bed (21%) and regional nodes.
- Most common sites for metastasis: liver, lung, and bone.
Surveillance
- Follow-up protocol includes history and physical examination every 4 months for the first year, then every 6 months for the following two years, transitioning to annual exams thereafter.
Prognosis
- Prognostic factors to consider include stage at diagnosis, histological type, and treatment response.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers key aspects of gastric cancer, including its incidence, distribution, and the types of tumors prevalent in the stomach. You'll also learn about the most common genetic abnormalities and tumor markers associated with gastric adenocarcinoma. Test your knowledge on this significant health issue.
