1. By Dr. Gehan Mohamed Dr. Abdelaty Shawky
Gastric carcinoma By
Dr. Gehan Mohamed Dr. Abdelaty Shawky

2. Learning objectives
Identify the Etiological Factors of Gastric Cancer.
Recognize the histopathologic classification for gastric cancer .
Discussing Gastric adenocarcinoma in more details regarding its risk factors, methods of diagnosis.
Identify the different gross morphology and microscopic types of Gastric adenocarcinoma.
understand special terms such as Linitis plastica,Virchow’s sign, Sister Mary Joseph’s nodule and Krukenberg tumor

3. Histopathologic classification of gastric tumors:
Adenocarcinoma %
Lymphoma %
Stromal tumors %
Carcinoid <1%
Metastasis <1%
Adenosquamous/squamous <1%

4. Etiological Factors of Gastric Cancer Environmental factors
H. pylori
Genetic factors
Gastric
Cancer
The development of gastric cancer is a multi-factor process. A large number of risk factors have been associated with gastric cancer. These include dietary factor, smoking, H. pylori infection, low gastric acidity, genetic factors. Excessive intake of salt or salty food, low consumption of fresh fruits and vegetables are likely contribute to the development of gastric cancer. Studies had indicated there was a significant association between cigarette smoking and gastric cancer risk, particularly in male smokers. H. pylori is a definite carcinogen accounting for at least new cases of gastric cancer each year worldwide. Familiar studies have found that the risk of developing gastric cancer for relatives of cases is increased two- to three-fold suggesting a role of genetic factors. Low gastric acidity may increase intraluminal formation of N-nitroso compounds which are carcinogens.
Environmental factors
Precancerous changes

5. Environmental factors
Lower socioeconomic
status
Mucosal damage
Eating lessFresh vegetable/fruits
Pro-carcinogen/
Carcinogen
Gastrric
Carcinoma
Tobacco/alcohol
Lack of antioxidant
Eating salted/
Smoked food

6. Genetic factors The majority of cases are sporadic.
However, there are rare inherited cases.

7. Precancerous lesions:
1. Gastric dysplasia:
About 10% of these cases progress to gastric carcinoma specially high-grade dysplasia.
2. Atrophic gastritis: which associated with intestinal metaplasia.
3. Chronic gastric peptic ulcer:
4. Gastric adenoma:

8. Sequence of histologic events in the progression to gastric adenocarcinoma
H. Pylori
Adenomas
Chronic Superficial Gastritis
Gastric Adenocarcinoma
Intestinal Metaplasia
Atrophic Gastritis
Dysplasia

9. Gastric adenocarcinoma

10. * Diagnosis of gastric adenocarcinoma:
1. Clinical history:
2. Endoscopy: for evaluating both gross and microscopic appearance of the tumor by taking biopsy for definitive diagnosis
3. Immunohistochemical study.

11. * Clinical manifestations of gastric carcinoma:
Asymptomatic or silent %
Peptic ulcer symptoms %
Nausea or vomiting %
Anorexia %
Early satiety %
Abdominal pain %
Gastrointestinal blood loss <2%
Weight loss <2%
Dysphagia <1%

12. * Gross morphology of gastric adenocarcinoma:
A. Polypoid (fungating) mass.
B. Ulcerating (malignant ulcer).
C. infiltrating:
- Localized.
- Diffuse (linnitus plastica).

13. Polypoid (fungating)

14. Ulcerating (malignant ulcer)

15. Linnitus plastica

16. * Types of gastric adenocarcinoma:
1. Intestinal type.
2. Signet ring (diffuse type ): consists of scattered cells with intracytoplasmic mucin, diffusely infiltrate the gastric wall with poor prognosis

18. Adenocarcinoma, intestinal type

19. Gastric adenocarcinoma (signet ring type)

20. Immunohistochemical diagnosis
Tumor markers:
Carcino Embryonic Antigen (CEA).
CA 19-9.
Cytokeratin.

21. Gastric carcinoma positive with cytokeratin

22. * Complications of gastric carcinoma:
GIT bleeding.
Gastric obstruction.
Gastric perforation specially in the ulcer type.
Spread:
Direct.
Lymphatic: especially to the left supraclavicular lymph node (Virchow’s sign).
Blood.
Transcoelomic (Krukenberg’s tumor).

23. Special terms
Linnitis plastica: when cancer of the stomach diffusely infiltrating its wall causing its rigidity.
Virchow’s node: when cancer reach left supraclavicular lymph node
Sister Mary Joseph’s node: is umbilical nodule caused by spread of gastric cancer.
Krukenberg tumor: is a tumor in the ovary caused by the spread of stomach cancer

24. Sister Mary Joseph’s nodule

25. Sister Mary Joseph nodule
Also called Sister Mary Joseph sign, refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen.
Gastrointestinal malignancies account for about half of underlying sources (most commonly gastric cancer, colonic cancer or pancreatic cancer.
Gynecological cancers can cause it primarily ovarian cancer and also uterine cancer.

26. Unknown primary tumors and rarely, urinary or respiratory tract malignancies cause umbilical metastases. How exactly the metastases reach the umbilicus remains largely unknown.
Proposed mechanisms for the spread of cancer cells to the umbilicus include direct transperitoneal spread, via the lymphatics which run alongside the obliterated umbilical vein, hematogenous spread

27. Prevention of gastric carcinoma
1. Eradication of H. Pylori infection in those high risk
population
- family history of gastric cancer
- chronic gastritis with apparent abnormality (atrophy)
- gastric ulcer
2. Management of dietary risk factor
intake adequate amount of fruits, vegetables
minimize their intake of salty/smoked foods

28. 3. Tightly follow up those with precancerous lesions.
4. Endoscopic or radiologic screening

29. Thanks