Pathology of Gastric Cancer

Nardos Mulu(SR1)
Moderator – Dr. Hailu Wondimu
(Asst Professor of surgery)
July 22, 2020
 Outline
• Introduction
• Epidemiology
• Risk factor
• Precancerous conditions
• Classification
• Staging
• Clinical manifestations
• References
 Intro
• Most common malignant gastric neoplasm
(95%) is adenocarcinoma
• GIST, Lymphoma, NEC, …….
• Primary Vs secondary
 Epidemiology
• 4th leading CA and 2nd leading cause of death
• Male Vs female
• Age – 69yrs; young pts
• Race: Asian
• Survival: 15% and 27%
Gastric carcinoma at Tikur Anbessa Hospital, Addis Ababa
O Johnson 1 , T Ersumo, A Ali
 Risk factors

•* diet
•* smocking
•* H. Pylori (3x)
•* EBV (10%)
•* previous gastric surgery

Acquired
* BG A
* pernicious anemia
* family history (2-3x)
* FAP
* HNPCC
* Li Fraumani

Genetic
 Precancerous lesions: polyps
• Asymptomatic (90%)
1. Gastric fundic – sporadic Vs ass. With FAP
2. Inflammatory or hyperplastic – 75%
3. Hemartomatous – juvenile, PJS, Cowden’s
4. Adenomatous – 6-10%
 Precancerous cont.
• Atrophic gastritis
• Intestinal metaplasia
• Gastric ulcer
• Gastric remnant
Classification
Lauren classification (intestinal type (53%), diffuse type (33%), and unclassified (14%))
Staging
 Clinical
• Location: distal (40%), middle (30%),
proximal (30%)
• Late presentation
• Early gastric ca
Symptoms
Signs
 Prognosis
• Depth of invasion
• Nodal status
• Grade
• HER2
• 24 Vs 8Vs 5
 Screening
• High risk population
• Hereditary syndromes
• EGD

• HDGC (hereditary diffuse gastric cancer)

 Gastric lymphoma
• 4%
• NHL-nodal involvement Vs extranodal disease
• DLBCL or MALT
• Low grade Vs high grade
• Celiac disease, H. pylori, HIV, EBV, and IBD
 GIST
• 2/3 in the stomach
• Interstitial cell of Cajal
• c-KIT, PDGFRA, CD34
• Risk stratification: very low, low, intermediate,
high
 Neuroendocrine tumor
• <2%
• ECL cells
• 3 types
# Type 1 (75%)
# Type 2
# Type 3
 References
• Schwartz’s Principle of Surgery 11 th ed
• Maingot’s abdominal operations 13 th ed
• Shackelford’s surgery of the alimentary tract 7 th ed
• Uptodate
• O Johnson 1 , T Ersumo, A Ali Gastric carcinoma at
Tikur Anbessa Hospital, Addis Ababa 2000
• Hailu W. Gebresillasse, Girmaye Tamrat, Tewodros
Abule Gatric cancer features and outcomes at a tertiary
teaching hospital in Addis Ababa, Ethiopia: A 5-year
retrospective study 2019