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Carcinoma of the Stomach

 

Precancerous states

           •Pernicious anemia—18X normal population

             •Adenomas of the stomach—especially those over 2cm

             •Atrophic Gastritis—disputable

             •Hiatal hernia—disputable

             •Gastric stumps for ulcer disease (Bilroth II>Bilroth I)

             •Achlorhydria

Histology

             • Adenocarcinoma (95%)

             • Rarely, squamous cell

Morphology

             • Polypoid/fungating carcinoma

             • Ulcerating/penetrating carcinoma (70%)

             • Infiltrating/scirrhous type=linitis plastica

             • Superficial spreading type-confined to mucosa/submucosa-NOT linitis plastica

Metastases

             • Along peritoneal ligaments

                        ∆ Gastrocolic ligament to transverse colon

                        ∆ Gastrohepatic and hepatoduodenal to liver

             • To lymph nodes

                        ∆ Locally

                        ∆ Lymphangitic to lungs

             • Hematogenous

                        ∆ Liver (most common)/adrenals/ovaries/bones

             • Peritoneal seeding

                        ∆ Rectal wall=Blumer shelf

             • Left supraclavicular node=Virchow’s node

• Overall 5 year survival 5-18%

Malignant ulcer—is a carcinoma which presents with the radiographic appearance of an ulcer niche; these have the radiographic appearance of a benign ulcer but demonstrate microscopic foci of malignancy, usually at the edge of the ulcer

Ulcerating malignancy—is a carcinoma having sufficient bulk to present as a mass which also contains a persistent collection representing an ulcer; the mucosa is frequently nodular and the folds do not radiate to the base of the ulcer

Linitis plastica (scirrhous carcinoma)—is a diffuse involvement of the wall of the stomach, frequently with flattening of the mucosa, and poor distensibility and contraction of the wall; usually associated with significant fibrosis and muscular hypertrophy; very frequently a signet ring cell type

 

 

WH/92

 

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