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Gastric Cancer

*Carcinoma ventriculi*

For medical students2 min readUpdated 2026-10-10

Carcinoma ventriculi is a malignant epithelial tumor ranking second in global cancer incidence. It is classically divided into intestinal and diffuse types, which feature distinct pathways of development and molecular alterations.

IncidenceOne of the leading causes of cancer-related mortality worldwide
Main Factor*Helicobacter pylori* infection and chronic inflammation
Tumor TypesIntestinal type (via metaplasia cascade) and diffuse type (de novo)
Borrmann Macrotypes4 main types: polypoid, ulcerated, ulcerofungating/infiltrative, linitis plastica/diffuse

Major Histological Types and Development

Pathology divides gastric cancer into two fundamentally different variants:

The extreme manifestation of diffuse endophytic growth is linitis plastica (linitis plastica), which causes marked, rigid thickening of the gastric wall.

Borrmann Macroscopic Classification

To describe advanced gross forms of the tumor, the Borrmann classification divides the process into four types:

  1. Type 1 (Polypoid / Fungating) — Exophytic solitary mass forming a nodule or cauliflower-like lesion with clear borders from healthy tissue.
  2. Type 2 (Ulcerated with distinct margins) — Crater-like "ulcer-cancer" with elevated, rolled borders and clear demarcation from the mucosa.
  3. Type 3 (Ulcerofungating / Infiltrative) — Ulceration without clear boundaries, sloping edges, and deep invasion into the wall layers.
  4. Type 4 (Diffusely infiltrative / Linitis plastica) — Endophytic growth with diffuse wall thickening and loss of fold pliability.

Early Gastric Cancer and Precancerous Changes

The term early gastric cancer refers to a tumor restricted to the mucosa or submucosa, critically sparing the muscularis propria of the organ wall. Despite this limitation, the presence of lymphatic channels in the lamina propria means a baseline risk of lymph node metastasis still exists.

The central concept of gastrointestinal precancerous lesions is intraepithelial neoplasia (epithelial dysplasia):

Mnemonic

Remember the Correa cascade via the chain: «Bacteria hits mucosa -> inflammation -> intestinal cell metaplasia -> adenoma with dysplasia -> invasive cancer».

Frequently asked questions

What are the main pathways of metastasis in gastric cancer?

The primary pathways of metastasis in gastric cancer include lymphatic, hematogenous, and peritoneal seeding.

  • Lymphatic pathway — Can be orthograde (to regional lymph nodes along the lesser and greater curvatures) or retrograde. Distant retrograde metastases include:
  • Virchow's node — Left supraclavicular lymph node.
  • Krukenberg tumor — Ovaries.
  • Schnitzler's metastasis — Rectouterine pouch (rectovaginal septum / pararectal tissue).
  • Irish's node — Anterior axillary lymph node.
  • Hematogenous and peritoneal seeding pathways — Lead to involvement of the liver, peritoneum, ovaries, and other organs.
What clinical symptoms are characteristic of early and late stages of gastric cancer?

Clinical manifestations depend on localization, growth pattern, and presence of metastasis.

  • Early stages — Usually asymptomatic or accompanied by non-specific complaints: dyspepsia, decreased appetite, aversion to meat.
  • Advanced disease — General symptoms of tumor cachexia and toxicity appear: fatigue, weight loss, anemia.

Symptoms dependent on localization and morphology:

  • Cardioesophageal junction involvement — Dysphagia.
  • Antral involvement with gastric outlet obstruction (pyloric stenosis) — Nausea and vomiting of previously ingested food.
  • Ulcerated cancer — Bleeding and perforation.
  • Diffuse-infiltrative cancer — Wall rigidity, decreased gastric capacity, and early satiety after small meals.
What diagnostic methods are used to confirm a diagnosis of gastric cancer?

Diagnosis relies on endoscopic, radiographic, and surgical modalities.

  • EGD (upper endoscopy) with targeted biopsy — The gold standard for diagnosis, coupled with mandatory histological evaluation of biopsy specimens.
  • Double-contrast barium swallow (upper GI series) — Reveals filling defects. Multi-positional contrast examination is especially effective for diffuse infiltrative cancer (linitis plastica), where endoscopic biopsies can yield false negatives.
  • Diagnostic laparoscopy — Used to detect peritoneal dissemination, including peritoneal washings for cytology and biopsy.
  • Neck ultrasound — Used to evaluate systemic spread and rule out Virchow's node involvement.
What is the main difference between intestinal and diffuse types of gastric cancer?

The intestinal type develops step-by-step through precancerous conditions and metaplasia, whereas the diffuse type arises de novo, bypasses the adenoma stage, and is characterized by the presence of signet-ring cells.

What defines early gastric cancer based on depth of invasion?

It is a tumor strictly confined to the mucosa or submucosa, without invasion into the muscularis propria of the stomach wall.

Is reactive foveolar hyperplasia a precancerous condition?

No, reactive foveolar hyperplasia reflects a response to injury or mitogenic stimuli and does not qualify as a premalignant lesion.

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