CARCINOMA OF STOMACH

Aetiopathogenesis of carcinoma of stomach

A. Environmental factors

B. Host factors

C. Genetic factors

A. Environmental factors

1. diet

• nitrites derived from nitrates

• Smoked and salted foods

• Lack of fresh fruits and vegetables

2. Low socioeconomic status

3. Cigarette smoking

Aetiopathogenesis of carcinoma of stomach

B. Host factors

B. Host factors

1. chronic gastritis due to H.pylori

2. Autoimmune gastritis

3. Partial gastrectomy

4. Gastric adenomas

5. Barret esophagus

6. Atrophic gastritis

Aetiopathogenesis of carcinoma of stomach

C. Genetic factors

C. Genetic factors

1. Increase risk with blood group A

2. family history of gastric cancer

3. Hereditary non polyposis colon cancer syndrome

4. Familial gastric carcinoma (E-Cadherin mutation)

Clinical presentation

• often asymptomatic

• Weight loss

• Anorexia

• Epigastric abdominal pain like peptic ulcers

• Early satiety and pain

• Occult bleeding and iron deficiency anemia

Gross features of carcinoma of stomach

1. Location

• cardia

• Body and fungus

• Pylorus and antrum

2. Flat / polyploid/ excavated lesion

3. Ulcer >3cm, heaped up margin , necrotic ulcer base

Histological features

1. Intestinal type

• gland forming adenocarcinoma

2. Diffuse type

• not related to H.pylori

• Diffuse infiltration of stomach by poorly differentiated tumor cells

• Signet ring cell

• Nucleus is displaced to periphery by intracellular mucin

Modes of transmission

1. Virchow node

• left supraclavicular lymph node

2. Sister Joseph Mary nodule

• subcutaneous nodule in peri umbilical region

3. Krukenberg tumor

• spread to ovary

4. Paraneoplastic skin lesion

• multiple outcropping of seborrheic keratoses

Prognosis of carcinoma stomach