Tag: Gastric Carcinoma

Gastric Carcinoma

GASTRIC CARCINOMA

Q. 1

Which of the following is a risk factor for development of gastric carcinoma?

 A

Blood group O

 B

Intestinal metaplasia type III

 C

Duodenal ulcer

 D

All of the above

Q. 1

Which of the following is a risk factor for development of gastric carcinoma?

 A

Blood group O

 B

Intestinal metaplasia type III

 C

Duodenal ulcer

 D

All of the above

Ans. B

Explanation:

Blood group A, not O was considered as the risk factor for Gastric carcinoma but blood group A is also not considered as risk factor according to standard books.

 About duodenal ulcers standard books writes “Although once considered a premalignant conditions, it is likely that older literatures was confounded by mistakenly labeling inadequately biopsied ulcers and healing ulcers as ‘benign’ when in fact they were malignant to begin with”.

Intestinal metaplasia is a premalignant condition and among intestinal metaplasia , intestinal metaplasia type III is more likely to progress to gastric cancer.
 
Ref: Schwartz 9/e, Page 927; Maingot’s 10/e, Page 1006.

 


Q. 2

Which of the following vitamin deficiency is found in patients with gastric cancer ?

 A

Vitamin C

 B

Vitamin B 12

 C

Vitamin A

 D

Vitamin D

Q. 2

Which of the following vitamin deficiency is found in patients with gastric cancer ?

 A

Vitamin C

 B

Vitamin B 12

 C

Vitamin A

 D

Vitamin D

Ans. B

Explanation:

Gastric cancers can grow to an extent to cause damage to cells producing intrinsic factors and hence vitamin B12 deficiency. Vitamin B12 deficiency may also occur in post gastrectomy patients of gastric carcinoma, autoimmune pernicious anemia predisposing to gastric cancer and atrophic gastritis.

 


Q. 3

True about gastric cancer are A/E

 A

Incidence increasing world wide

 B

Incidence of upper gastric cancer increasing

 C

Surgically correctable

 D

Prognosis depends on the depth of the lesion than the size of the lesion

Q. 3

True about gastric cancer are A/E

 A

Incidence increasing world wide

 B

Incidence of upper gastric cancer increasing

 C

Surgically correctable

 D

Prognosis depends on the depth of the lesion than the size of the lesion

Ans. A

Explanation:

Ans. is ‘a’ i.e. Incidence increasing world-wide 

“For unclear reason, the incidence and mortality rates for gastric cancer have decreased markedly during the past 65 years… Gastric cancer incidence has decreased worldwide but remains high in Japan, China, Chile and Ireland” – Harrison 16/e, p 524

Other options:

  • Option b

Schwartz writes – “Several decades ago, the large majority of gastric cancers were in the distal stomach. Recently, there has been a proximal migration of tumors so that currently the distribution is closer to 40% distal, 30% middle and 30% proximal”.

  • Option c

Surgery is the only curative treatment for gastric cancer. It is also the best mode of palliation

  • Option d

Most important prognostic factors for gastric carcinoma are

1)       lymph node status

2)       depth of tumor invasion

Robbins 7/e, p 824 writes ‑

“The morphologic feature having the greatest impact on clinical outcome is the depth of invasion.”

Quiz In Between


Q. 4

True of early gastric carcinoma –

 A

Invasion of mucosa and sub-mucosa with neighbouring lymphnode

 B

Invasion of mucosa and submucosa irrespective to L.N. spread

 C

Radical Gastrectomy perferred

 D

b and c

Q. 4

True of early gastric carcinoma –

 A

Invasion of mucosa and sub-mucosa with neighbouring lymphnode

 B

Invasion of mucosa and submucosa irrespective to L.N. spread

 C

Radical Gastrectomy perferred

 D

b and c

Ans. D

Explanation:

Answer ‘b’ i.e. Invasion of mucosa and submucosa irrespective to lymph node spread. ; ‘c’ i.e. Radical gastrectomy preferred 

  • As already explained before, Early gastric cancer is carcinoma limited to the mucosa and submucosa of the stomach regardless of the lymphnode status
  • Radical subtotal gastrectomy is the standard operation for gastric cancers.
  • Endoscopic Resection
  • It has been demonstrated that some patients with early gastric cancer can be adequately treated by an endoscopic mucosal resection.
  • Currently endoscopic mucosal resection is limited to :early gastric cancers, confined to mucosa, < 2 cm in size, with no node involvement

Q. 5

True about Gastric carcinoma are all, except:

 A

Haemetemesis present in majority of patients

 B

H. Pylori association is present

 C

D2 gastrectomy includes total gastrectomy

 D

All

Q. 5

True about Gastric carcinoma are all, except:

 A

Haemetemesis present in majority of patients

 B

H. Pylori association is present

 C

D2 gastrectomy includes total gastrectomy

 D

All

Ans. A

Explanation:

Ans is A (Haemetemesis present in majority of patients)

Option C

There is confusion about option C. It is not a completely true statement, but it’s not totally false either. See the explanation below:

D2 gastrectomy refers to the extent of lymphadenectomy done along with the gastrectomy.

Extended lymph node dissections for the treatment of gastric cancer have best been described by the Japanese, and subsequently the JCGC D categories are used to define the extent of lymphatic dissection performed. In the JCGC (Japanese classification of gastric cancer) system, lymph node basins are numbered and subsequently grouped according to the location of the primary. These are grouped into 3 levels: N1, N2 & N3. The nodal stations defined as level NI, N2, and N3 vary depending on the location of the tumor. In general, N1 nodes are within 3 cm of the tumor, N2 nodes are along the hepatic and splenic arteries, and N3 nodes are the most distant.

A D1 gastrectomy refers to the removal of NI lymph nodes, D2 gastrectomy to dissection of 1\11 and N2, and D3 resection to a D2 resection plus removal of para-aortic lymph nodes.


Q. 6

All of the following predispose to gastric carcinoma except –

 A

Achlorhydria

 B

‘O’ blood group

 C

Pernicious anaemia

 D

Post gastrectomy

Q. 6

All of the following predispose to gastric carcinoma except –

 A

Achlorhydria

 B

‘O’ blood group

 C

Pernicious anaemia

 D

Post gastrectomy

Ans. B

Explanation:

Ans. is ‘b’ i.e., ‘O’ blood group 

Quiz In Between


Q. 7

Gastric carcinoma involving the antrum with lymph node involvements. The pancreas, liver, peritoneal cavity are normal. Most appropriate surgery is ‑

 A

Total radical gastrectomy

 B

Palliative gastrectomy

 C

Gastrojejunostomy

 D

None of the above

Q. 7

Gastric carcinoma involving the antrum with lymph node involvements. The pancreas, liver, peritoneal cavity are normal. Most appropriate surgery is ‑

 A

Total radical gastrectomy

 B

Palliative gastrectomy

 C

Gastrojejunostomy

 D

None of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., None of the above 

Most appropriate surgery is -3 Radical subtotal gastroectomy


Q. 8

Which of the following anaemias is a risk factor for the development of gastric carcinoma ‑

 A

Pernicious anaemia

 B

Megaloblastic anaemia

 C

Aplastic anaemia

 D

Haemolytic anaemia

Q. 8

Which of the following anaemias is a risk factor for the development of gastric carcinoma ‑

 A

Pernicious anaemia

 B

Megaloblastic anaemia

 C

Aplastic anaemia

 D

Haemolytic anaemia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pernicious anaemia 


Q. 9

Early gastric cancer generally indicates :

 A

Gastric adencarcinoma detected early

 B

Gastric adenocarcinoma confined to the mucosa

 C

Gastric adenocarcinoma confined to the mucosa & submucosa

 D

Gastric adenocarcinoma less than 1 cm. In size

Q. 9

Early gastric cancer generally indicates :

 A

Gastric adencarcinoma detected early

 B

Gastric adenocarcinoma confined to the mucosa

 C

Gastric adenocarcinoma confined to the mucosa & submucosa

 D

Gastric adenocarcinoma less than 1 cm. In size

Ans. C

Explanation:

Answer is C (Gastric adenocarcinoma confined to mucosa and submucosa):

Early gastric carcinoma is defined as a lesion confined to the mucosa and submucosa regardless of the presence or absence of perigastric lymphnode metastasis

Quiz In Between


Q. 10

All the following indicates early gastric cancer except

 A

Involvement of mucosa

 B

Involvement of mucosa and submucosa

 C

Involvement of mucosa, submucosa and muscularis

 D

Involvement of mucosa, submucosa and adjacent lymph nodes

Q. 10

All the following indicates early gastric cancer except

 A

Involvement of mucosa

 B

Involvement of mucosa and submucosa

 C

Involvement of mucosa, submucosa and muscularis

 D

Involvement of mucosa, submucosa and adjacent lymph nodes

Ans. C

Explanation:

Answer is C (Involvement of mucosa, submucosa and muscularis)

Early gastric cancer:      Cancer limited to the mucosa and submucosa with or without lymph node involvement.

Late gastric cancer :       Cancer involving the muscularis.


Q. 11

Gastric carcinoma is associated with all EXCEPT ‑

 A

Inactivation of p53

 B

Over expression of C-erb

 C

Over expression of C-met

 D

Activation of RAS

Q. 11

Gastric carcinoma is associated with all EXCEPT ‑

 A

Inactivation of p53

 B

Over expression of C-erb

 C

Over expression of C-met

 D

Activation of RAS

Ans. D

Explanation:

Ans. is ‘d’ Activation of RAS

  • In the course of multi-step stomach carcinogenesis, various genetic and epigenetic alterations of oncogenes, tumor-suppressor genes, DNA repair genes, cell cycle regulators and cell adhesion molecules are involved. Genetic alteration in gastric cancer include:
  • Intestinal type gastric cancer: K-ras mutation, APC mutation, pS2 methylation, HMLH1 methylation, p I ema methylation, p 73 deletion and C-erb B-2 amplification.
  1. Diffuse type gastric caner: CDH I gene (E-Cadherin) mutation, K-sam amplification.
  2. For both type: Telomerase reduction (telomerase shortening), hTERT expression, genetic instability, overexpression of the cyclin E & CDC25B & E2F I genes,p53 mutations, reduced expression, CD44 aberrabont transcripts, and amplification of the C-met Cyclin E genes.

Coming to question:

  • All the given four genetic alterations may be associated with stomach cancer.
  • However among the given options K-ras is best answer as it is associated with gastric cancer in minimum percentage (amongst given options):

Source: Textbook of mechanism of carcinogenesis and cancer prevention

K-ras mutation -4 <10%
p53 mutation   30-60%
C-erb B-2 amplifcation –> 20%
C-met amplifciation –> 20%

Quiz In Between



Gastric Carcinoma

GASTRIC CARCINOMA


GASTRIC CARCINOMA

  • Carcinoma of stomach is the second most common cause of cancer death.
  • More common in males.
  • Proximal stomach carcinoma is the most common site for gastric carcinoma.
  • Gastric cancers can grow to an extent to cause damage to cells producing intrinsic factors and hence vitamin B12 deficiency.

Etiology-

  1. Risk factors-
  • Smoking, alcohol
  • EBV, H. Pylori
  • Pernicious anaemia

2. Genetic & familial

  • E- cadherin gene
  • CDH1 (90%)

3. Premalignant lesions-

  • Chronic atrophic gastritis- most common precursor lesion
  • Chronic gastric ulcer
  • Intestinal metaplasia (H. Pylori)
  • After Billroth II GJ or vagotomy GJ

Pathology

I) Lauren classification is the most useful classification of gastric cancer- 

 II) According to the depth of invasion- 

Clinical features- 

  • Vague epigastric discomfort after food.
  • Pain
  • Weight loss (most common symptom), anorexia, fatigue, vomiting.
  • Melena, hematemesis
  • Dysphagia
  • Gastric carcinomas are often associated with hypochlorhydria and achlorhydria.

Investigations-

  1. Complete blood picture- iron deficiency anaemia (microocytic, hypochromic)
  2. Oesophagogastroduodenoscopy- extent of the lesion & confirms the diagnosis.
  3. Ultrasound & CT scan- useful in detecting metastatic carcinoma.
  4. Laproscopy- laproscopic peritoneal lavage for cytology is the best test.
  5. Barium meal useful incase of linitis plastica.

Histopathalogy-

  • Hourglass appearance of the stomach caused by carcinoma.

Treatment-

  • Surgical resection of the stomach is the only curative treatment.
  • Endoscopic mucosal resection – tumours
  • Total radical gastrectomy with OG anastomosis of proximal stomach, linitis plastica.
  • Lower radical gastrectomy- growth in pylorus
  • Radical Gastrectomy perferred- early gastric cancer
  • Neo- adjuvant chemotherapy- epirubicin, cis- platinum, 5- FU infusion.
  • D2 gastrectomy refers to the extent of lymphadenectomy done along with the gastrectomy.

Exam Important

  • Carcinoma of stomach is the second most common cause of cancer death.
  • More common in males.
  • Proximal stomach carcinoma is the most common site for gastric carcinoma.
  • Gastric cancers can grow to an extent to cause damage to cells producing intrinsic factors and hence vitamin B12 deficiency.

Etiology-

  1. Risk factors-
  • Smoking, alcohol
  • EBV, H. Pylori
  • Pernicious anaemia

Premalignant lesions-

  • Chronic atrophic gastritis- most common precursor lesion
  • Chronic gastric ulcer
  • Intestinal metaplasia (H. Pylori)
  • After Billroth II GJ or vagotomy GJ

Clinical features- 

  • Gastric carcinomas are often associated with hypochlorhydria and achlorhydria.

Histopathalogy-

  • Hourglass appearance of the stomach caused by carcinoma.

Treatment-

  • Surgical resection of the stomach is the only curative treatment.
  • Endoscopic mucosal resection – tumours
  • Total radical gastrectomy with OG anastomosis of proximal stomach, linitis plastica.
  • Lower radical gastrectomy- growth in pylorus
  • Radical Gastrectomy perferred- early gastric cancer
  • D2 gastrectomy refers to the extent of lymphadenectomy done along with the gastrectomy.
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