Gastric Neoplasia

Gastric Neoplasia

·        Symptoms & Signs

o  „Ulcer-like dyspepsia‟ lasting more than a few weeks in middle aged or older

o  Early satiety, fullness Þ small cancer in pylorus, large in body of stomach, extrinsic compression, or linitis plastica (infiltrates stomach so can‟t distend)

o  Vomiting, haematemesis/melaena

o  Weight loss, malaise

o  Anaemia

o  Metastases: Knobbly enlarged liver, ascites, pleural effusion, left anterior axillary node

·        Investigations:

o  FBC (anaemia), LFT (mets?)

o  Endoscopy: biopsy and assess obstruction

o  CT/ultrasound to assess metastases

·        Differential:

o  Ulcer or non-ulcer dyspepsia

o  Reflux oesophagitis

o  Anaemia of other causes

o  Depression

·        Types:

o  Benign Tumours:

§  Polyps: hyperplastic/inflammatory – 90%, Neoplastic/adenomatous – 10%

§  Stromal tumours: leiomyomas, etc

o  Gastric Carcinoma:

§  Epidemiology: high in Japan (due to diet ® screening programme), China, decreasing in Western world (better water ® ¯helicobacter and better food preservation ® ¯oxidised food which is carcinogenic). 6/100,000. M > F

§  Aetiology: Diet (­pickles, ­smoked food, ¯green leafy vegetables), genetic, associated with chronic gastritis and adenomatous polyps, and helicobacter

§  Evolution: dysplasia ® carcinoma-in-situ (confined to submucosa) ® invasive

§  Macroscopic: Early – thickening, hyperaemia. Go on to 1) ulcerating, fungating masses, rolled overhanging edge, 2) diffusely infiltrative (linitis plastica – “leather bottle stomach” – thickened wall and folds), 3) polypoid mass 

§  Microscopic appearance: 1) Intestinal type: malignant glands, 2) Diffuse or gastric type: cygnet ring cells

§  Outcome: depends on stage not type.  Metastasis to lymph nodes, peritoneum, liver, lungs

·        Treatment:

o   Resection

o   Chemotherapy for palliation only

o   Symptomatic drug treatment