Most common malignancy of the stomach

Aetiology

Risk factors

• H. pylori infection
• Chronic gastritis
• Smoking
• Food preservatives (nitrates)
• Smoked food
• High salt intake
• Family history

Pathophysiology

• Most adenocarcinoma are in the pylorus/antrum and predominantly along the lesser curve

Intestinal type

• Exophytic mass with histology representative of the intestinal epithelium
• Slightly better prognosis - well differentiated

Diffuse type

• Arise from normal gastric mucosa
• Expands/infiltrates the stomach wall
• Can result in linitis plastica - whole stomach becomes rigid as it is overgrown by cancer, discrete lesion difficult to identify
  • ‘Signet ring’ morphology - nucleus is squeezed to the edge of the cell and the remainder of the cell is distended by mucin

Clinical features