Gastric Carcinoma
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Direct answer
Gastric carcinoma is an adenocarcinoma whose Laurén types dictate pathology and behaviour: the intestinal type grows as glands forming polypoid or ulcerated masses in atrophic, metaplastic mucosa of older patients, linked to Helicobacter pylori, smoked and salted foods and pernicious anaemia; the diffuse type infiltrates the wall as discohesive signet ring cells filled with mucin, thickening the stomach into linitis plastica, affecting younger patients and frequently carrying CDH1 (E-cadherin) mutations. Early gastric cancer, confined to mucosa or submucosa, carries an excellent prognosis, while advanced disease spreads by lymphatics, transcoelomically and haematogenously with famous named metastatic sites.
What you must remember
- Intestinal type (Laurén): cohesive gland-forming tumour with expanding growth; background of chronic atrophic gastritis and intestinal metaplasia; environmental risk factors dominate; relatively better outcome.
- Diffuse type: infiltrating signet ring cells (mucin-displaced nuclei) with desmoplastic stroma, poorly differentiated; linitis plastica — a rigid, thickened "leather-bottle" stomach with a shrunken lumen; hereditary diffuse gastric cancer with CDH1 mutation.
- Risk factors: Helicobacter pylori (a class 1 carcinogen), salted-smoked-picked diets and nitrosamines, chronic atrophic gastritis, pernicious anaemia, prior partial gastrectomy and the Zollinger-Ellison setting; Epstein-Barr virus association in a subset; blood group A is a weak association.
- Sites and growth: antrum and pylorus classically, with proximal/cardia tumours rising; gross patterns are polypoid fungating, flat, ulcerated (everted margins) and diffusely infiltrating.
- Early gastric cancer: carcinoma confined to mucosa or submucosa regardless of nodal status; detected by population endoscopy in Japan with high cure rates.
- Spread with named signs: lymphatic to Virchow node (left supraclavicular); transcoelomic to ovaries (Krukenberg tumour), periumbilical Sister Mary Joseph nodule and rectal shelf (Blumer); haematogenous to liver, lung and bone; direct to transverse colon and pancreas.
- Clinical: vague dyspepsia, early satiety in linitis plastica, anaemia from occult bleeding, weight loss; diagnosis by endoscopy with biopsy; treatment is surgical resection with perioperative or adjuvant therapy per current guidance.
Common confusion
The malignant ulcer versus benign peptic crater: carcinoma shows heaped, everted margins with a necrotic, shaggy base and friable rolled edges, while the peptic ulcer is punched out with straight walls. Within carcinoma, signet ring cells belong to the diffuse type, glands to the intestinal — and linitis plastica is diffuse-type pathology, not a late peptic ulcer. Krukenberg tumour refers specifically to ovarian metastasis containing signet ring cells, classically from stomach.
Exam-focused takeaway
Stems describe epigastric fullness in a young woman with a leather-bottle stomach (diffuse, CDH1), an elderly farmer from a high-salt-diet region with an ulcerated antral mass (intestinal), or a man with a left supraclavicular node and dyspepsia (Virchow). Photomicrographs of signet ring cells are frequent; one-liners test named metastases and H. pylori as a carcinogen. Organise answers by type, gene, gross pattern and spread.
Frequently asked questions
What are the Laurén types of gastric carcinoma?
Intestinal type with cohesive glands, expanding growth and environmental risk factors, and diffuse type with infiltrating signet ring cells and linitis plastica.
What is a signet ring cell?
A tumour cell whose cytoplasm is distended by a single mucin droplet pushing the nucleus to the periphery — the hallmark of diffuse gastric carcinoma and Krukenberg metastases.
What is linitis plastica?
A diffusely infiltrating carcinoma that thickens and rigidifies the stomach wall into a non-distensible leather-bottle stomach.
Which gene mutation marks hereditary diffuse gastric cancer?
CDH1, encoding E-cadherin, whose loss dissociates tumour cells and drives signet ring infiltration.
What is a Krukenberg tumour?
An ovarian metastasis, usually bilateral, containing mucin-secreting signet ring cells transcoelomically seeded from a gastric primary.