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The advanced gastric carcinoma which invades...

Saturday 16 February 2013

The advanced gastric carcinoma which invades into muscularispropria or beyond carries a much worse prognosis, with a 5 years survival rate at about 60% or less.

The gross appearance of advanced gastric carcinomas can be exophytic, ulcerated, infiltrative or combined.

Based on Borrmann’s classification, the gross appearance of advanced gastric carcinomas can be divided into:
- type I for polypoid growth,
- type II for fungating growth,
- type III for ulcerating growth,
- type IV for diffusely infiltrating growth which is also referred to as linitisplastica in signet ring cell carcinoma when most of gastric wall is involved by infiltrating tumor cells.

Histologically, advanced gastric carcinoma often demonstrates marked architectural and cytological heterogeneity, with several co-existing histologic growth patterns.

The distinction between early and advanced gastric carcinoma before resection is clinically important because it helps decide if a neoadjuvant (pre-operative) therapy which has shown to improve disease free survival and overall survival is warranted.

While the macroscopic appearance is informative, the most accurate pre-operative staging information is generally obtained with endoscopic ultrasonography (EUS) and computer tomography (CT).