Pathology of gastric cancer

Abstract

This paper reviews the gross morphology, histologic classification, location, and modes of spread of gastric cancer. On the basis of gross appearance, we have classified gastric carcinoma into 4 types: (a) superficial spreading (6% of cases), (b) polypoid (11% of cases), (c) ulcerated (45% of cases), and (d) diffuse infiltrating (38% of cases). Our histologic classification includes 4 categories: (a) adenocarcinoma (70% of cases), (b) round cell carcinoma, (c) mucinous carcinoma, and (d) rare forms of carcinoma (squamous, adenoacanthoma, carcinosarcoma, collision tumor, ductogenic carcinoma). These main histologie categories are subdivided according to the degree of differentiation of each tumor. From 81 to 86% of gastric cancers arise in the pyloric region. Multifocal origin of stomach cancers occurs in about 10% of cases. The prognosis of gastric cancer depends on the extent of spread at the time of treatment. Intramural propagation beyond the grossly apparent margins is common, and extension into the duodenum and esophagus from lesions in the pylorus and cardia regularly occurs. Approximately 50% of gastric cancers infiltrate neighboring organs. Metastases to regional lymph nodes, particularly in the lesser curvature drainage area, occur in over half of the cases. Blood‐borne spread, to the liver and beyond, and peritoneal seeding are common.

Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer

“…Initial hemostasis was achieved in 93% of these patients. Few patients underwent clipping because of tumor characteristics such as marked fibrosis in the ulcer bed or hardness of the adjacent gastric mucosa because of tumor infiltration . The number of patients treated only with injection therapy or spray of hemostatic agents was also small because guidelines recommended that these procedures should not be used alone for treating nonvariceal UGIB .…”

“…Few patients underwent clipping because of tumor characteristics such as marked fibrosis in the ulcer bed or hardness of the adjacent gastric mucosa because of tumor infiltration. 26 The number of patients treated only with injection therapy or spray of hemostatic agents was also small because guidelines recommended that these procedures should not be used alone for treating nonvariceal UGIB. [8][9][10][11]23 Taken together, these results suggest that endoscopic electrocoagulation should be considered as a primary treatment for UGIB from unresectable AGC, although further studies will be needed.…”

Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

“…Meanwhile, mechanical therapy using hemoclips was performed in a small number of patients, and the rate of initial hemostasis was low, resulting from difficult hemoclip placement because of tumor bed characteristics, such as marked fibrosis and hardness of the adjacent mucosa. 43 In addition, hemoclip placement is difficult for treating a bleed resulting from a peptic ulcer with fibrotic and hard mucosa. 41 Thus, electrocoagulation may be a better option than hemoclips in cases with a spurting hemorrhage and non-bleeding visible vessels on endoscopy.…”

Gastric cancer: A neoplastic enigma

“…The extent of locoregional gastric cancer spread can be unpredictable and diffuse, since the lymphatic drainage of the stomach widely overlaps, leading to secondary tumor spread at sites far removed from the primary lesion [7] ( Fig. 2).…”