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Gastric Cancer

Reference: OHCM 508, Lec Not Onc 90, Sur Talk 109

Epidemiology

Increasing at GOJ, decreasing at distal/body. Common. 5th biggest killer in UK.

Risk Factors

Pathology

95% adenocarcinoma. Early are confined to mucosa/submucosa.
Macroscopic appearances:

Clinical

Symptoms

Often non-specific.
Dyspepsia: (abdominal pain, epigastric, worse with meals), anorexia, vomiting, dysphagia, anaemia
Incurable signs: Epigastric mass, hepatomegaly, jaundice, ascites, Virchows node (=Troissier's sign), acanthosis nigricans (pigmented warty axillary skin)

Differential

Another cancer, pernicious anaemia, uraemia

Investigations

Spread

Local: e.g. oesophagus, duodenum, pancreas
Lymphatic: classically Virchow's
Blood: via portal vein to liver
Transcoelomic: e.g. to ovaries = Krukenberg tumour

Management

  1. Radical Surgery + lymphadenectomy. Gastrectomy: equal survival for total/subtotal.
  2. Palliative: Chemotherapy, pyloric stenting

Prognosis

Most present w mets so 30% 5YS. If caught early (rare) then good prognosis.
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