MRCS Knowledge: Gastric Carcinoma

14/09/14 18:23 Filed in: MRCS Knowledge

MRCS Part B Knowledge: Gastric Carcinoma


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Today’s MRCS Knowledge short notes are on gastric carcinoma.


Background

90% Adenocarcinoma,
5% lymphoma,
5% gastro intestinal stromal tumours (GISTs)

2nd commonest cancer-related death worldwide
Peak age >50years
Male: female 3:1

Aetiology

  • H. Pylori infection and chronic ulceration
  • Diet high in nitrosamines (smoked fish)
  • Smoking
  • Alcohol
  • Chronic atrophic gastritis
  • Low social class
  • Blood group A

Signs and Symptoms

  • Troisier’s sign: palpable left supraclavicular (Virchow’s) lymph node suggests disseminated disease,
  • Palpable epigastric mass
  • Succession splash
  • Cachectic

  • Dyspepsia (new onset >45 years requires investigation)
  • Anorexia
  • Weight loss
  • Anaemia
  • Post-prandial fullness
  • Late symptoms: gastric outlet obstruction, dysphagia, upper GI Bleed

Investigations

  • OGD and biopsy for histology and grading
  • Barium meal
  • CT/Laparoscopy for staging

Management

Early (T1/2 N0 M0): curative partial or total gastrectomy plus lymph node resection
Late (T3/4 N1/2 M1/2/3): palliative chemotherapy, surgery for obstruction

Prognosis

Complications: Linitis plastica ‘leather bottle’ stomach in diffuse disease, transceolomic spread to ovaries ‘Krukenburg tumour’
5-year survival: 20%

Further Info:
For further info and commonly asked questions on gastric carcinoma be sure to sign up to the Question Bank.

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