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Gastric Tumours - Adenocarcinoma (Clinical Presentation (Vomiting is…
Gastric Tumours - Adenocarcinoma
Epidemiology
Incidence increases with age - peak age is 50 - 70 years
Rare under age of 30
More common in MALES than females
Highest incidence found in Eastern Asia, Eastern Europe and South America
Gastric cancer is the 4th most common cause of cancer worldwide
Incidence of adenocarcinoma in the body and distal stomach is falling
Main Causes
Dietary factors
High salt and nitrates increase risk
Non-starchy vegetables, fruit, garlic and low salt DECREASE RISK
Loss of p53 (tumour suppressor gene) and APC genes
Helicobacter pylori infection
H.pylori infection causes chronic gastritis which eventually leads to atrophic gastritis and pre-malignant intestinal metaplasia
First degree relative with gastric cancer - CDH1 gene
Smoking
Pernicious anaemia increases risk due to accompany atrophic gastritis
Risk Factors
Smoking
Dietary factors
High salt and nitrates increases risk
Non-starchy vegetables, fruit, garlic and low salt DECREASE RISK
First degree relative with gastric cancer - family history
Pathophysiology
Helicobacter pylori infection
Causes gastritis, then intestinal metaplasia, dysplasia, advanced gastric cancer
Two major types of gastric cancer - all ADENOCARCINOMA
TYPE 1 - INTESTINAL. Well formed and differentiated, this type is more likely to involve the distal stomach and occur in patients with atrophic gastritis
TYPE 2 - DIFFUSE. Has a worse prognosis than intestinal
Clinical Presentation
Vomiting is frequent and can be severe if tumour encroaches on the pylorus
Dysphagia if tumour is in fundus
Weight loss
Anaemia from occult blood loss (haematemesis is rare)
Nausea, anorexia
Liver metastasis resulting in jaundice
Epigastric pain that is indistinguishable from peptic ulcer disease (may be relieved by food and antacids), pain is constant and severe
Metastases also occur in bone, brain and lung
Most patients with carcinoma of the stomach have advanced disease at the time of presentation
Palpable lymph node in supraclavicular fossa - Virchow's node - usually on left side
Treatment
Nutritional support
Diagnosis
Endoscopic ultrasound to evaluate the depth of invasion
CT/MRI for staging
Gastroscopy and biopsy to histologically confirm adenocarcinoma
Positive biopsies can be obtained in almost all cases of obvious carcinoma, but a negative biopsy doesn't rule out diagnosis
Thus 8-10 biopsies are taken
PET scan to identify masses