Please enable JavaScript.
Coggle requires JavaScript to display documents.
Path: Stomach (ii) Tumours (Malignant (carcinoma (risk factors (dietary:…
Path: Stomach (ii) Tumours
Benign
hyperplastic polyps
polyp = nodule/mass that projects above the level of the surrounding mucosa (uncommon in stomach, more in colon)
90%
arise in the setting of chronic gastritis
adenoma
5-10%
prolif of dysplastic epithelium, implying malignant potential
can be sessile (no stalk) or pedunculated (with stalk)
hamartoma
normal tissue excessively increased in size
rare
Peutz-Jeghers polyps
juvenile polyps
fundic gland polyp
lipoma
schwannoma (neural tissue)
Malignant
carcinoma
most common (90-95%)
2nd most common cause of deaths related to cancer worldwide
M:F = 2:1
geographic: commoner in East Japan + China
risk factors
dietary: smoked + salted foods, lack of fruit + veg
nitrites: food, drinking water, preservation of meats
adenomatous polyps
pernicious anaemia (chronic atrophic gastritis)
prior partial gastrectomy (>20 yrs ago - due to reflux)
PUD
H pylori
intestinal metaplasia
blood group A
family hx
usually in distal third, but tumours in proximal stomach/GOJ increasing in incidence
presentation
insidious disease: often asymp until late
dyspepsia (indigestion), nausea, anorexia, weight loss, abdo pain, dysphagia, anaemia, haematemesis
histology: can be intestinal or diffuse (entire wall thickened in a longitudinal manner)
Signet ring cells: large vacuole, a/w carc esp stomach carc
lymphoma (4%)
carcinoid (3%)
mesenchymal tumours (2%)
GIST
can be benign or malignant
primary non-epithelial neoplasms
arise from interstitial of Cajal (control peristalsis)
can be solitary or multiple
most are a/w with a mutation of CD117 (c-kit - tyrosine kinase R)
targeted tx using imatinib (gleevec) tyrosine kinase R
do IHC for c-kit protein (brown = +ve)
in adults mostly
abdo pain, melaena, rarely obstruction
can be in multiple sites (e.g. intestine)
graded based on mitotic activity
white solid fibrous tissue tumours, don't ulcerate, no glands just stroma
histology: white elongated malignant mesenchymal cells
leiomyosarcoma
irregularly raised rolled edges + bleeding
spread
local: duodenum, pancreas, retroperitoneum
transcoelomic (across peritoneal cavity): Krukenberg tumour of ovaries
lymphatic: virchow's node (supraclavicular) - Troisier's sign
haematogenous
prognosis depends on depth of invasion, extent of nodal + distant mets
generally poor (5yr survival = 10-20%)
early presentation NB for survival
if early: confined to mucosa + submucosa (regardless of perigastric lymph node mets)
cure rate for intramucosal cancers = 93%
cure rate for submucosal involvement = 80-89%