Malignant Diseases of the Stomach Diagnosis of Gastric Carcinoma

Diagnosis

Endoscopic diagnostic criteria u TO

TO U

The endoscopic appearance of gastric carcinoma depends on its stage and the primary type of tumor growth (see above). In the following outline of endoscopic features, it should be kept in mind that a tumor cannot be classified as early carcinoma by endoscopic biopsy, but only after it has been surgically removed.

Early carcinoma (Fig. 3.109)

► Type I, protruding type

- Polypoid protrusion

- Mucosa may appear normal, irregular, or erythema-tous

► Type II, superficial type

- Mucosa discolored, irregular, or nodular

- IIa: minimally raised

- IIc: minimally depressed

► Type III, excavating type

- Craterlike excavation

- Central ulceration

Advanced carcinoma (Fig. 3.110)

- Broad-based polypoid tumor

- Mucosa irregular, fissured, or cauliflowerlike

- Relatively well demarcated from surroundings

Fig. 3.110 Advanced gastric carcinoma a Type I

b Type II

Fig. 3.110 Advanced gastric carcinoma a Type I

b Type II

t c Type III

d Type IV

Fig. 3.109 Early gastric carcinoma, type IIa

► Type II, polypoid form with ulceration

- Fungating tumor

- Central ulceration

- Craterlike

- Ulcer base smooth, nodular, or necrotic

- Relatively well demarcated from surroundings

► Type III, infiltrating form with ulceration

- Superficial ulceration

- Poorly demarcated from surroundings

- Shallow undermining of the surrounding mucosa

► Type IV, diffusely infiltrating form

- Mucosa irregular, nodular, or indurated

- Firm or hard consistency of the stomach wall

- Stricture formation

- Altered peristalsis

Differential diagnosis

Checklist for endoscopic evaluation

► Surface characteristics

► Consistency

► Craniocaudal extent

► Relation to surroundings

Additional Studies

► Endosonography

► Usual staging work-up: chest radiograph, abdominal ultrasound, abdominal computed tomography (CT), tumor markers for follow-up.

The treatment of choice is surgical resection. Mucosectomy is an experimental therapy that should be reserved for specialized investigations and centers.

d Type IV

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