Gastrointestinal surgery: hereditary diffuse gastric cancer: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: hereditary diffuse gastric cancer

Sample item

A 28-year-old woman carries a germline CDH1 mutation and her mother and aunt died of diffuse-type gastric cancer. Endoscopy and random biopsies are normal. What is the recommended management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Prophylactic total gastrectomy

CDH1 mutation carriers have a very high lifetime risk of diffuse gastric cancer, and diffuse tumours are hard to detect endoscopically because they spread submucosally. Prophylactic total gastrectomy is advised, typically in early adult life.

Option by option

  • A. Prophylactic total gastrectomy (correct)

    Correct. Total gastrectomy removes all gastric mucosa at risk in a mutation carrier.

  • B. Helicobacter pylori eradication only

    Eradication of H. pylori does not alter the germline risk.

  • C. Annual endoscopy only

    Endoscopic surveillance misses submucosal signet-ring foci, so it is not a safe substitute.

  • D. Subtotal gastrectomy

    Subtotal gastrectomy leaves at-risk mucosa behind.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Prophylactic total gastrectomy. CDH1 mutation carriers have a very high lifetime risk of diffuse gastric cancer, and diffuse tumours are hard to detect endoscopically because they spread submucosally.

Why is "Helicobacter pylori eradication only" not the answer?

Eradication of H. pylori does not alter the germline risk.

Why is "Annual endoscopy only" not the answer?

Endoscopic surveillance misses submucosal signet-ring foci, so it is not a safe substitute.

Why is "Subtotal gastrectomy" not the answer?

Subtotal gastrectomy leaves at-risk mucosa behind.

What concept does this question test?

It tests Gastrointestinal surgery: hereditary diffuse gastric cancer in General Surgery. Prophylactic total gastrectomy is advised, typically in early adult life.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: hereditary diffuse gastric cancer?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.