Precancerous states

           •Pernicious anemia—18X normal population

             •Adenomas of the stomach—especially those over 2cm

             •Atrophic Gastritis—disputable

             •Hiatal hernia—disputable

             •Gastric stumps for ulcer disease (Bilroth II>Bilroth I)

             •Achlorhydria

Histology

             • Adenocarcinoma (95%)

             • Rarely, squamous cell

Morphology

             • Polypoid/fungating carcinoma

             • Ulcerating/penetrating carcinoma (70%)

             • Infiltrating/scirrhous type=linitis plastica

             • Superficial spreading type-confined to mucosa/submucosa-NOT linitis plastica

Metastases

             • Along peritoneal ligaments

                        ∆ Gastrocolic ligament to transverse colon

                        ∆ Gastrohepatic and hepatoduodenal to liver

             • To lymph nodes

                        ∆ Locally

                        ∆ Lymphangitic to lungs

             • Hematogenous

                        ∆ Liver (most common)/adrenals/ovaries/bones

             • Peritoneal seeding

                        ∆ Rectal wall=Blumer shelf

             • Left supraclavicular node=Virchow’s node

• Overall 5 year survival 5-18%

Malignant ulcer—is a carcinoma which presents with the radiographic appearance of an ulcer niche; these have the radiographic appearance of a benign ulcer but demonstrate microscopic foci of malignancy, usually at the edge of the ulcer

Ulcerating malignancy—is a carcinoma having sufficient bulk to present as a mass which also contains a persistent collection representing an ulcer; the mucosa is frequently nodular and the folds do not radiate to the base of the ulcer

Linitis plastica (scirrhous carcinoma)—is a diffuse involvement of the wall of the stomach, frequently with flattening of the mucosa, and poor distensibility and contraction of the wall; usually associated with significant fibrosis and muscular hypertrophy; very frequently a signet ring cell type

Carcinoma of the Stomach, UGI. A double-contrast upper GI of the stomach shows a markedly rigid and non-distensible body and antrum of the stomach (black arrows) which did not change on multiple views. The proximal portion of the stomach (white arrow) does distend suggesting the tumor involves only the distal stomach..

Carcinoma of the Stomach, CT. The gastric wall in the region of the antrum of the stomach shows marked soft-tissue thickening (white arrows) while the lumen (L) is constricted by the surrounding mass.