Gastric Cancer

Answer Explanation:

• The correct answer is Pernicious anaemia. This is because Pernicious anaemia is a well-recognized risk factor for gastric adenocarcinoma.
• Pernicious anaemia is an autoimmune condition that affects the stomach, leading to chronic atrophic gastritis. This chronic inflammation can lead to gastric adenocarcinoma over time.
• While Crohn’s disease, long-term omeprazole use, laxative abuse, and long-term aspirin use can have effects on the gastrointestinal system, they are not recognized risk factors for gastric adenocarcinoma.

Overview of Gastric Adenocarcinoma:

Etiology:

• Gastric adenocarcinoma is a type of stomach cancer that begins in the glandular cells of the stomach lining.
• It is the most common type of stomach cancer.
• It is associated with several risk factors, including Pernicious anaemia, Helicobacter pylori infection, smoking, certain dietary factors, and certain genetic conditions.

Pathophysiology:

• The exact pathophysiology of gastric adenocarcinoma is complex and not fully understood.
• It is thought to involve a combination of genetic and environmental factors, leading to the development of mutations in the DNA of stomach cells.
• These mutations can cause the cells to grow and divide uncontrollably, forming a tumor.

Clinical Presentation:

• Early-stage gastric adenocarcinoma often causes no symptoms.
• As the disease progresses, symptoms may include indigestion, stomach pain, nausea, loss of appetite, weight loss, and fatigue.
• In advanced stages, gastric adenocarcinoma can cause difficulty swallowing, vomiting blood, or blood in the stool.

Diagnosis and Treatment:

• Diagnosis typically involves a combination of physical examination, medical history, and diagnostic tests such as endoscopy and biopsy.
• Treatment options include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.

Answer Explanation:

• The correct answer is ‘Acanthosis nigricans is an extra-gastrointestinal feature of the disease’. Acanthosis nigricans, a skin condition characterized by dark, velvety patches in body folds and creases, is indeed an extra-gastrointestinal feature of gastric adenocarcinoma. It is associated with many malignancies, including gastric adenocarcinoma, and is thought to be due to the secretion of substances that stimulate skin growth by the tumor.

Incorrect Options Explanation:

• ‘Most are located in the cardia of the stomach’ – This statement is incorrect. Gastric adenocarcinomas are most commonly located in the antrum of the stomach, not the cardia.
• ‘It may present with a right-sided supraclavicular lymph node (Virchow’s node)’ – While this is true, it is not the most common presentation and is typically indicative of advanced disease.
• ‘It is an inoperable malignancy’ – This statement is too broad. Operability depends on the stage of the disease at diagnosis. Early-stage gastric adenocarcinomas can often be resected, while late-stage tumors may be inoperable.
• ‘Radiotherapy offers the best hope of a cure’ – This is not accurate. The mainstay of curative treatment for gastric adenocarcinoma is surgical resection, often in combination with chemotherapy. Radiotherapy may be used in certain circumstances, but it is not typically the primary treatment.

Overview of Gastric Adenocarcinoma:

• Definition: Gastric adenocarcinoma is a type of cancer that starts in the glandular cells of the stomach lining. It is the most common type of stomach cancer.
• Epidemiology: It is the third leading cause of cancer-related deaths worldwide, with a higher prevalence in East Asia, Eastern Europe, and South America.
• Risk Factors: These include Helicobacter pylori infection, chronic gastritis, smoking, certain dietary factors (such as consumption of smoked foods, salted fish and meat, and pickled vegetables), and certain genetic conditions.
• Clinical Features: Symptoms can be non-specific and include dyspepsia, weight loss, abdominal pain, anorexia, and symptoms of anemia. In advanced stages, it may present with a palpable abdominal mass, hepatomegaly, ascites, or supraclavicular lymphadenopathy (Virchow’s node).
• Extra-gastrointestinal Features: These include acanthosis nigricans, Leser-Trélat sign (sudden appearance of multiple seborrheic keratoses), and Sister Mary Joseph’s nodule (a palpable nodule bulging into the umbilicus as a result of metastasis).
• Treatment: The mainstay of treatment is surgical resection, often combined with chemotherapy. The role of radiotherapy is limited and is typically used in a palliative setting or as an adjuvant therapy.