Neoplastic Gastric Mucosa Disorders Flashcards
• 4th most common cancer • 1 M cases, 800k deaths annually • 70% in developing countries • Higher risk with higher geographic latitudes
Gastric Adenocarcinoma
Risks associated with gastric adenomarcinoma
Other risks: smoking, salt, nitrates
What is true about the rate of gastric adenocarcinoma dx?
• Rates have been declining for distal cancers (previously 2nd most common)
Most common type of gastric adenomacarcinoma and where does it occur
- Most common type (50-75%)
* Occurs in distal stomach
Main risk factor for Intestinal type of gastric adenocarcinoma
• H. pylori infection main risk factor – Also increased with pernicious anemia • Background of intestinal metaplasia – Precursor stem cells from bone marrow, not gastric epithelium • More common in men, older age
What type of gastric adenocarcinoma has an unknonw precursor lesion and affects men and women the same?
Diffuse type adenocarcinoma
YOu see Signet ring on histology (– Mucin-filled vacuol diplaces nucleus ) what is this indicitive of?
Diffuse type adenocarcinoma
Diffuse type adenocarcinoma is more aggresive then intestinal and associated with what blood type?
Blood group A
Hereditary Diffuse Type Adenocarcinoma has what type of inheritance
Autosomal dominant with high
penetrance
• 80% of carriers will develop disease
What is the mutation in heriditary diffuse type adenocarcinoma
- Mutation in E-cadherin gene (CDH1)
- Tumor suppressor gene affecting cellular adhesion/motility
- Mutations also seen in 50% of sporadic diffuse gastric cancers
Average age of onset of heridiatry diffuse type and assoicated with risk of what other type of cancer?
- Average age of onset is 38 years
- < 1% risk before age 20
- 4% risk by age 30
- Increased risk of breast cancer
- 39% risk of lobular breast cancer by age 80
What are some other heritable associations of adenocarcinoma
Familial adenomatous polyposis(FAP)
• Lynch Syndrome
• Peutz-Jeghers syndrome
• Li-Fraumeni syndrome
Gastric Adenocarcinoma
Diffuse Type EBV-Associated
seen in what population?
- Male predominant
- No age predilection
- Higher proportion of all cancers in developed countries
Gastric Adenocarcinoma
Diffuse Type EBV-Associated…
aggresive? represents what % of cancers?
About 10% of gastric
carcinomas world wide
less aggresive
What is different about incidence of Adenocarcinoma of Cardia compared to other gastric adenocarcinoma
Unlike other gastric adenocarcinomas,
incidence is rising, similar to
esophageal adenocarcinoma in GERD
Risk factors for adenocarcinoma of cardia
– Lack of H. pylori
– Male gender
– Obesity
– Smoking
Pt presents with abdominal pain, quickly full after meals and get nauseaous. Recent weight loss, dysphagia, vomitting and GI bleeds.
Symptoms of Gastric adenocarcinoma
a (aggressive form of diffuse type gastric adenocarcinoma)
Linitis plastica
most common extranodal site of lymphoma (70%)
Gastric lymphoma
Peak incidence of gastric lymphoma, male or female what type of lymphoma most common?
50-60 yrs
male
most are non-hodgkin (NHLs)
LYmphoma in gastric area associated with H.pylori
MALToma (marginal zone B cell, mucosa associated)
80% regression with eradication for gastric MALToma only if:
Does not extend below submucosa
– No t(11:18) chromosomal translocation
What is more common; primary or secondary gastric lymphomas
• Primary NHLs: rare (1-4% of all
gastrointestinal malignancies)
• Secondary involvement: common
• Limited stage: 10%; advanced: 60%
Risk factors for gastric lymphomas
- Immunodeficiency/ immunosuppression
- Celiac disease
- Autoimmune disorders
most common presentation of gastric lymphoma
- Epigastric pain: 78-93%
- Anorexia: 47%
- Weight loss: 25%
Less common clinical presentaiton of gastric lymphoma
- Nausea and/or vomiting: 18%
- Occult gastrointestinal bleeding: 19%
- B symptoms: 12%
- Rarely perforation (risk after treatment)
Endoscopy of this presents all the following ways: • Mucosal erythema • Mass • Ulcer • Nodularity • Thickened gastric folds
Gastric lymphoma
Gastric carcinoid tumors are derieved from:
Derived from enterochromaffin-like (ECL) cells
Gastric carcinoid tumor Proliferate and transform in response to
high circulating levels of gastrin
- Achlorhydria:
* Ectopic gastrin secretion:
- Atrophic gastritis
- • Sporadic gastrinoma or MEN 1
Common age, gender, location of Gastric Carcinoid Tumors
women
60-70
Usually smaller than 1 cm and multiple
• Usually indolent, nonfunctioning, and benign
Do Gastric Carcinoid tumors commonly metestasize?
• Metastasis in < 10% of tumor < 2 cm, 20% in larger tumors
What are gastrin levels like in gastric carcinoid tumors?
NORMAL gastrin
In Aggresive Gastric Carcinoid tumors, up to 65% present with
hepatic or local metastases
What do gastric carcinoid tumors look like with endoscope?
multiple nodules
