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Q1: Metastatic eponyms (2 min)
- Virchow/Troisier, Sister Mary Joseph, Krukenberg, Blumer’s shelf
- Any one usually means stage IV — systemic therapy ± palliation
Q2: Pathogenesis (2 min)
- Correa cascade and H. pylori Class I carcinogen
- Lauren intestinal vs diffuse; linitis plastica
- Risks: smoked/salted foods, smoking, atrophic gastritis, pernicious anaemia, CDH1, EBV subset
Q3: Staging pathway (2 min)
- OGD multi-biopsy → CT CAP → staging laparoscopy for potentially resectable ≥T2/N+
- HER2, MMR/MSI for systemic options
- Avoid non-therapeutic open exploration when peritoneal disease present
Q4: Surgery and D2 (3 min)
- Subtotal vs total by site/histology
- D2 vs D1: improved cancer-specific outcomes with modern spleen-preserving D2
- Roux-en-Y reconstruction common after distal/total
- Margins and frozen section for diffuse type
Q5: Perioperative therapy (3 min)
- FLOT perioperative standard for fit patients (FLOT4)
- MAGIC established perioperative chemo concept (ECF)
- Metastatic: chemo ± trastuzumab if HER2+; immunotherapy if MSI-H/high PD-L1 per indication
- Palliative stent/gastrojejunostomy for GOO; bleeding management
Q6: Post-gastrectomy care (2 min)
- Lifelong B12 after total; iron deficiency common
- Early dumping (osmotic/vasomotor) vs late dumping (hypoglycaemia)
- Small frequent meals; dietitian
Q7: Early disease and screening (2 min)
- ESD for selected intramucosal well-differentiated lesions
- Population screening where incidence high (East Asia); India opportunistic for alarm symptoms
Q8: Exam traps (2 min)
- Do not give mFOLFIRINOX as gastric perioperative standard — that is pancreas; gastric fit patients get FLOT
- Virchow = stage IV — systemic therapy, not curative D2 alone
- Always stage laparoscopy before radical resection when occult peritoneum risk is high