1. Gastric cancer

4. Malignant tumors
Adenocarcinoma
95%
Lymphoma
4%
GIST
1%

5. symptoms
Symptom
Percent
Weight loss
62
Abdominal pain
52
Nausea
34
Dysphagia
24
Melena
20
Early satiety
18
Ulcer-type pain
17
anorexia
?

6. Physical exam
- Normal PH/E except for metastasis.
- The most common metastatic distribution is to the
liver, peritoneal surfaces, and nonregional or distant
lymph nodes. Less commonly, ovaries, central
nervous system, bone, pulmonary or soft tissue
metastases occur.

7. lymphatycs
left supraclavicular adenopathy : Virchow's node
periumbilical nodule :Sister Mary Joseph's node
left axillary node : Irish node

8. peritoeal Metastatic signs
Peritoneal spread can present with an enlarged ovary
Krukenberg's tumor or a mass in the cul-de-sac on
rectal examination Blumer's shelf .

9. liver
palpable liver
Jaundice
ascites

10. Paraneoplastic signs
seborrheic keratoses (sign of Leser-Trelat)

11. Paraneoplastic signs
acanthosis nigricans

12. who should go under further
evaluations?
- Age > 45 or
- Alarming sign or
- Family history

13. screening
Atrophic gastritis
Gastric epithelial polyps
Gastric metaplasia and dysplasia
Pernicious anemia and gastric carcinoid tumors
Postgastric surgery
Familial adenomatous polyposis and hereditary
nonpolyposis colorectal cancer (Lynch syndrome)

14. classifications
Histologic classification
Vienna classification:
Category 1: Negative for neoplasia/dysplasia
Category 2: Indefinite for neoplasia/dysplasia
Category 3: Noninvasive low-grade neoplasia (low-grade
adenoma/dysplasia)
Category 4: Noninvasive high-grade neoplasia
4.1: High-grade adenoma/dysplasia
4.2: Noninvasive carcinoma (carcinoma in situ)
4.3: Suspicion of invasive carcinoma
Category 5: Invasive neoplasia
5.1: Intramucosal carcinoma (invasion into the lamina propria
or muscularis mucosae)
5.2: Submucosal carcinoma or beyond

15. classification
Morphology: Lauren classification
intestinal (well-differentiated)
diffuse (undifferentiated)

16. Intestinal vs. diffuse
morphology: intercellular adhesion molecules
differences are attributable to intercellular adhesion
molecules, which are well preserved in intestinal-type
tumors and defective in diffuse carcinomas. In intestinal
tumors, the tumor cells adhere to each other, and tend
to arrange themselves in tubular or glandular
formations.
Molecular : expression of E-cadherin
Epidemiology: high risk population vs. genetic defect

17. H pylori and intestinal gastric cancer
precancerous process or cascade:
Nonatrophic
gastritis
Atrophic
gastritis
Intestinal
metaplasia
Dysplasia

18. Macroscopic classification
Borrmann system:
Polypoid
Fungating
Ulcerated
diffusely infiltrating tumors

19. staging
Primary tumor (T)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria
T1
Tumor invades lamina propria, muscularis mucosae, or submucosa
T1a
Tumor invades lamina propria or muscularis mucosae
T1b
Tumor invades submucosa
T2
Tumor invades muscularis propria*
T3
Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures
T4
Tumor invades serosa (visceral peritoneum) or adjacent structures
T4a
Tumor invades serosa (visceral peritoneum)
T4b
Tumor invades adjacent structures
Regional lymph nodes (N)
NX
Regional lymph node(s) cannot be assessed
N0
No regional lymph node metastasis◊
N1
Metastasis in 1-2 regional lymph nodes
N2
Metastasis in 3-6 regional lymph nodes
N3
Metastasis in seven or more regional lymph nodes
N3a
Metastasis in 7-15 regional lymph nodes
N3b
Metastasis in 16 or more regional lymph nodes
Distant metastasis (M)
M0
No distant metastasis
M1
Distant metastasis