ABSITE - Stomach questions and answers with solutions 2025

A 60 year old man presents with weight loss, early satiety, and mild anemia. Upper endoscopy r
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eveals an ulcerated mucosal mass in the antrum of the stomach. Biopsy reveals gastric adenocar
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cinoma. The endoscopic ultrasound stage is T2N1. A CT of the chest, abdomen, and pelvis is obt
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ained and there is no evidence of metastatic disease. In order to complete the staging, he will re
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quire:

A. PET scan
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B. CEA and CA 19-9 levels
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C. MRI of the abdomen
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D. Diagnostic laparoscopy
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E. Genetic risk assessment - ANSWER Diagnostic laparoscopy
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Correct.

PET is not used routinely for the staging of gastric cancer as only 50% of gastric cancers are PET-
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avid. Staging laparoscopy identifies occult metastatic disease in 23-
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37% of patients thought to have localized disease as assessed by CT. This is a safe, low-
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risk procedure that helps to prevent unnecessary laparotomies in patients with otherwise undet
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ectable metastatic disease. Staging laparoscopy should be performed prior to neoadjuvant thera
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py.



A 72-year-old woman had upper endoscopy because of anemia. A 1.5-
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cm submucosal mass in the body of the stomach in addition to 3 small (< 0.5 cm) nodules were f
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ound along with a lack of rugal folds. Biopsies show the small nodules and largest mass are carci
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noid tumors and other biopsies show atrophic gastric mucosa. Her serum gastrin level is 550 pg/
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mL (normal < 100 pg/mL). Optimal treatment at this time would be:
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A. Total gastrectomy
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B. Observation
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C. Wedge excision of the largest tumor
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D. Antrectomy in addition to enucleation or wedge excision of the largest tumor
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, E. Proximal gastrectomy with esophagogastrostomy -
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ANSWER Antrectomy in addition to enucleation or wedge excision of the largest tumor
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Correct.

The treatment of patients with gastric carcinoid tumors depends on the size of the tumor and th
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e cause. There are 3 groups of patients: those with atrophic gastritis or pernicious anemia, those
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Owith Zollinger- O



Ellison syndrome, or those whose tumors occur sporadically. Sporadic tumors are assumed to be
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Omalignant until proven otherwise. Tumors associated with hypergastrinemia (Zollinger-
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Ellison syndrome or atrophic gastritis) are less aggressive, and treatment of these 2 populations
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is directed toward eradication of hypergastrinemia. In fact, complete regression of all tumors aft
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er antrectomy alone has been documented in patients with atrophic gastritis and multiple small
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carcinoids.



This patient's tumor is due to hypergastrinemia in the setting of atrophic gastritis. A work-
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up to rule out Zollinger-
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Ellison syndrome is not indicated because the mucosa in patients with Zollinger-
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Ellison syndrome is hypertrophic. In a patient with atrophic gastritis, the best treatment for a tu
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mor < 2 cm would be local excision of the dominant tumor with antrectomy.
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A 50-year-
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old man presents with an asymptomatic, incidentally discovered mass arising from the stomach.
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OThis is a 10-cm, partially cystic lesion arising from a 2-
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cm stalk on the greater curvature of the stomach. Biopsy reveals a GIST with 4 mitoses/10 hpf. T
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he tumor is positive for a c-
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kit exon 11 mutation. Axial imaging reveals no evidence of metastatic disease. The most appropr
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iate treatment is: O O




A. Watchful waiting with serial CT scans every 3-6 months
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B. Wedge resection of the greater curvature of the stomach to remove the cystic mass and assoc
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iated stalk O




C. Distal gastrectomy with D1 lymphadenectomy
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D. Distal gastrectomy with D2 lymphadenectomy
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