Classification and Clinical features

Mithun Padmanabhan

The most important and the most common (90% to 95%) malignant tumor of stomach

Second leading cause of cancer-related deaths in the world

Two types WHO classification Lauren classification

Intestinal-Type Adenocarcinoma Diffuse Adenocarcinoma

Intestinal type Diffuse

Glandular structures with intestinal morphology

Predisposing

influences are many Gastric atrophy and

intestinal metaplasia, which are followed by dysplasia and cancer

Diffuse infiltrative growth of poorly differentiated malignant cells

Risk factors remain undefined

Precursor lesions have not been identified

Epithelial tumors Intraepithelial neoplasia: adenoma Adenocarcinoma

Papillary Tubular Mucinous Signet-ring Undifferenciated Adenosquamous

Small-cell carcinoma Carcinoid tumor

Non epithelial tumors Leiomyoma Schwannoma Granular cell tumor Leiomyosarcoma Gastrointestinal stromal cell tumor Kaposi sarcoma Others Malignant Lymphoma

Early gastric carcinoma Insidious disease Usually asymptomatic until late in course Non specific symptoms-Dyspesia Diagnostic endoscopy improves outcome Common screening procedure in Japan 5-year survival rate of 90-95%

Dyspepsia Endoscopy

5-year survival rate 5%

Early satiety Bloating Distention Vomiting Iron deficiency

anaemia Weight loss

Cardiac involvement – dysphagia Pyloric involvement –Obstructive symptoms Metastatic involvement of the left supraclavicular

lymph nodes-Virchow’s node Metastasis to periumbilical subcutaneous tissue-

Sister Joseph Mary nodule No metastatic effects-thrombophlebitis(Trosseau’s

sign) and deep vein thrombosis

Depends on extend of disease progression Depth of invasion Extent of nodal and distant metastasis at the

time of diagnosis

TREATMENT Surgical resection with or without adjuvant

chemotherapy and radiation