MRCS Part B Revision · Surgical pathology
Stomach Carcinoma — MRCS Part B Surgical pathology
By Dr Richard Miller, MBChB FRCS · Reviewed
Stomach Carcinoma is a surgical pathology station. Two of the seventeen examined stations in the MRCS Part B OSCE are surgical pathology. The surgical pathology stations ask you to reason from a specimen, a slide, a report or a vignette to a diagnosis, and then to say what it means for the patient in front of you.
What you need to know for the Stomach Carcinoma station
A patient with vomiting and deranged electrolytes whose stomach turns out to be the problem. Gastric cancer, from risk factors to staging and treatment.
Epidemiology and risk
Around 6,000 cases a year in the UK, mostly in men over 65, falling for decades in the West but still among the commonest cancers in East Asia. Risk factors: Helicobacter pylori (chronic gastritis to atrophy to intestinal metaplasia to dysplasia), smoking, a diet high in salted and smoked food and low in fresh fruit and vegetables, pernicious anaemia and atrophic gastritis, previous partial gastrectomy, adenomatous polyps, blood group A, and a family history, including hereditary diffuse gastric cancer with CDH1 mutations.
Presentation
Dyspepsia and epigastric pain, weight loss and anorexia, early satiety, dysphagia from a cardia tumour or outlet obstruction from an antral one, iron-deficiency anaemia, haematemesis or melaena. Signs come late: an epigastric mass, a left supraclavicular node (Virchow's; Troisier's sign), a periumbilical nodule (Sister Mary Joseph), a shelf on rectal examination (Blumer), ascites, jaundice.
Investigation
Endoscopy with multiple biopsies is the diagnosis. Staging: CT of chest, abdomen and pelvis, endoscopic ultrasound for depth of invasion and nodes, staging laparoscopy to find peritoneal disease before an attempted resection, and PET-CT in selected cases. Bloods for anaemia, nutrition and liver function.
Pathology
Adenocarcinoma in about 95%. Lauren's intestinal type forms glands, arises on metaplasia, and is the type falling in incidence; the diffuse type infiltrates as single signet-ring cells, occurs in the young, and can produce a rigid linitis plastica stomach. Other tumours of the stomach: lymphoma (MALT, driven by Helicobacter), gastrointestinal stromal tumours and neuroendocrine tumours.
Staging
TNM. T1 the mucosa or submucosa (early gastric cancer), T2 the muscularis propria, T3 the subserosa, T4 through the serosa or into adjacent organs. N by the number of involved nodes (N1 one or two, N2 three to six, N3 seven or more). M1 for distant spread, including peritoneal deposits and positive cytology.
Treatment and prognosis
Curative treatment for stage II and III disease is perioperative chemotherapy (FLOT, before and after) with a D2 gastrectomy: total for proximal tumours, subtotal for distal ones, with the nodes along the named arteries. Early T1 disease confined to the mucosa can be removed endoscopically. Unresectable or metastatic disease is treated with palliative chemotherapy, stenting for obstruction or dysphagia, and occasionally a bypass. Five-year survival is about 20% overall, over 90% for early gastric cancer, and around 40–50% after a resection for stage II disease with chemotherapy.
Complications
Of the tumour: bleeding, obstruction, perforation, malnutrition. Of gastrectomy: anastomotic leak, duodenal stump blow-out, dumping, bile reflux, B12 and iron deficiency, and weight loss.
What are you asked at the Stomach Carcinoma station?
The station runs to 15 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- How would you manage this patient?
- What do the blood gas and electrolytes demonstrate?
- The SHO has requested chest and abdominal films What do they show?
- What is your differential diagnosis?
- What are the risk factors for stomach cancer?
- What investigations would help you to identify an underlying cause?
- What signs and symptoms might you expect a patient with stomach cancer to present with?
- How common is stomach cancer?
- The patient undergoes an OGD and biopsy. What does the biopsy film demonstrate?
- What type of tumours are gastric malignancies?
- How do you stage gastric malignancy?
- What is the definitive management of stomach cancer?
And 3 more at this station.
How is the surgical pathology station marked in MRCS Part B?
Like the anatomy stations, a surgical pathology station is marked out of 20 with all 20 marks going to clinical knowledge and its application. The second of the two may be a microbiology station.
FAQ
What does the Stomach Carcinoma station ask?
It opens with "How would you manage this patient?" and runs to 15 questions over nine minutes. Like the anatomy stations, a surgical pathology station is marked out of 20 with all 20 marks going to clinical knowledge and its application. The second of the two may be a microbiology station.
How many pathology stations are in MRCS Part B?
Two of the seventeen examined stations. The intercollegiate blueprint titles the second one surgical pathology and/or microbiology, so infection and antimicrobial topics appear here rather than in a station of their own.
How is the pathology station marked?
Out of 20, with every mark awarded for clinical knowledge and its application. There are no communication or professionalism marks available in it.
What should I revise for surgical pathology?
The general processes the syllabus names, inflammation, healing, neoplasia and infection, applied to the specimens and reports a surgical trainee meets. Candidates most often report malignancies and their mutations, inherited cancer syndromes, and obstructive jaundice.
How many stations are in the MRCS Part B OSCE?
Seventeen examined stations of nine minutes each, with a minute to read the task before each one. Two preparation stations and at least one rest station bring the circuit to about twenty, and the exam takes about three and a half hours.
What is the pass mark for MRCS Part B?
There is no published pass mark. The cut score is set separately for Applied Knowledge and Applied Skills, for each circuit, by borderline regression. Published pass rates across the 2024/25 diets ranged from 51% to 66%.
Can I fail a station and still pass?
Yes. There is no rule about how many stations you may fail: the cut score applies to your total mark in each component, so a weak station costs the marks you lost on it and strong stations elsewhere can make them back. Applied Knowledge and Applied Skills are passed separately and must both be passed at the same sitting, so a strong anatomy performance cannot rescue a weak communication one.
Dr Richard Miller, MBChB FRCS
Station summaries are reviewed against the current intercollegiate MRCS syllabus and the published marking blueprint. Guidance changes between diets: check the royal colleges' own pages before relying on a date, a fee or a threshold.
Practise this station
The question bank carries the model answer to every question above, with the rest of the surgical pathology stations.
More surgical pathology stations