Carcinoma of the stomach


Gastric cancer can be an eminently curable disease due to all except


A. It rarely disseminates widely before it has involved the lymph nodes
B. Helicobacter pylori eradication constitutes a primary prevention
C. Surgical resection enhanced by standardized lymphadenectomy remains the gold standard in gastric cancer therapy
D. Early presentation is the key to success with this disease



Which of the following diseases are associated with increased risk of gastric cancer except


A. Epstein–Barr virus (EBV) infection

B. Aspirin users

C. Pernicious anemia

D. Ménétrier disease



True of sporadic gastric cancers are

A. Occur in relatively younger people
B. Males are two times more often affected than females
C. Has a particular geographic distribution
D. No risk factor has been identified



Not true of early onset gastric cancer


A. Occur before the age of 45 years
B. Often multifocal & diffuse
C. More frequently observed in females
D. Environmental factors implicated



Features of gastric stump cancer includes all except


A. Gastrectomy is a well-established risk factor
B. H. pylori infection is more often found
C. Occurs in the gastric remnant at least 5 years after the surgery for peptic ulcer
D. Commonly preceded mostly by dysplasia



Site of gastric cancer varies indifferent scenario as all except

A. The proximal stomach is the most common site for gastric cancer in resource-rich western countries.
B. Lower esophagus is involved in cases of adenocarcinoma
C. Distal cancer still predominates in Japan
D. Heavy alcohol consumption is associated with non-cardia carcinoma



In short


Multidisciplinary team


Multidisciplinary team (MDT) for managing gastric cancer should include at least a surgeon, pathologist, gastroenterologist, medical and radiation oncologist.


Curative surgery


Curative surgery involves complete resection with a standardized D2 lymphadenectomy.


First line Chemotherapy regimens


First line Chemotherapy regimens include a combination of fluoropyrimidine doublet, but adding an anthracycline has been shown to be beneficial. The most commonly used protocols are ECF (epirubicin, cisplatin, 5-FU), ECX (epirubicin, cisplatin, capecitabine), EOF (epirubicin, oxaliplatin, 5-FU), and EOX (epirubicin, oxaliplatin, capecitabine).
“Trastuzumab” in combination with capecitabine or 5-FU and cisplatin is now the standard of care for HER2-positive GCs.


Second-line therapy


Second-line therapy is based on irinotecan, docetaxel, and paclitaxel.


Addition of radiotherapy


Addition of radiotherapy in a preoperative setting may be beneficial. Radiotherapy is well tolerated, improves the resectability of the tumor, and does not increase the frequency of surgical complications.


Palliative chemotherapy


Palliative chemotherapy in patients with inoperable gastric cancer prolongs survival and improves the quality of life.


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