21st Century Adult Cancer Sourcebook: Gastric Cancer (Stomach Cancer) - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - October 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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PART ONE
Chapter 1A: Gastric (Stomach) Cancer Patient Information
Chapter 2A: Gastric (Stomach) Cancer Health Professional Information
Chapter 3A: Gastric (Stomach) Cancer NCI Drugs
Chapter 4A: Gastric (Stomach) Cancer Background Information
Chapter 5A: Gastric (Stomach) Cancer Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Gastric (Stomach) Cancer Patient Information
Patient Version
Last Modified: 11/11/2010
General Information About Gastric Cancer
Key Points for This Section
* Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach.
* Age, diet, and stomach disease can affect the risk of developing gastric cancer.
* Possible signs of gastric cancer include indigestion and stomach discomfort or pain.
* Tests that examine the stomach and esophagus are used to detect (find) and diagnose gastric cancer.
* Certain factors affect prognosis (chance of recovery) and treatment options.
Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach.
The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. Food moves from the throat to the stomach through a hollow, muscular tube called the esophagus. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.
The stomach and esophagus are part of the upper digestive system.
The wall of the stomach is made up of 3 layers of tissue: the mucosal (innermost) layer, the muscularis (middle) layer, and the serosal (outermost) layer. Gastric cancer begins in the cells lining the mucosal layer and spreads through the outer layers as it grows.
Stromal tumors of the stomach begin in supporting connective tissue and are treated differently from gastric cancer
Age, diet, and stomach disease can affect the risk of developing gastric cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for gastric cancer include the following:
* Having any of the following medical conditions:
* Helicobacter pylori (H. pylori) infection of the stomach.
* Chronic gastritis (inflammation of the stomach).
* Pernicious anemia.
* Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
* Familial adenomatous polyposis (FAP) or gastric polyps.
* Eating a diet high in salted, smoked foods and low in fruits and vegetables.
* Eating foods that have not been prepared or stored properly.
* Being older or male.
* Smoking cigarettes.
* Having a mother, father, sister, or brother who has had stomach cancer.
Possible signs of gastric cancer include indigestion and stomach discomfort or pain.
These and other symptoms may be caused by gastric cancer. Other conditions may cause the same symptoms.
In the early stages of gastric cancer, the following symptoms may occur:
* Indigestion and stomach discomfort.
* A bloated feeling after eating.
* Mild nausea.
* Loss of appetite.
* Heartburn.
In more advanced stages of gastric cancer, the following symptoms may occur:
* Blood in the stool.
* Vomiting.
* Weight loss for no known reason.
* Stomach pain.
* Jaundice (yellowing of eyes and skin).
* Ascites (build-up of fluid in the abdomen).
* Trouble swallowing.
A doctor should be consulted if any of these problems occur.
Tests that examine the stomach and esophagus are used to detect (find) and diagnose gastric cancer.
The following tests and procedures may be used:
* Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
* Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
* Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
* The number of red blood cells, white blood cells, and platelets.
* The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
* The portion of the sample made up of red blood cells.
* Upper endoscopy: A procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus.
Upper endoscopy. A thin, lighted tube is inserted through the mouth to look for abnormal areas in the esophagus, stomach, and first part of the small intestine.
* Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
* Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
Barium swallow for stomach cancer. The patient swallows barium liquid and it flows through the esophagus and into the stomach. X-rays are taken to look for abnormal areas.
* Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy of the stomach is usually done during the endoscopy.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
* The stage and extent of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body).
* The patient’s general health.
When gastric cancer is found very early, there is a better chance of recovery. Gastric cancer is often in an advanced stage when it is diagnosed. At later stages, gastric cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the NCI Web site 5.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
ascites (uh-SY-teez)
* Abnormal buildup of fluid in the abdomen that may cause swelling. In late-stage cancer, tumor cells may be found in the fluid in the abdomen. Ascites also occurs in patients with liver disease.
barium swallow (BAYR-ee-um SWAH-loh)
* The process of getting x-ray pictures of the esophagus or the upper gastrointestinal (GI) tract (esophagus, stomach, and duodenum). The x-ray pictures are taken after the patient drinks a liquid that contains barium sulfate (a form of the silver-white metallic element barium). The barium sulfate coats and outlines the inner walls of the esophagus and the upper GI tract so that they can be seen on the x-ray pictures.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood chemistry study (blud KEH-mih-stree STUH-dee)
* A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
carbohydrate (KAR-boh-HY-drayt)
* A sugar molecule. Carbohydrates can be small and simple (for example, glucose) or they can be large and complex (for example, polysaccharides such as starch, chitin or cellulose).
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chronic (KRAH-nik)
* A disease or condition that persists or progresses over a long period of time.
clinical trial (KLIH-nih-kul TRY-ul)
* A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
complete blood count (kum-PLEET blud kownt)
* A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called blood cell count and CBC.
connective tissue (kuh-NEK-tiv TIH-shoo)
* Supporting tissue that surrounds other tissues and organs. Specialized connective tissue includes bone, cartilage, blood, and fat.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
cure (kyoor)
* To heal or restore health; a treatment to restore health.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
digestive system (dy-JES-tiv SIS-tem)
* The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum.
duodenum (DOO-ah-DEE-num)
* The first part of the small intestine that connects to the stomach.
endoscope (EN-doh-SKOPE)
* A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.
endoscopy (en-DOS-koh-pee)
* A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
esophagus (ee-SAH-fuh-gus)
* The muscular tube through which food passes from the throat to the stomach.
familial adenomatous polyposis (fuh-MIH-lee-ul A-deh-NOH-muh-tus PAH-lee-POH-sis)
* An inherited condition in which numerous polyps (growths that protrude from mucous membranes) form on the inside walls of the colon and rectum. It increases the risk of colorectal cancer. Also called familial polyposis and FAP.
fecal occult blood test (FEE-kul uh-KULT...)
* A test to check for blood in the stool. Small samples of stool are placed on special cards and sent to a doctor or laboratory for testing. Blood in the stool may be a sign of colorectal cancer. Also called FOBT.
fluid (FLOO-id)
* A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
gastric (GAS-trik)
* Having to do with the stomach.
gastric cancer (GAS-trik KAN-ser)
* Cancer that forms in tissues lining the stomach. Also called stomach cancer.
gastritis (gas-TRY-tis)
* Inflammation of the lining of the stomach.
gastrointestinal stromal tumor (GAS-troh-in-TES-tih-nul STROH-mul TOO-mer)
* A type of tumor that usually begins in cells in the wall of the gastrointestinal tract. It can be benign or malignant. Also called GIST.
Helicobacter pylori (HEEL-ih-koh-BAK-ter py-LOR-ee)
* A type of bacterium that causes inflammation and ulcers in the stomach or small intestine. People with Helicobacter pylori infections may be more likely to develop cancer in the stomach, including MALT (mucosa-associated lymphoid tissue) lymphoma. Also called H. pylori.
hemoglobin (HEE-moh-GLOH-bin)
* The substance inside red blood cells that binds to oxygen in the lungs and carries it to the tissues.
infection (in-FEK-shun)
* Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
inflammation (IN-fluh-MAY-shun)
* Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
intestinal (in-TES-tih-nul)
* Having to do with the intestines.
intestine (in-TES-tin)
* The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.
jaundice (JAWN-dis)
* A condition in which the skin and the whites of the eyes become yellow, urine darkens, and the color of stool becomes lighter than normal. Jaundice occurs when the liver is not working properly or when a bile duct is blocked.
large intestine (larj in-TES-tin)
* The long, tube-like organ that is connected to the small intestine at one end and the anus at the other. The large intestine has four parts: cecum, colon, rectum, and anal canal. Partly digested food moves through the cecum into the colon, where water and some nutrients and electrolytes are removed. The remaining material, solid waste called stool, moves through the colon, is stored in the rectum, and leaves the body through the anal canal and anus.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
metaplasia (meh-tuh-PLAY-zhuh)
* A change of cells to a form that does not normally occur in the tissue in which it is found.
mineral (MIH-neh-rul)
* In medicine, a mineral is a nutrient that is needed in small amounts to keep the body healthy. Mineral nutrients include the elements calcium, magnesium, and iron.
mucosa (myoo-KOH-suh)
* The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucosa make mucus (a thick, slippery fluid). Also called mucous membrane.
nausea
* A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
nutrient (NOO-tree-ent)
* A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
pernicious anemia (per-NIH-shus uh-NEE-mee-uh)
* A type of anemia (low red blood cell count) caused by the body's inability to absorb vitamin B12.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
* An exam of the body to check for general signs of disease.
platelet (PLATE-let)
* A tiny piece of a cell found in the blood that breaks off from a large cell found in the bone marrow. Platelets help wounds heal and prevent bleeding by forming blood clots. Also called thrombocyte.
polyp (PAH-lip)
* A growth that protrudes from a mucous membrane.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
protein (PROH-teen)
* A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
red blood cell (red blud sel)
* A cell that carries oxygen to all parts of the body. Also called erythrocyte and RBC.
risk factor (... FAK-ter)
* Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
small intestine (... in-TES-tin)
* The part of the digestive tract that is located between the stomach and the large intestine.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stomach (STUH-muk)
* An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.
stomach cancer (STUH-muk KAN-ser)
* Cancer that forms in tissues lining the stomach. Also called gastric cancer.
stool (stool)
* The material in a bowel movement. Stool is made up of undigested food, bacteria, mucus, and cells from the lining of the intestines. Also called feces.
symptom (SIMP-tum)
* An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
throat (throte)
* The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
upper GI series (UH-per ... SEER-eez)
* A series of x-ray pictures of the esophagus, stomach, and duodenum (the first part of the small intestine). The x-ray pictures are taken after the patient drinks a liquid containing barium sulfate (a form of the silver-white metallic element barium). The barium sulfate coats and outlines the inner walls of the upper gastrointestinal tract so that they can be seen on the x-ray pictures. Also called upper gastrointestinal series.
vitamin (VY-tuh-min)
* A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.
vomit (VAH-mit)
* To eject some or all of the contents of the stomach through the mouth.
white blood cell (hwite blud sel)
* A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Table of Links
1 http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/Patient
2 http://www.cancer.gov/cancertopics/pdq/treatment/unusual-cancers-childhood/Patient
3 http://www.cancer.gov/cancertopics/pdq/prevention/gastric/Patient
4 http://www.cancer.gov/cancertopics/pdq/screening/gastric/Patient
5 http://cancer.gov/clinicaltrials
Stages of Gastric Cancer
Key Points for This Section
* After gastric cancer has been diagnosed, tests are done to find out if cancer cells have spread within the stomach or to other parts of the body.
* There are three ways that cancer spreads in the body.
* The following stages are used for gastric cancer:
* Stage 0 (Carcinoma in Situ)
* Stage I
* Stage II
* Stage III
* Stage IV
After gastric cancer has been diagnosed, tests are done to find out if cancer cells have spread within the stomach or to other parts of the body.
The process used to find out if cancer has spread within the stomach or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
* β-hCG (beta-human chorionic gonadotropin), CA-125, and CEA (carcinoembryonic antigen) assays: Tests that measure the levels of β-hCG, CA-125, and CEA in the blood. These substances are released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, they can be a sign of gastric cancer or other conditions.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
* Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
* PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for gastric cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the inside lining of the mucosal (innermost) layer of the stomach wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed. Stage I is divided into stage IA and stage IB, depending on where the cancer has spread.
* Stage IA: Cancer has spread completely through the mucosal (innermost) layer of the stomach wall.
* Stage IB: Cancer has spread:
* completely through the mucosal (innermost) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or
* to the muscularis (middle) layer of the stomach wall.
Stage II
In stage II gastric cancer, cancer has spread:
* completely through the mucosal (innermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or
* to the muscularis (middle) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or
* to the serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs.
Stage III
Stage III gastric cancer is divided into stage IIIA and stage IIIB depending on where the cancer has spread.
* Stage IIIA: Cancer has spread to:
* the muscularis (middle) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or
* the serosal (outermost) layer of the stomach wall and is found in 1 to 6 lymph nodes near the tumor; or
* organs next to the stomach but not to lymph nodes or other parts of the body.
* Stage IIIB: Cancer has spread to the serosal (outermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor.
Stage IV
In stage IV, cancer has spread to:
* organs next to the stomach and to at least one lymph node; or
* more than 15 lymph nodes; or
* other parts of the body.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
beta-hCG (BAY-tuh...)
* A hormone normally found in the blood and urine during pregnancy. It may also be produced by some tumor cells. An increased level of beta-hCG may be a sign of cancer of the testis, uterus, ovary, liver, stomach, pancreas, or lung. Beta-hCG may also be produced in response to certain conditions that are not cancer. Beta-hCG is being studied in the treatment of Kaposi sarcoma. Also called beta-human chorionic gonadotropin.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
bone cancer (bone KAN-ser)
* Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
CA-125
* A substance that may be found in high amounts in the blood of patients with certain types of cancer, including ovarian cancer. CA-125 levels may also help monitor how well cancer treatments are working or if cancer has come back. Also called cancer antigen 125.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
capillary (KA-pih-layr-ee)
* The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
carcinoma in situ (KAR-sih-NOH-muh in SY-too)
* A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
CEA
* A substance that may be found in the blood of people who have colon cancer, other types of cancer or diseases, or who smoke tobacco. CEA levels may help keep track of how well cancer treatments are working or if cancer has come back. It is a type of tumor marker. Also called carcinoembryonic antigen.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray (chest EX-ray)
* An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
endoscope (EN-doh-SKOPE)
* A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.
endoscopic ultrasound (en-doh-SKAH-pik...)
* A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument that has a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal organs to make a picture (sonogram). Also called endosonography and EUS.
gastric (GAS-trik)
* Having to do with the stomach.
glucose (GLOO-kose)
* A type of sugar; the chief source of energy for living organisms.
incision (in-SIH-zhun)
* A cut made in the body to perform surgery.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
invasive cancer (in-VAY-siv KAN-ser)
* Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
laparoscope (LA-puh-ruh-SKOPE)
* A thin, tube-like instrument used to look at tissues and organs inside the abdomen. A laparoscope has a light and a lens for viewing and may have a tool to remove tissue.
laparoscopy (LA-puh-ROS-koh-pee)
* A procedure that uses a laparoscope, inserted through the abdominal wall, to examine the inside of the abdomen. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
lymph (limf)
* The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymph vessel (limf ...)
* A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem)
* The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
malignant (muh-LIG-nunt)
* Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
metastasis (meh-TAS-tuh-sis)
* The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
mucosa (myoo-KOH-suh)
* The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucosa make mucus (a thick, slippery fluid). Also called mucous membrane.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
PET scan (… skan)
* A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
radioactive (RAY-dee-oh-AK-tiv)
* Giving off radiation.
rectum (REK-tum)
* The last several inches of the large intestine closest to the anus.
scanner (SKA-ner)
* In medicine, an instrument that takes pictures of the inside of the body.
serosa (seh-ROH-suh)
* The outer lining of organs and body cavities of the abdomen and chest, including the stomach. Also called serous membrane.
sonogram (SAH-noh-gram)
* A computer picture of areas inside the body created by bouncing high-energy sound waves (ultrasound) off internal tissues or organs. Also called ultrasonogram.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage 0 gastric carcinoma in situ (... GAS-trik KAR-sih-NOH-muh in SY-too)
* Abnormal cells are found in the inside lining of the mucosal (innermost) layer of the stomach wall. These abnormal cells may become cancer and spread into nearby normal tissue.
stage I gastric cancer (... GAS-trik KAN-ser)
* Stage I is divided into stage IA and stage IB, depending on where the cancer has spread. In stage IA, cancer has spread completely through the mucosal (innermost) layer of the stomach wall. In stage IB, cancer has spread completely through the mucosal (innermost) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor, or has spread to the muscularis (middle) layer of the stomach wall.
stage II gastric cancer (... GAS-trik KAN-ser)
* Cancer has spread (1) completely through the mucosal (innermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor, or (2) to the muscularis (middle) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor, or (3) to the serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs.
stage III gastric cancer (... GAS-trik KAN-ser)
* Stage III is divided into stage IIIA and stage IIIB depending on where the cancer has spread. In stage IIIA, cancer has spread to (1) the muscularis (middle) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor, or (2) the serosal (outermost) layer of the stomach wall and is found in 1 to 6 lymph nodes near the tumor, or (3) to organs next to the stomach but not to lymph nodes or other parts of the body. In stage IIIB, cancer has spread to the serosal (outermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor.
stage IV gastric cancer (... GAS-trik KAN-ser)
* Cancer has spread (1) to organs next to the stomach and to at least one lymph node, or (2) to more than 15 lymph nodes, or (3) to other parts of the body.
staging (STAY-jing)
* Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
stomach (STUH-muk)
* An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.
surgery (SER-juh-ree)
* A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Recurrent Gastric Cancer
Recurrent gastric cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the stomach or in other parts of the body such as the liver or lymph nodes.
Treatment Option Overview
Key Points for This Section
* There are different types of treatment for patients with gastric cancer.
* Four types of standard treatment are used:
* Surgery
* Chemotherapy
* Radiation therapy
* Chemoradiation
* New types of treatment are being tested in clinical trials.
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatment for patients with gastric cancer.
Different types of treatments are available for patients with gastric cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
Surgery is a common treatment of all stages of gastric cancer. The following types of surgery may be used:
* Subtotal gastrectomy: Removal of the part of the stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor. The spleen may be removed. The spleen is an organ in the upper abdomen that filters the blood and removes old blood cells.
* Total gastrectomy: Removal of the entire stomach, nearby lymph nodes, and parts of the esophagus, small intestine, and other tissues near the tumor. The spleen may be removed. The esophagus is connected to the small intestine so the patient can continue to eat and swallow.
If the tumor is blocking the stomach but the cancer cannot be completely removed by standard surgery, the following procedures may be used:
* Endoluminal stent placement: A procedure to insert a stent (a thin, expandable tube) in order to keep a passage (such as arteries or the esophagus) open. For tumors blocking the passage into or out of the stomach, surgery may be done to place a stent from the esophagus to the stomach or from the stomach to the small intestine to allow the patient to eat normally.
* Endoluminal laser therapy: A procedure in which an endoscope (a thin, lighted tube) with a laser attached is inserted into the body. A laser is an intense beam of light that can be used as a knife.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemoradiation
Chemoradiation combines chemotherapy and radiation therapy to increase the effects of both. Chemoradiation treatment given after surgery to increase the chances of a cure is called adjuvant therapy. If it is given before surgery, it is called neoadjuvant therapy.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web site 1.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options by Stage
Stage 0 (Carcinoma in Situ)
Stage I Gastric Cancer
Stage II Gastric Cancer
Stage III Gastric Cancer
Stage IV Gastric Cancer
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 is usually surgery (total or subtotal gastrectomy).
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 gastric cancer 1. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage I Gastric Cancer
Treatment of stage I gastric cancer may include the following:
* Surgery (total or subtotal gastrectomy).
* Surgery (total or subtotal gastrectomy) followed by chemoradiation therapy.
* A clinical trial of chemoradiation therapy given before surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I gastric cancer 3. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage II Gastric Cancer
Treatment of stage II gastric cancer may include the following:
* Surgery (total or subtotal gastrectomy).
* Surgery (total or subtotal gastrectomy) followed by chemoradiation therapy.
* Chemotherapy given before and after surgery.
* A clinical trial of surgery followed by chemoradiation therapy testing new anticancer drugs.
* A clinical trial of chemoradiation therapy given before surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II gastric cancer 4. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage III Gastric Cancer
Treatment of stage III gastric cancer may include the following:
* Surgery (total gastrectomy).
* Surgery followed by chemoradiation therapy.
* Chemotherapy given before and after surgery.
* A clinical trial of surgery followed by chemoradiation therapy testing new anticancer drugs.
* A clinical trial of chemoradiation therapy given before surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III gastric cancer 5. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage IV Gastric Cancer
Treatment of stage IV gastric cancer that has not spread to distant organs may include the following:
* Surgery (total gastrectomy).
* Surgery followed by chemoradiation therapy.
* Chemotherapy given before and after surgery.
* A clinical trial of surgery followed by chemoradiation therapy testing new anticancer drugs.
* A clinical trial of chemoradiation therapy given before surgery.
Treatment of stage IV gastric cancer that has spread to distant organs may include the following:
* Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
* Endoluminal laser therapy or endoluminal stent placement to relieve a blockage in the stomach.
* Radiation therapy as palliative therapy to stop bleeding, relieve pain, or shrink a tumor that is blocking the stomach.
* Surgery as palliative therapy to stop bleeding or shrink a tumor that is blocking the stomach.
* A clinical trial of new combinations of chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV gastric cancer 6. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Treatment Options for Recurrent Gastric Cancer
Treatment of recurrent gastric cancer may include the following:
* Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
* Endoluminal laser therapy or endoluminal stent placement to relieve a blockage in the stomach.
* Radiation therapy as palliative therapy to stop bleeding, relieve pain, or shrink a tumor that is blocking the stomach.
* Surgery as palliative therapy to stop bleeding or shrink a tumor that is blocking the stomach.
* A clinical trial of new combinations of chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent gastric cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
* * * * * * * * * * * *
Chapter 2A: Gastric (Stomach) Cancer Health Professional Information
General Information About Gastric Cancer
Incidence and Mortality
Estimated new cases and deaths from gastric cancer in the United States in 2010:[1]
• New cases: 21,000.
• Deaths: 10,570. Epidemiology
* Management of adenocarcinoma histology, which accounts for 90% to 95% of all gastric malignancies, is discussed in this summary. The site of cancer origin within the stomach has changed in frequency in the United States over recent decades.[2] Cancer of the distal half of the stomach has been decreasing in the United States since the 1930s. However, in the last 2 decades, the incidence of cancer of the cardia and gastroesophageal junction has been rapidly rising. The incidence of this cancer has increased dramatically, especially in patients younger than 40 years.
Risk Factors
In the United States, gastric cancer ranks 14th in incidence among the major types of cancer malignancies. While the precise etiology is unknown, acknowledged risk factors for gastric cancer include:[3-5]
• Helicobacter pylori gastric infection.
• Advanced age.
• Male gender.
• Diet low in fruits and vegetables.
• Diet high in salted, smoked, or preserved foods.
• Chronic atrophic gastritis.
• Intestinal metaplasia.
• Pernicious anemia.
• Gastric adenomatous polyps.
• Family history of gastric cancer.
• Cigarette smoking.
• Menetrier disease (giant hypertrophic gastritis).
• Familial adenomatous polyposis.
Prognosis
The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall.[6,7] Tumor grade may also provide some prognostic information.[8]
In localized distal gastric cancer, more than 50% of patients can be cured. However, early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States. The remaining patients present with metastatic disease in either regional or distant sites. The overall survival rate in these patients at 5 years ranges from almost no survival for patients with disseminated disease to almost 50% survival for patients with localized distal gastric cancers confined to resectable regional disease. Even with apparent localized disease, the 5-year survival rate of patients with proximal gastric cancer is only 10% to 15%. Although the treatment of patients with disseminated gastric cancer may result in palliation of symptoms and some prolongation of survival, long remissions are uncommon.
Gastrointestinal stromal tumors occur most commonly in the stomach.
References
1. American Cancer Society.: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010. Also available online. Last accessed June 16, 2011.
2. Blot WJ, Devesa SS, Kneller RW, et al.: Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265 (10): 1287-9, 1991.
3. Kurtz RC, Sherlock P: The diagnosis of gastric cancer. Semin Oncol 12 (1): 11-8, 1985.
4. Scheiman JM, Cutler AF: Helicobacter pylori and gastric cancer. Am J Med 106 (2): 222-6, 1999.
5. Fenoglio-Preiser CM, Noffsinger AE, Belli J, et al.: Pathologic and phenotypic features of gastric cancer. Semin Oncol 23 (3): 292-306, 1996.
6. Siewert JR, Bbttcher K, Stein HJ, et al.: Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 228 (4): 449-61, 1998.
7. Nakamura K, Ueyama T, Yao T, et al.: Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer 70 (5): 1030-7, 1992.
8. Adachi Y, Yasuda K, Inomata M, et al.: Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type. Cancer 89 (7): 1418-24, 2000.
Cellular Classification of Gastric Cancer
There are two major types of gastric adenocarcinoma including the following:
• Intestinal.
• Diffuse.
Intestinal adenocarcinomas are well differentiated, and the cells tend to arrange themselves in tubular or glandular structures. The terms tubular, papillary, and mucinous are assigned to the various types of intestinal adenocarcinomas. Rarely, adenosquamous cancers can occur.
Diffuse adenocarcinomas are undifferentiated or poorly differentiated, and they lack a gland formation. Clinically, diffuse adenocarcinomas can give rise to infiltration of the gastric wall (i.e., linitis plastica).