Today you are doing a gross dissection of the stomach and small intestines on Mrs. Dige Stron. Prior to the dissection your favourite anatomy instructor gives a brief overview and asks a few questions. Whoever gets the questions right gets a free chocolate bar, and the smell of formaldehyde is making you hungry. Today the question is “Which of the following is NOT one of the four main anatomical regions of the stomach”? You answer:

You are a R2 Family Practice resident and one rainy Friday afternoon while the clinic is slow, you are reviewing the file of a patient with Gastric cancer and you harken back to your days in medical school. You opt to quiz yourself and try to see if you can remember the 5 layers of the wall of the stomach from deep to superficial?

Today you are working with Dr. Gut, an Oncologist who treats Gastric cancers. It just so happens that his interests include: the superbowl, air-force history, and cancer subtypes, in that order. Seeing as he already asked you who won the 1993 Superbowl, to which you unfortunately disappointed him with your answer, he asks you: If you received a pathology report that stated: “This tissue sample, taken from the patient’s stomach who was found to have a suspicious lesion on gastroscopy appears to have glandular tissue resembling that found in the colon”, what type of gastric cancer specifically would you suspect the patient has?

Mr. Gus Trick has just walked into your clinic today. He is a 67 year old male of East Asian descent, who is presenting with a 6mth history of abdominal pain and weight loss. In addition he endorses some new onset difficulty swallowing and some dark stools. Throughout your appointment Mr. Trick believes he has been told he has an h.pylori infection, but he had to move before he got it treated. Additionally, he endorses a lifestyle of smoking, alcohol consumption, and salt consumption. Which of his risk factors for gastric cancer is non-modifiable?

In Western populations there is a low incidence of gastric cancer, and therefore screening in average risk patients is not endorsed. That being said, there are some screening programs in areas where gastric cancer is more endemic, or for patients with hereditary cancer syndromes. Which of the following is a potential screening modality for gastric cancer?

You are on an oncology elective and have just been tasked to go and see Mrs. Hanna Pylorus, a 63 year old female who had a gastric biopsy showing intestinal gastric adenocarcinoma. On history she endorses long standing abdominal pain, as well as dysphagia, early satiety, melena stools, and weight loss. Physical exam is largely non-contributory except for the presence of melena stool on your glove following the digital rectal exam. Laboratory findings show a microcytic anemia. Which of the following is the most common symptom of gastric cancer at diagnosis:

You are a 4th year medical student just starting an elective in rural family medicine. Your preceptor, Dr. Tummy, is a huge proponent of the early identification of cancer, which he believes can be achieved in part through conscious effort during your history, physical, and differential diagnoses. He gives you the following 5 hypothetical patients, and asks, which of the following patients would you consider for for further workup for suspected Gastric Cancer:

You are working in an oncology clinic and just about to see your patient Mr. Gus Trick. He is a 67 year old male who was recently diagnosed with gastric cancer. Mr. Trick was found to have metastatic disease, and he is presenting today to discuss treatment options. Other than the sequela of his gastric cancer, he is fairly healthy, and is willing to do whatever it takes. What is a good treatment regimen for him?

You are a third year medical student who has just started their third year clinical rotation in Oncology. Today you will be working with Dr. Rumbly, who primarily treats Gastric cancers. You begin the day with a quick review of TNM staging. To gauge your knowledge she asks the following: If you have a patient with a known gastric cancer that has the following characteristics: The cancer invades the serosa, there are 24 positive regional lymph nodes, and metastasis to the pancreas. What TNM stage would it be?

Approximately how many patients who had gastric cancer treated surgically with curative intent will experience recurrence of their disease?

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