gastric cancer

Gastric cancer

Adenocarcinoma 95%

Lymphoma 4%

GIST 1%

Malignant tumors

Symptom Percent

Weight loss 62

Abdominal pain 52

Nausea 34

Dysphagia 24

Melena 20

Early satiety 18

Ulcer-type pain 17

anorexia ?

symptoms

- Normal PH/E except for metastasis.- The most common metastatic distribution is

to the liver, peritoneal surfaces, and nonregional or distant lymph nodes. Less commonly, ovaries, central nervous system, bone, pulmonary or soft tissue metastases occur.

Physical exam

 left supraclavicular adenopathy : Virchow's node

 periumbilical nodule :Sister Mary Joseph's node

 left axillary node : Irish node

lymphatycs

Peritoneal spread can present with an enlarged ovary Krukenberg's tumor or a mass in the cul-de-sac on rectal examination Blumer's shelf .

peritoeal Metastatic signs

palpable liver Jaundice ascites

liver

seborrheic keratoses (sign of Leser-Trelat)

Paraneoplastic signs

acanthosis nigricans

Paraneoplastic signs

- Age > 45 or- Alarming sign or- Family history

who should go under further evaluations?

Atrophic gastritis Gastric epithelial polyps Gastric metaplasia and dysplasia Pernicious anemia and gastric carcinoid

tumors Postgastric surgery Familial adenomatous polyposis and

hereditary nonpolyposis colorectal cancer (Lynch syndrome)

screening

Histologic classification Vienna classification:

Category 1: Negative for neoplasia/dysplasia Category 2: Indefinite for neoplasia/dysplasia Category 3: Noninvasive low-grade neoplasia (low-

grade adenoma/dysplasia) Category 4: Noninvasive high-grade neoplasia 4.1: High-grade adenoma/dysplasia 4.2: Noninvasive carcinoma (carcinoma in situ) 4.3: Suspicion of invasive carcinoma Category 5: Invasive neoplasia 5.1: Intramucosal carcinoma (invasion into the

lamina propria or muscularis mucosae) 5.2: Submucosal carcinoma or beyond

classifications

Morphology: Lauren classification intestinal (well-differentiated) diffuse (undifferentiated)

classification

 morphology: intercellular adhesion molecules  differences are attributable to intercellular

adhesion molecules, which are well preserved in intestinal-type tumors and defective in diffuse carcinomas. In intestinal tumors, the tumor cells adhere to each other, and tend to arrange themselves in tubular or glandular formations.

Molecular : expression of E-cadherin Epidemiology: high risk population vs.

genetic defect

Intestinal vs. diffuse

precancerous process or cascade:

H pylori and intestinal gastric cancer

Non-atrophi

c gastriti

s

Atrophic

gastritis

Intestinal

metaplasia

Dysplasia

Borrmann system: Polypoid Fungating Ulcerated diffusely infiltrating tumors

Macroscopic classification

staging Primary tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria T1 Tumor invades lamina propria, muscularis mucosae, or submucosa T1a Tumor invades lamina propria or muscularis mucosae T1b Tumor invades submucosa T2 Tumor invades muscularis propria* T3 Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or

adjacent structures T4 Tumor invades serosa (visceral peritoneum) or adjacent structures T4a Tumor invades serosa (visceral peritoneum) T4b Tumor invades adjacent structures Regional lymph nodes (N) NX Regional lymph node(s) cannot be assessed N0 No regional lymph node metastasis◊ N1 Metastasis in 1-2 regional lymph nodes N2 Metastasis in 3-6 regional lymph nodes N3 Metastasis in seven or more regional lymph nodes N3a Metastasis in 7-15 regional lymph nodes N3b Metastasis in 16 or more regional lymph nodes Distant metastasis (M) M0 No distant metastasis M1 Distant metastasis