Gastric adenocarcinoma

Gastric adenocarcinoma 

Updated: 11/03/2023

© Jun Wang, MD, PhD

General features
  • Most common malignancy of stomach
  • More common: Japan, Chile, Northern Italy, China, Portugal, Russia
  • More common in men, elder, populations of low social economic status
  • May be associated with Lynch Syndrome
Pathogenesis
  • Intestinal type non-cardia gastric cancer: Helicobacter pylori infection, progressing from chronic non-atrophic gastritis to atrophic gastritis, then intestinal metaplasia, and finally dysplasia (Correa’s cascade), Wnt/beta-catenin pathways
  • Cancer of cardia: Associated with Barrett esophagus, chronic GERD and obesity
  •  Diffuse type CA or Familial: CDH1 (E-cadherin) mutation
Classification by morphology
  • Tubular adenocarcinoma
  • Papillary adenocarcinoma
  • Mucinous adenocarcinoma, tumor shows >50% mucin
  • Poorly cohesive carcinomas, including signet ring cell carcinoma
  • Other rare variants: Adenosquamous carcinoma, etc
Intestinal type
  • Majority, associated with intestinal metaplasia
  • Mean age 55 years, more common in men
  • Risk factors: Diet containing nitrates, smoked and salted foods, pickled vegetables, lack of citrus fruit, lack of green leafy vegetable; also low socioeconomic status, cigarette smoking
  • Host factors: chronic gastritis (intestinal metaplasia is a precursor lesion), H pylori infection, autoimmune gastritis, partial gastrectomy, gastric adenomas
Diffuse type
  • Also called linitis plastica or signet ring cell adenocarcinoma 
  • Aggressive clinical course
  • Infiltrative growth of poorly differentiated discohesive malignant cells
  • More common in younger age
  • No known risk factors except rarely hereditary diffuse gastric cancer (rare, autosomal dominant, related to mutations in E-cadherin gene (CDH1)
Kruckenberg tumor
Clinical presentations
  • Early stage usually asymptomatic
  • Symptoms in later stage include: Indigestion, nausea or vomiting, dysphagia, GI bleeding, weight loss, etc
Key pathological features
Genetic abnormalities
Loss of function mutation of APC
Gain of function mutation of beta catenin
  • E-cadherin gene (CDH1): diffuse type
Treatment
  • Surgery, chemo, radiation
Poor prognostic indicators:
  • Younger age
  • Proximal half of stomach, deep invasion, infiltrative margin
  • Diffuse histologic type
  • Positive surgical margins (predicts local recurrence), lymph node metastases



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