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Pathology - Gastric carcinoma
Definition • A malignant epithelial neoplasm originating in the stomach.
Epidemiology • Significant geographical diversity in incidence attributable to dietary variables. Changes in diet in nations with a historically high incidence are resulting in a consistent decrease in global incidence.
Aetiology: Diet is the most consistent determinant. Excessive salt consumption is a significant risk factor, whereas fresh fruits and vegetables offer protection due to their antioxidant properties. H. pylori and autoimmune gastritis are significant risk factors, as they facilitate a progression from chronic gastritis to gastric atrophy, then to intestinal metaplasia, followed by epithelial dysplasia, and ultimately cancer.
Carcinogenesis • Free radicals, oxidants, and reactive oxygen species generated by H. pylori infection and dietary carcinogens induce DNA damage. Common genetic targets encompass TP53 and KRAS. Diffuse-type carcinomas frequently exhibit a lack of E-cadherin.
Presentation • Early gastric cancer may be asymptomatic or elicit nonspecific symptoms such as dyspepsia. • Advanced cases result in chronic stomach pain accompanied by weight loss. • Tumors may also hemorrhage, resulting in hematemesis, or impede the gastric exit, leading to emesis.
Macroscopy • A tumor mass within the gastric wall that may present as exophytic or diffusely infiltrative.
Histopathology: Predominantly adenocarcinomas. Intestinal-type adenocarcinoma has infiltrating malignant epithelial cells that create discernible glandular structures. Diffuse-type adenocarcinoma is characterized by infiltrating malignant epithelial cells that exhibit weak cohesion and minimal to no glandular development. Malignant cells may possess intracytoplasmic vacuoles filled with mucin. Cells engorged with mucin, causing the nucleus to be shifted to one side, are referred to as 'signet ring' cells. Tumors characterized by a high prevalence of signet ring cells are typically extensively infiltrative.
Prognosis • Varies with stage, but typically manifests late with an unfavorable prognosis
Definition • A malignant epithelial neoplasm originating in the stomach.
Epidemiology • Significant geographical diversity in incidence attributable to dietary variables. Changes in diet in nations with a historically high incidence are resulting in a consistent decrease in global incidence.
Aetiology: Diet is the most consistent determinant. Excessive salt consumption is a significant risk factor, whereas fresh fruits and vegetables offer protection due to their antioxidant properties. H. pylori and autoimmune gastritis are significant risk factors, as they facilitate a progression from chronic gastritis to gastric atrophy, then to intestinal metaplasia, followed by epithelial dysplasia, and ultimately cancer.
Carcinogenesis • Free radicals, oxidants, and reactive oxygen species generated by H. pylori infection and dietary carcinogens induce DNA damage. Common genetic targets encompass TP53 and KRAS. Diffuse-type carcinomas frequently exhibit a lack of E-cadherin.
Presentation • Early gastric cancer may be asymptomatic or elicit nonspecific symptoms such as dyspepsia. • Advanced cases result in chronic stomach pain accompanied by weight loss. • Tumors may also hemorrhage, resulting in hematemesis, or impede the gastric exit, leading to emesis.
Macroscopy • A tumor mass within the gastric wall that may present as exophytic or diffusely infiltrative.
Histopathology: Predominantly adenocarcinomas. Intestinal-type adenocarcinoma has infiltrating malignant epithelial cells that create discernible glandular structures. Diffuse-type adenocarcinoma is characterized by infiltrating malignant epithelial cells that exhibit weak cohesion and minimal to no glandular development. Malignant cells may possess intracytoplasmic vacuoles filled with mucin. Cells engorged with mucin, causing the nucleus to be shifted to one side, are referred to as 'signet ring' cells. Tumors characterized by a high prevalence of signet ring cells are typically extensively infiltrative.
Prognosis • Varies with stage, but typically manifests late with an unfavorable prognosis
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