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# | '''Gastric carcinoma''', also '''carcinoma of the stomach''', is an epithelial derived [[malignant]] tumour that arises from the [[stomach]]. | ||
Many gastric carcinomas form glands and can thus be called '''gastric adenocarcinoma''' or '''adenocarcinoma of the stomach'''. | |||
==General== | |||
Epidemiology: | |||
*Prognosis is often poor as it is discovered at a late stage. | |||
*Higher prevalence in countries in the far east (e.g. Japan) - thought to be environmental, e.g. diet. | |||
Risk factors: | |||
*Associated with helicobacter infections, i.e. [[Helicobacter gastritis]]. | |||
*[[Alcohol]] - heavy use.<ref name=pmid21993435>{{Cite journal | last1 = Duell | first1 = EJ. | last2 = Travier | first2 = N. | last3 = Lujan-Barroso | first3 = L. | last4 = Clavel-Chapelon | first4 = F. | last5 = Boutron-Ruault | first5 = MC. | last6 = Morois | first6 = S. | last7 = Palli | first7 = D. | last8 = Krogh | first8 = V. | last9 = Panico | first9 = S. | title = Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. | journal = Am J Clin Nutr | volume = 94 | issue = 5 | pages = 1266-75 | month = Nov | year = 2011 | doi = 10.3945/ajcn.111.012351 | PMID = 21993435 }}</ref> | |||
*Genetic syndromes - see [[hereditary gastric cancer]]. | |||
Note: | |||
*Possible association with tobacco use - dependent on the study.<ref>{{Cite journal | last1 = Nomura | first1 = A. | last2 = Grove | first2 = JS. | last3 = Stemmermann | first3 = GN. | last4 = Severson | first4 = RK. | title = Cigarette smoking and stomach cancer. | journal = Cancer Res | volume = 50 | issue = 21 | pages = 7084 | month = Nov | year = 1990 | doi = | PMID = 2208177 | URL = http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=2208177}}</ref> | |||
Treatment: | |||
*Surgical excision. | |||
**Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part. | |||
===Classification=== | |||
*Two different classification schemes. | |||
**Lauren<ref name=pmid14320675>{{cite journal |author=LAUREN P |title=THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION |journal=Acta Pathol Microbiol Scand |volume=64 |issue= |pages=31–49 |year=1965 |pmid=14320675 |doi= |url=}}</ref> - two types: | |||
***Intestinal type (mass forming). | |||
***Diffuse type (infiltrative). | |||
**WHO classification - 6 subtypes for adenocarcinoma:<ref name=Ref_PBoD823>{{Ref PBoD |823}}</ref> | |||
**#Papillary carcinoma. | |||
**#Tubular carcinoma. | |||
**#Mucinous carcinoma. | |||
**#Signet-ring carcinoma. | |||
**#Undifferentiated carcinoma. | |||
**#[[Adenosquamous carcinoma]]. | |||
Lame memory device ''STOMACH'': | |||
*'''S'''ignet ring, '''T'''ubular, '''O'''h papillary, '''M'''ucinous, '''A'''denosquamouas, '''C'''rappy '''H'''igh grade (Undifferentiated). | |||
==Gross== | |||
Location: | |||
*Large carcinomas preferentially involve the lesser curvature.<ref name=pmid2550682>{{Cite journal | last1 = Yamagawa | first1 = H. | last2 = Onishi | first2 = T. | title = [A clinicopathological study of early gastric cancers with a diameter larger than five centimeters]. | journal = Gan No Rinsho | volume = 35 | issue = 10 | pages = 1114-8 | month = Sep | year = 1989 | doi = | PMID = 2550682 }}</ref> | |||
*Ulceration with heaped (raised) edges. | |||
**Appearance of the typical intestinal type tumour. | |||
*Diffuse wall thickening with loss of the rugae - called ''linitis plastica''. | |||
**Typically due to diffuse carcinoma. | |||
Main DDx of ulcer: | |||
*[[Peptic ulcer disease]] - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa. | |||
===Images=== | |||
<gallery> | |||
Image:Linitis_plastica.jpg | Linitis plastica - endoscopic image. (WC) | |||
Image:Adenocarcinoma_of_the_stomach.jpg | Ulcerating gastric carcinoma. (WC) | |||
Image:Adenocarcinoma,_stomach,_gross_pathology_IMG0037a_lores.jpg | Ulcerating gastric carcinoma. (WC) | |||
</gallery> | |||
==Microscopic== | |||
Features - variable, either of the two following: | |||
#"Typical adenocarcinoma": | |||
#*Gland-forming lesion that infiltrates into the lamina propria or beyond. | |||
#*Nuclear pleomorphism - common. | |||
#+/-Signet ring carcinoma. | |||
#*Scattered single cells in the lamina propria or beyond with: | |||
#**Abundant cytoplasm containing one large (mucin-filled) vacuole. | |||
#**A peripheral nucleus (displaced by the vacuole). | |||
DDx: | |||
*[[Gastric xanthoma]] - may mimic signet ring cell carcinoma. | |||
*[[Neuroendocrine tumour]] - esp. for poorly differentiated; no gland formation. | |||
===Grading=== | |||
*Moderately differentiated >=50 % glands.{{fact}} | |||
*Poorly differentiated >=50% no glands (sheeting or nests). | |||
===Images=== | |||
<gallery> | |||
Image:Gastric_adenocarcinoma.jpg | Gastric adenocarcinoma. (WC) | |||
Image:Gastric_signet_ring_cell_carcinoma_histopatholgy_%282%29_PAS_stain.jpg | Gastric SRC - PAS stain. (WC) | |||
</gallery> | |||
www: | |||
*[http://path.upmc.edu/cases/case196.html Gastric adenocarcinoma - several images (upmc.edu)]. | |||
==Stains== | |||
*Mucicarmine +ve. | |||
==IHC== | |||
*CK7 +ve. | |||
*CK20 -ve, occasionally +ve. | |||
Others: | |||
*p53 +ve in upto 75% of cases.<ref name=pmid21772890>{{Cite journal | last1 = Zali | first1 = MR. | last2 = Moaven | first2 = O. | last3 = Asadzadeh Aghdaee | first3 = H. | last4 = Ghafarzadegan | first4 = K. | last5 = Ahmadi | first5 = KJ. | last6 = Farzadnia | first6 = M. | last7 = Arabi | first7 = A. | last8 = Abbaszadegan | first8 = MR. | title = Clinicopathological significance of E-cadherin, β-catenin and p53 expression in gastric adenocarinoma. | journal = J Res Med Sci | volume = 14 | issue = 4 | pages = 239-47 | month = Jul | year = 2009 | doi = | PMID = 21772890 }}</ref> | |||
==Molecular== | |||
*May have HER2 over expression - more common in intestinal-type tumours.<ref name=pmid22213295>{{Cite journal | last1 = Romiti | first1 = A. | last2 = Di Rocco | first2 = R. | last3 = Milione | first3 = M. | last4 = Ruco | first4 = L. | last5 = Ziparo | first5 = V. | last6 = Zullo | first6 = A. | last7 = Duranti | first7 = E. | last8 = Sarcina | first8 = I. | last9 = Barucca | first9 = V. | title = Somatostatin receptor subtype 2 A (SSTR2A) and HER2 expression in gastric adenocarcinoma. | journal = Anticancer Res | volume = 32 | issue = 1 | pages = 115-9 | month = Jan | year = 2012 | doi = | PMID = 22213295 }}</ref> | |||
**Poor prognosis - like in breast cancer. | |||
**Scoring system different than in breast cancer - complete membrane staining is not required. | |||
==Sign out== | |||
===Biopsy=== | |||
====Intestinal type==== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED. | |||
- Gastric mucosa with moderate chronic active inflammation and extensive | |||
intestinal metaplasia. | |||
- Benign small bowel mucosa with erosions. | |||
</pre> | |||
<pre> | |||
GASTRIC ULCER, BIOPSY: | |||
- INVASIVE ADENOCARCINOMA, INTESTINAL-TYPE, MODERATELY DIFFERENTIATED. | |||
</pre> | |||
====Diffuse type==== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- INVASIVE ADENOCARCINOMA, DIFFUSE TYPE. | |||
COMMENT: | |||
A pankeratin immunostain demonstrates single (infiltrating) epithelial cells in the | |||
lamina propria. | |||
</pre> | |||
=====Micro===== | |||
The tumour consists of single cells with abundant foamy-appearing cytoplasm and eccentric | |||
nuclei with mild nuclear atypia. | |||
====Poorly differentiated==== | |||
<pre> | |||
GASTRIC ULCER, BIOPSY: | |||
- INVASIVE ADENOCARCINOMA, POORLY-DIFFERENTIATED. | |||
</pre> | |||
==See also== | |||
*[[Stomach]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Stomach]] | |||
[[Category:Diagnosis]] | |||