Surgery

Gastric / Stomach Cancer

Q: What is the most common histological type of gastric cancer according to the Lauren Classification?

The intestinal type is the most common, characterized by well-differentiated, gland-forming cells. It is associated with H. pylori infection, chronic gastritis, and intestinal metaplasia, and is more common in older males.

Q: Which bacterial infection is a major modifiable risk factor for gastric cancer?

H. pylori infection is a major modifiable risk factor for gastric cancer. Its toxins (CagA+, VacA) cause chronic gastritis and decreased acid production, leading to bacterial overgrowth and metaplasia.

Q: What is the Correa Cascade sequence in gastric cancer development?

The Correa Cascade describes the stepwise progression from chronic gastritis to atrophy, then intestinal metaplasia, dysplasia, and finally carcinoma in intestinal-type gastric cancer.

Q: Which gene mutation is associated with the diffuse type of gastric cancer?

CDH1 mutation causing E-cadherin loss is characteristic of diffuse-type gastric cancer, leading to scattered cells and signet-ring cell formation.

Q: What is Virchow's node?

Virchow's node refers to left supraclavicular lymph node involvement, which is a metastatic warning sign in gastric cancer indicating lymphatic spread.

Gastric cancer is a malignancy of the stomach that typically presents late with nonspecific symptoms such as dyspepsia, early satiety, and weight loss, progressing to epigastric pain, vomiting, anemia, and palpable masses in advanced stages. It arises through distinct pathways including the Correa cascade driven by H. pylori infection leading to intestinal-type adenocarcinoma, and CDH1 mutations causing diffuse-type disease with signet-ring cells, while rarer gastric tumors include GIST, lymphoma, and carcinoid. Medical students must understand the modifiable risk factors such as H. pylori eradication, dietary modifications, and smoking cessation, recognize warning signs like Virchow's node and Sister Mary Joseph nodule indicating metastatic disease, and appreciate that prognosis is heavily stage-dependent with early mucosal disease having greater than 90% five-year survival compared to less than 20% for advanced cases.

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1. What is the most common histological type of gastric cancer according to the Lauren Classification?

2. Which bacterial infection is a major modifiable risk factor for gastric cancer?

3. What is the Correa Cascade sequence in gastric cancer development?

4. Which gene mutation is associated with the diffuse type of gastric cancer?

5. What is Virchow's node?

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Gastric / Stomach Cancer

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