Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-25T18:12:24.774Z Has data issue: false hasContentIssue false

2 - Pathology of gastric cancer

Published online by Cambridge University Press:  31 March 2010

By
Curtis R. Hall
Edited by
Richard M. Gore
Richard M. Gore
Affiliation:
Northwestern University Medical School, Illinois
Get access

Summary

Introduction

The stomach is an eccentric tubular organ between the esophagus and the duodenum that functions as a food capacitor and, using hydrochloric acid and pepsin secreted by cells within it, contributes to food digestion. Like other components of the gastrointestinal (GI) tract, the stomach includes several layers of tissue, the two most relevant to a discussion of gastric neoplasia being the mucosa and the muscularis propria. The mucosa is subject to inflammatory processes, a familiarity with which aids in the understanding of the genesis of neoplasms arising from that layer of tissue. Neoplastic pathology of the stomach has been well reviewed in depth in recent years; the following will serve as a brief introduction to the gross and microscopic characteristics of gastric neoplasms and their precursors, with special consideration of features relevant to prognosis. Current genetics and molecular biology of these processes will also be considered.

Gross and microscopical anatomy

The wall of the stomach is formed by several layers of tissue (Figure 2.1). The mucosa is the innermost layer and is derived from the fetal endoderm. The character of the mucosa varies somewhat depending on its location within the stomach. The mucosa lining the gastric fundus and body is made up of densely packed test-tube-like units divided into two zones: the pit and the gland. The pit, populated by tall mucus cells, extends from the surface to the glandular compartment, which is lined almost exclusively by parietal and chief cells.

Type
Chapter
Information
Gastric Cancer , pp. 22 - 41
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fenoglio-Preiser, C, Munoz, N, Carneiro, Fet al. Gastric cancer. In Hamilton, SR and Aaltonen, eds., Pathology and Genetics: Tumours of the Digestive System. Lyon, France: IARC Press, 2000; pp. 38–52.Google Scholar
Day, DW, Jass, JR, Price, ABet al. Morson and Dawson's Gastrointestinal Pathology, 4th edn. Malden, MA: Blackwell Science, 2003; pp. 162–213.CrossRefGoogle Scholar
Fenoglio-Preiser, CM, Noffsinger, AE, Stemmerman, GNet al. The neoplastic stomach. In Gastrointestinal Pathology: An Atlas and Text, 3rd edn. Philadelphia, PA: Lippincott Williams & Wilkins, 2008; pp. 233–73.Google Scholar
Owen, DA. Stomach. In Sternberg, SS ed., Histology for Pathologists, 2nd edn. Philadelphia, PA: Lippincott-Raven, 1997; pp. 481–93.Google Scholar
Warren, JR and Marshall, B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983; 1: 1273–5.Google ScholarPubMed
Marshall, B. Helicobacter pylori: 20 years on. Clin Med 2002; 2: 147–52.CrossRefGoogle Scholar
Atherton, JC. The pathogenesis of Helicobacter pylori-induced gastro-duodenal diseases. Annu Rev Pathol Mech Dis 2006; 1: 63–96.CrossRefGoogle ScholarPubMed
Taylor, DN and Blaser, MJ. The epidemiology of Helicobacter pylori infection. Epidemiol Rev 1991; 13: 42–59.CrossRefGoogle ScholarPubMed
Kerkhoven, LAS, Eikandal, T, Laheij, RJFet al. Gastrointestinal symptoms are still common in a general Western population. Neth J Med 2008; 66: 18–22.Google Scholar
Tahara, T, Arisawa, T, Shibata, Tet al. Association of endoscopic appearances with dyspeptic symptoms. J Gastroenterol 2008; 43: 208–15.CrossRefGoogle ScholarPubMed
Marshall, BJ and Warren, JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1: 1311–14.CrossRefGoogle ScholarPubMed
Honda, S, Fujioka, T, Tokieda, Met al. Gastric ulcer, atrophic gastritis and intestinal metaplasia caused by Helicobacter pylori infection in Mongolian gerbils. Scand J Gastroenterol 1998; 33: 454–60.Google ScholarPubMed
Ikeno, T, Ota, H, Sugiyama, Aet al. Helicobacter pylori-induced chronic active gastritis, intestinal metaplasia, and gastric ulcer in Mongolian gerbils. Am J Pathol 1999; 154: 951–60.CrossRefGoogle ScholarPubMed
Zhang, C, Yamada, N, Wu, Y-Let al. Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early cancer. World J Gastroenterol 2005; 11: 791–6.CrossRefGoogle Scholar
Owen, DA. Gastritis and carditis. Mod Pathol 2003; 16: 325–41.CrossRefGoogle ScholarPubMed
Lauren, P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand 1965; 64: 31–49.CrossRefGoogle ScholarPubMed
Ming, S-C. Gastric carcinoma: a pathobiological classification. Cancer 1977; 39: 2475–85.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Ohata, H, Kitauchi, S, Yoshimura, Net al. Progression of chronic atrophic gastritis associated with Helicobacter pylori infection increases risk of gastric cancer. Int J Cancer 2004; 109: 138–43.CrossRefGoogle ScholarPubMed
Correa, P. Human gastric carcinogenesis: a multistep and multifactorial process. Cancer Res 1992; 52: 6735–40.Google ScholarPubMed
Meining, A, Morgner, A, Miehlke, Set al. Atrophy-metaplasia-dysplasia-carcinoma sequence in the stomach: a reality or merely an hypothesis?Best Pract Res Clin Gastroenterol 2001; 15: 983–98.CrossRefGoogle ScholarPubMed
Elfvin, A, BÖlin, I, Bothmer, Cet al. Helicobacter pylori induces gastritis and intestinal metaplasia but no gastric adenocarcinoma in Mongolian gerbils. Scand J Gastroenterol 2005; 40: 1313–20.CrossRefGoogle ScholarPubMed
Zheng, Q, Chen, XY, Shi, Yet al. Development of adenocarcinoma in Mongolian gerbils after long-term infection with Helicobacter pylori. J Gastroenterol Hepatol 2004; 19: 1192–8.CrossRefGoogle ScholarPubMed
Watanabe, T, Tada, M, Nagai, Het al. Helicobacter pylori infection induces gastric cancer in Mongolian gerbils. Gastroenterology 1998; 115: 642–8.CrossRefGoogle ScholarPubMed
Gologan, A, Graham, DY, and Sepulveda, AR. Molecular markers in Helicobacter pylori-associated carcinogenesis. Clin Lab Med 2005; 25: 197–222.CrossRefGoogle Scholar
Vauhkonen, M, Vauhkonen, H, and Sipponen, P. Pathology and molecular biology of gastric cancer. Best Pract Res Clin Gastroenterol 2006; 20: 651–74.CrossRefGoogle ScholarPubMed
Shiotani, A, Iishi, H, Uedo, Net al. Evidence that loss of sonic hedgehog is an indicator of Helicobacter pylori-induced atrophic gastritis progressing to gastric cancer. Am J Gastroenterol 2005; 100: 581–7.CrossRefGoogle ScholarPubMed
Wang, L-H, Choi, Y-L, Hua, X-Yet al. Increased expression of sonic hedgehog and altered methylation of its promoter region in gastric cancer and its related lesions. Mod Pathol 2006; 19: 675–83.CrossRefGoogle Scholar
Brenner, H, Rothenbacher, D, and Arndt, V.Epidemiology of stomach cancer. Methods Mol Biol 2009; 472: 467–77.CrossRefGoogle ScholarPubMed
Adachi, Y, Mori, M, Tsuneyoshi, Met al. Benign gastric ulcer grossly resembling a malignancy: a clinicopathological study of 20 resected cases. J Clin Gastroenterol 1993; 16: 103–8.CrossRefGoogle Scholar
Bacani, JT, Soares, M, Zwingerman, Ret al. CDH1/E-cadherin germline mutations in early-onset gastric cancer. J Med Genet 2006; 43: 867–72.CrossRefGoogle ScholarPubMed
Chung, DC, Yoon, SS, Lauwers, GYet al. Case 22–2007: a woman with a family history of gastric and breast cancer. New Engl J Med 2007; 357: 283–91.CrossRefGoogle ScholarPubMed
Lynch, HT, Grady, W, Suriano, Get al. Gastric cancer: new genetic developments. J Surg Oncol 2005; 90: 114–33.CrossRefGoogle ScholarPubMed
Derakhshan, MH, Malekzadeh, R, Watabe, Het al. Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gastric cardia cancer. Gut 2008; 57: 298–305.CrossRefGoogle ScholarPubMed
McColl, KEL. Cancer of the gastric cardia. Best Pract Res Clin Gastroenterol 2006; 20: 687–96.CrossRefGoogle ScholarPubMed
Greene, FL, Page, DL, Fleming, IDet al. eds. Stomach. In AJCC Cancer Staging Manual, 6th edn. New York, NY: Springer, 2002; pp. 99–103.CrossRef
Maruyama, K. The most important prognostic factors for gastric cancer patients: a study using univariate and multivariate analyses. Scand J Gastroenterol 1987; 22 (S133): 63–8.CrossRefGoogle Scholar
Okabayashi, T, Kobayashi, M, Nishimori, Iet al. Clinicopathological features and medical management of early gastric cancer. Am J Surg 2008; 195: 229–32.CrossRefGoogle ScholarPubMed
Ohta, H, Noguchi, Y, Takagi, Ket al. Early gastric carcinoma with special reference to macroscopic classification. Cancer 1987; 60: 1099–106.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Morgner, A, Schmelz, R, Thiede, Cet al. Therapy of gastric mucosa associated lymphoid tissue lymphoma. World J Gastroenterol 2007; 13: 3554–66.CrossRefGoogle ScholarPubMed
Banks, PM. Gastrointestinal lymphoproliferative disorders. Histopathology 2007; 50: 42–54.CrossRefGoogle ScholarPubMed
Rindi, G, Bordi, C, Rappel, Set al. Gastric carcinoids and neuroendocrine carcinoma: pathogenesis, pathology, and behavior. World J Surg 1996; 20: 168–72.CrossRefGoogle Scholar
Levy, AD and Sobin, LH. Gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics 2007; 27: 237–57.CrossRefGoogle ScholarPubMed
Miettinen, M and Lasota, J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006; 130: 1466–78.Google ScholarPubMed
Perez, EA, Livingstone, AS, Franceschi, Det al. Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg 2006; 202: 623–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×