gastric cancer
DESCRIPTION
TRANSCRIPT
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