Gastric Cancer

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Introduction

10-12/100,000 in North America

70-80/100,000 in East Asia

 

Gastric maltomas (mucosal-associated lymphatic tissues) are antigen-induced lymphomas following chronic inflammation.

Gastrointestinal stromal tumours (GIST) original in the interstitial cells of Cajal (pacemaker cells of the gut). Almost all are associated with gain of functon in KIT genes.

 

 

The Case of...

 

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Causes and Risk Factors

Increasing age is a significant risk factor. Males have a 2:1 risk.

More cancers at the GE junction:

Nutritional

Environmental

 

medical

familial

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Pathophysiology

Development

Hyperplastic gastric polyps are found in 2-3% of endoscopies; almost half are fundic.

They do NOT gise to cancer

Colorectal neoplasia can be found in over half of patients with benign gastric polyps, while gastric adenocarcinoma develops in 2%

Adenomatous polyps account for 10% of polyps. They are most often antral and suggest increased risk of cancer development.

 

Cancers tend to not track further than the pylorus.

 

Staging

T3: through serosa without invading adjacent structures

Cancer is most likely along the lesser curve.

Cancer along the great curve is more likely to spread to nodes ajoining the spleen.

 

Intestinal

Diffuse (Leather bottle)

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Signs and Symptoms

  • history
  • physical exam

History

Loss of appetite

  • difficulty swallowing
  • vague abdominal fullness, particularly following meals and increasing over time
  • nausea and vomiting
  • vomiting/passing blood
  • abdominal pain
  • excessive belching
  • breath odor
  • excessive gas (flatus)
  • unintentional weight loss (poor predictor)
  • general decline in health

Physical Exam

 

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

 

Diagnostic Imaging

Endoscopy is the best means of identifying cancer

 

CT scan and laparoscopy can be helpful for pre-operative staging. Laparoscopy, along with peritonal lavage, can be helpful for diagnosing peritoneal

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Differential Diagnosis

peptic ulcer

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Treatments

Surgery

A distal cancer is resected, with generous margins extending but part of the body left intact to be attached to the duodenum. A more proximal cancer will result in total gastrectomy, with the esophagus becoming attached to the

 

Chemotherapy

GIST is treated very successfully with Gleevec, or imatinib.

 

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Consequences and Course

 

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Resources and References

 

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Topic Development

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