1. Cancer Staging:Gastric Cancer Medical Univ
Cancer Staging:Gastric Cancer Medical Univ. of South Carolina Digestive Disease Center Dr. Ian Penman and Dr. David Williams

2. TNM staging and grouping of Gastric Cancer (AJCC Cancer Staging Manual
TNM staging and grouping of Gastric Cancer (AJCC Cancer Staging Manual. Fifth Edition Lippincott-Raven, publishers). Depth of invasion correlates with reduced survival while regional nodal metastases are the most powerful prognostic indicator

5. Gastric Cancer, T1 On EUS, gastric cancers appear as irregular hypoechoic lesions with variable penetration of the gastric wall. An irregular heterogenous polypoid tumor can be seen extending into the submucosa. The underlying hypoechoic layer corresponding to the muscularis propria remains intact.

7. Gastric Cancer, T3 A large irregular heterogenous tumor is seen with disruption of gastric wall layer structure. The anechoic triangular space adjacent to the tumor represents ascites.

9. Gastric Cancer, T3 The hypoechoic layer corresponding to the muscularis propria has been breached by an irregular hypoechoic tumor(arrow) with complete disruption of the gastric wall layer structure.

11. Gastric Cancer, celiac axis invasion Using a linear array echoendoscope (Pentax FG-32UA) a large hypoechoic mass can be seen invading the celiac axis (CA) at its origin from the aorta.

13. Gastric Cancer, linitis plastica 5-15% of tumors are diffusely infiltrating, spreading mainly in the submucosa and muscularis. The gastric wall is markedly thickened (11mm; normally <5mm by EUS) and is completely replaced by hypoechoic tumor. The anechoic triangular structure adjacent to tumor is ascites.

15. Perigastric Tumor A 70-year-old woman with past history of ovarian carcinoma presented with melena and abdominal pain. At EGD there was the suggestion of an extramural mass resulting in gastric compression. EUS confirmed a large irregular heterogenous mass extending upto but not invading the gastric wall. (slide 21). The hypoechoic tumor can then be seen invading through the gastric wall with erosion onto the mucosal surface (slide 22).