Pathological anatomy.

Plaque-like cancer (flattened, superficial, creeping) occurs in 1-5% of cases of gastric cancer and is the rarest form. The tumor is often found in the pyloric region, on the lesser or greater curvature in the form of a small, 2-3 cm long, plaque-like thickening of the mucous membrane (Fig. 199). The mobility of the folds of the mucous membrane in this place is somewhat limited, although the tumor rarely grows into the submucosal layer. Histologically, plaque-like cancer usually has the structure of adenocarcinoma, less often - undifferentiated cancer.

Polyposis cancer accounts for 5% of gastric carcinoma cases. It has the appearance of a node with a villous surface with a diameter of 2-3 cm, which is located on a stalk (see Fig. 199). The tumor tissue is gray-pinkish or gray-red, rich in blood vessels. Sometimes polyposis cancer develops from an adenomatous polyp of the stomach, but more often it represents the next phase of exophytic growth of plaque-like cancer. Microscopic examination often reveals adenocarcinoma, sometimes undifferentiated cancer.

Fungal (fungal) cancer occurs in 10% of cases. Like polypous cancer, it has the appearance of a nodular, lumpy (less often with a smooth surface) formation, sitting on a short wide base (see Fig. 199). On the surface of the tumor node, erosions, hemorrhages or fibrinous-purulent deposits are often found. The tumor is soft, gray-pink or gray-red, well demarcated. Fungal cancer can be considered as a phase of exophytic growth of polyposis cancer, therefore, upon histological examination, it is represented by the same types of carcinoma as polyposis.

Ulcerated cancer is very common (more than 50% of gastric cancer cases). It unites malignant gastric ulcerations of various genesis, which include primary ulcerative cancer, saucer-shaped cancer (cancer) and cancer from a chronic ulcer (ulcer-cancer).

Primary ulcerative gastric cancer (Fig. 200) has been little studied. It is rarely discovered. This form includes exophytic cancer with ulceration at the very beginning of its development (plaque-like cancer), the formation of an acute and then chronic cancer ulcer, which is difficult to distinguish from an ulcer-cancer. Microscopic examination often reveals undifferentiated cancer.

Saucer-shaped cancer (ulcer cancer) is one of the most common forms of stomach cancer (see Fig. 200). It occurs when an exophytically growing tumor ulcerates (polypous or fungosous cancer) and is a round formation, sometimes reaching large sizes, with roller-like whitish edges and ulceration in the center. The bottom of the ulcer may be neighboring organs into which the tumor grows. Histologically, it is more often represented by adenocarcinoma, less often by undifferentiated cancer.

Ulcer-cancer develops from a chronic gastric ulcer (see Fig. 200), so it occurs where a chronic ulcer is usually localized, i.e. on the lesser curvature. The signs of a chronic ulcer distinguish ulcer-cancer from saucer-shaped cancer: extensive proliferation of scar tissue, sclerosis and thrombosis of blood vessels, destruction of the muscle layer in the scar base of the ulcer and, finally, thickening of the mucous membrane around the ulcer. These signs remain with the malignancy of a chronic ulcer. Particular importance is attached to the fact that in saucer-shaped cancer the muscle layer is preserved, although it is infiltrated by tumor cells, and in ulcer cancer it is destroyed by scar tissue. The tumor grows predominantly exophytically in one of the edges of the ulcer or along its entire circumference. More often it has the histological structure of adenocarcinoma, less often - undifferentiated cancer.

Infiltrative ulcerative cancer occurs in the stomach quite often. This form is characterized by pronounced cancrosis infiltration of the wall and ulceration of the tumor, which in time sequence can compete: in some cases it is late ulceration of massive endophytic carcinomas, in others it is endophytic tumor growth from the edges of a malignant ulcer. Therefore, the morphology of infiltrative-ulcerative cancer is unusually diverse - these are small ulcers of varying depths with extensive infiltration of the wall or huge ulcerations with a tuberous bottom and flat edges. Histological examination reveals both adenocarcinoma and undifferentiated cancer.

Diffuse cancer (see Fig. 199) is observed in 20-25% of cases. The tumor grows endophytically in the mucous, submucosal and muscular layers along the connective tissue layers. The wall of the stomach becomes thickened, dense, whitish and motionless. The mucous membrane loses its usual relief: its surface is uneven, folds of uneven thickness, often with small erosions. Damage to the stomach can be limited (in this case, the tumor is most often found in the pyloric region) or total (the tumor covers the entire length of the stomach wall). As the tumor grows, the wall of the stomach sometimes shrinks, its size decreases, and the lumen narrows. Diffuse cancer is usually represented by variants of undifferentiated carcinoma.

Transitional forms of cancer account for approximately 10-15% of all gastric cancers. These are either exophytic carcinomas, which at a certain stage of development acquired pronounced infiltrating growth, or endophytic, but limited to a small territory cancer with a tendency to intragastric growth, or, finally, two (sometimes more) cancer tumors of different clinical and anatomical shapes in the same stomach .

In recent years, the so-called early stomach cancer has been isolated, which has up to 3 cm in diameter and grows no deeper than the submucosal layer. Diagnosis of early gastric cancer has become possible thanks to the introduction of targeted gastrobiopsy into practice. Isolation of this form of cancer is of great practical importance: up to 100% of such patients live after surgery for more than 5 years, only 5% of them have metastases.

Gastric cancer tends to spread beyond the organ itself and invade neighboring organs and tissues. Cancer, located on the lesser curvature with a transition to the anterior and posterior walls and in the pyloric region, grows into the pancreas, porta hepatis, portal vein, bile ducts and gallbladder, lesser omentum, mesenteric root and inferior vena cava. Cardiac gastric cancer spreads to the esophagus, while fundal cancer grows into the hilum of the spleen and diaphragm. Total cancer, like cancer of the greater curvature of the stomach, grows into the transverse colon, the greater omentum, which shrinks and shortens.

Histological types of gastric cancer reflect the structural and functional characteristics of the tumor. Adenocarcinoma, which occurs very often with exophytic tumor growth, can be tubular, papillary and mucinous (Fig. 201), and each type of adenocarcinoma is differentiated, moderately differentiated and poorly differentiated. Undifferentiated cancer, characteristic of endophytic tumor growth, is represented by several variants - solid, scirrhous (Fig. 202), signet ring cell. Squamous cell, glandular squamous cell (adenocancroid) and unclassified types of gastric cancer are rare.

In addition to the International Histological Classification, gastric cancer is divided according to the nature of its structure into intestinal and diffuse types [Lauren, 1965]. The intestinal type of stomach cancer is represented by glandular epithelium, similar to the columnar epithelium of the intestine with mucous secretion. The diffuse type of cancer is characterized by diffuse infiltration of the stomach wall with small cells containing and not containing mucus and forming glandular structures here and there.

Metastases are very typical for stomach cancer; they occur in 3/4-2/3 of cases. Metastasizes stomach cancer in various ways - lymphogenous, hematogenous and implantation (contact).

The lymphogenous route of metastasis plays a major role in the spread of the tumor and is clinically the most important (Fig. 203). Of particular importance are metastases to regional lymph nodes located along the lesser and greater curvature of the stomach. They occur in more than half of cases of gastric cancer, appear first and largely determine the volume and nature of surgical intervention. In distant lymph nodes, metastases appear in both orthograde (along the lymph flow) and retrograde (against the lymph flow) pathways. Retrograde lymphogenous metastases, which have important diagnostic value in gastric cancer, include metastases to the supraclavicular lymph nodes, usually left ("Virchow metastases", or "Virchow gland"), to the lymph nodes of the perirectal tissue ("Schnitzler metastases"). A classic example of lymphogenous retrograde metastases of gastric cancer is the so-called Krukenberg ovarian cancer. As a rule, metastatic lesions affect both ovaries, which sharply enlarge and become dense and whitish. Lymphogenic metastases appear in the lungs, pleura, and peritoneum.

Peritoneal carcinomatosis is a common companion to stomach cancer; in this case, the lymphogenous spread of cancer throughout the peritoneum is complemented by implantation (see Fig. 203). The peritoneum becomes dotted with tumor nodes of various sizes, merging into conglomerates, among which intestinal loops are immured. Often, a serous or fibrinous-hemorrhagic effusion (the so-called cancrosis peritonitis) appears in the abdominal cavity.

The clinical and anatomical classification of stomach cancer is based on the following parameters: tumor localization in the stomach, growth pattern, macroscopic shape, histological type.

Depending on the location in different parts of the stomach, cancer of the pylorus, lesser curvature of the stomach with transition to the posterior and anterior walls, cardia, greater curvature, and fundus of the stomach are distinguished

If the tumor occupies more than one of the above sections, cancer is called subtotal, with damage to all parts of the stomach - total.

The tumor can be located in any part of the stomach, but the most common location is the pylorus and lesser curvature. These 2 locations account for ¾ of gastric carcinomas.

Gastric tumors grow either into the lumen (exophytic) or into the thickness of the wall (endophytic) and are macroscopically subdivided taking into account the predominant growth pattern.

Currently, there are four forms of stomach cancer:

· tumors rising above the mucous membrane;

· neoplasms located at the level of the mucous membrane;

· tumors lying below the mucous membrane (ulcerated);

· volumetric formations that grow diffusely in the thickness of the organ wall and cause its sharp thickening.

In addition, in the domestic literature, a more detailed classification by V.V. Serov (1970) is generally accepted, which not only identifies all of these forms, but also provides clear detail and classification of each macroscopic form of gastric cancer, starting with the initial forms of cancer.

Clinical and anatomical forms of stomach cancer (V.V. Serov, 1970):

I. Cancer with predominantly exophytic expansive growth:

1. Plaque cancer

2. Polyposis cancer

3. Fungal (fungal) cancer

4. Ulcerated cancer:

· primary ulcerative;

· saucer-shaped (cancer-ulcer);

cancer from a chronic ulcer (ulcer-cancer)

II. Cancer with predominantly endophytic infiltrating growth:

1. Diffuse

2. Infiltrative-ulcerative

III. Cancer with exo-endophytic (mixed) growth pattern:

Transitional forms

Plaque cancer– a rare form of cancer, represented by a flat, plaque-like formation, slightly raised above the gastric mucosa, usually small in size (up to 2 cm). The tumor is located in the mucous membrane, the latter is mobile, and in the section the layers of the stomach wall are clearly visible. Usually it is not clinically manifested, it is not verified radiographically, therefore it is rarely diagnosed, usually detected as a finding during gastroscopy.

Polyposis cancer usually has the characteristic appearance of a polyp on a thin stalk, growing into the lumen of the stomach, mobile, and soft in consistency. Often the tumor develops as a result of malignancy of an adenomatous polyp, but can be the result of further growth of plaque-like cancer if the exophytic growth pattern predominates.

Fungal (mushroom) cancer differs from polypous in that it grows on a broad base and looks like cauliflower. The tumor is often located on the lesser curvature in the area of ​​the body of the stomach and is constantly injured, and therefore erosions, hemorrhages and foci of necrosis covered with fibrinous plaque are usually observed on its surface. Most often it is a stage of further growth of polypous cancer.

Ulcerated cancer– the most common macroscopic form of cancer. However, its genesis is different, so three types are distinguished - primary ulcerative, saucer-shaped and chronic ulcer cancer.

Primary ulcerative cancer characterized by the fact that from the very beginning of its occurrence, i.e. from the stage of a flat plaque, it undergoes ulceration. In this case, the tumor goes through three stages of development - the stage of cancerous erosion, acute ulcer and the stage of chronic cancerous ulcer. Typically, the tumor manifests symptoms characteristic of a peptic ulcer and more often in the later stages, when it is almost impossible to distinguish it from a chronic gastric ulcer that has undergone malignancy.

Saucer-shaped cancer (cancer-ulcer)– the most common macroscopic form of gastric cancer. The tumor has a characteristic structure in the form of a node protruding into the lumen of the stomach with roller-like raised edges and a bottom sinking in the center. Typically, saucer cancer is formed as a result of necrosis and ulceration of fungiform or polypous cancer.

Ulcer-cancer develops as a result of malignancy of a chronic gastric ulcer. The tumor is located on the lesser curvature, i.e., where a chronic ulcer is usually located, and is similar in appearance to it - it is represented by a deep defect in the wall of the stomach, the edges of which have a dense, callus-like consistency and characteristic edges - undermined proximal and gently sloping distal. Typically, a tumor in the form of dense whitish-gray tissue grows in one of the edges. In cases of an advanced process, it is sometimes possible to distinguish an ulcer-cancer from a saucer-shaped cancer only microscopically, while in a malignized ulcer it is possible to detect among the tumor tissue vessels with sclerotic walls, amputation neuromas and massive fields of scar tissue in place of the muscular lining of the stomach wall.

Diffuse cancer– a macroscopic form of gastric cancer, characterized by pronounced endophytic growth. The tumor germinates all layers of the gastric wall and grows along it, giving it exceptional strength and rigidity, for which such a stomach is compared to a leather bottle. Another name for diffuse gastric cancer is plastic linitis- originates from the times when this tumor was mistaken for inflammation of the submucosal membrane. The term "plastic linitis" was described in 1984. Lewis Brinton, who coined the term " linitis plastica"to denote a sharp thickening of the stomach wall due to the growth of cancer, rich in connective tissue stroma, mainly in the submucosal layer. With diffuse gastric cancer, the wall of the organ is thickened to several centimeters, dense, its layers are indistinguishable. The mucous membrane above the tumor is sharply smoothed, and the lumen is unevenly narrowed.

Infiltrative-ulcerative cancer is distinguished by pronounced growth of the stomach wall by a tumor, on the one hand, and numerous erosions or ulcers on the surface of the mucous membrane, on the other. The tumor develops as a result of the progression of either diffuse or saucer-shaped cancer and is often extensive in size - subtotal or total.

A thorough analysis of each macroscopic form of gastric cancer and comparison of them with each other show that they are often simultaneously phases of a single tumor process of a staged nature. Moreover, each of the forms bears the imprint of the predominance of the exophytic or endophytic nature of tumor growth.

From a clinical point of view, it is important to highlight early stomach cancer, growing no deeper than the submucosal layer, i.e., superficial cancer, in which the five-year postoperative survival rate is almost 100%.

Histological types of stomach cancer:

1) adenocarcinoma;

2) undifferentiated cancer;

3) squamous cell carcinoma;

4) glandular squamous cell carcinoma.

Adenocarcinoma is the most common histological type of gastric cancer. Depending on the shape of the glandular structures, it is divided into tubular, papillary, mucinous and signet ring cell carcinoma.

Tubular adenocarcinoma contains glands of various shapes and sizes, which are lined with cylindrical, cubic or flattened cells with polymorphic nuclei, as well as solid fields, sometimes with large lymphoid elements. The development of cancerous stroma varies.

Papillary form built from papillary structures, in which each papilla has a fibrovascular core and a single-layer or multi-layer lining of epithelial cells containing small drops of mucins. The cancerous epithelium includes goblet cells. A combination of papillary and tubular structures is possible.

Mucinous form (mucoid, mucous, colloid cancer) characterized by increased, predominantly extracellular mucus formation. Mucus can occupy more than 50% of the total volume of the tumor. Cancerous parenchyma is characterized by cystic transformation of the glands with the formation of “lake of mucus.”

Signet ring cell carcinoma contains at least 50% of cells with signs of intracellular mucus formation. The mucus accumulating in the cytoplasm moves the nucleus to the periphery, compresses it, and the cell takes on a resemblance to a “ring.” Since tumor cells produce mucus cyclically and cannot be in the same secretion phase at the same time, not all cells have the classic “signet rings”. In signet ring cell carcinoma, cells with a centrally located nucleus, eosinophilic cytoplasm, very small cells without signs of mucus production, and anaplastic cellular elements are also found. Tumor cells can grow diffusely and form solid fields and glandular structures.

Depending on the degree of differentiation, highly differentiated, moderately differentiated and poorly differentiated adenocarcinoma is distinguished, but even with a highly differentiated tumor, the cells do not reach full maturity. As the degree of tumor differentiation decreases, the ability to form glands is lost, so small gland-like structures are usually difficult to detect in poorly differentiated adenocarcinomas.

Well-differentiated adenocarcinoma It is represented by glands of various shapes and sizes, formed by cells with minor signs of cellular atypia. Many cells, despite mild atypia and polymorphism, resemble their normal counterparts. The lining of cancer glands consists mainly of goblet-shaped elements that secrete mucus, as well as bordered absorptive enterocytes, endocrine cells, parietal cells and Paneth cells. Tumor cells have a round vesicular nucleus with unevenly distributed clumpy chromatin and large, clearly defined nucleoli. Numerous mitotic figures are found.

Moderately differentiated adenocarcinoma is distinguished by a noticeable simplification of tissue architectonics with interglandular and intraglandular proliferation. This type of cancer reflects an intermediate degree of differentiation between well- and poorly differentiated carcinoma. It is characterized by the presence of solid layers of cancerous parenchyma (solid cancer).

Poorly differentiated adenocarcinoma has a weakly expressed ability to form glandular structures. Small and atypical cancer cells are often separated and grow in small groups or in isolation from each other, causing a pronounced fibroblastic reaction. Among them there are many figures of mitosis, often atypical. Adenocarcinoma with a scirrhosing type of growth is characterized by an abundance of fibrous stroma, which compresses the tumor parenchyma, represented by small clusters of sharply atypical hyperchromic cells and small glandular structures. This tumor has a cartilaginous consistency.

Undifferentiated gastric cancer characterized by a scattered type of growth of small atypical cells with hyperchromic nuclei, forming groups, cords, fields and exhibiting high mitotic activity.

Squamous cell carcinoma– an extremely rare histological type of stomach cancer. It may develop as a result of metaplasia of the glandular epithelium into stratified squamous epithelium during chronic inflammatory processes. It can arise from heterotopic islands of stratified squamous epithelium. Finally, squamous cell carcinoma may spread from the esophagus.

Glandular squamous cell carcinoma of the stomach is a combination of two histological types - adenocarcinoma and squamous cell carcinoma.

There is the following classification of stomach cancer.

1. According to localization, they are distinguished: pyloric, lesser curvature of the body with transition to the walls, cardiac, greater curvature, fundal and total.

2. According to the nature of growth, three forms are distinguished:

1) with predominantly exophytic growth (plaque-like, polypous, fungoid, or mushroom-shaped, and ulcerated);

2) with predominantly endophytic infiltrating growth (infiltrative-ulcerative, diffuse);

3) with exoendophytic growth, or mixed.

3. Microscopically, adenocarcinoma is distinguished (tubular, papillary, mucinous), undifferentiated (solid, scirrhous, mural cell), squamous cell, glandular squamous cell (adenocancroid) and unclassified cancer.

Pathological anatomy. Plaque cancer affects the submucosal layer. Polypous cancer is gray-pink or gray-red in color and is rich in blood vessels. These two forms of cancer have the histological structure of adenocarcinoma or undifferentiated cancer. Fungal cancer is a nodular formation with erosions on the surface, as well as hemorrhages or fibrinous-purulent overlays. The tumor is soft, gray-pink or gray-red and well circumscribed; histologically it is represented by adenocarcinoma. Ulcerated cancer by genesis is a malignant tumor; it is represented by primary ulcerative, saucer-shaped cancer and cancer from a chronic ulcer (ulcer-cancer). Primary ulcerative cancer is microscopically represented as undifferentiated cancer. Saucer-shaped cancer is a round formation, reaching large sizes, with roller-like whitish edges and ulceration in the center. The bottom of the ulcer may be represented by other (adjacent) organs. Histologically it is represented by adenocarcinoma. Ulcer-cancer is characterized by the formation of an ulcer at the site and is manifested by the proliferation of scar tissue, sclerosis and thrombosis of blood vessels, destruction of the muscle layer at the bottom of the ulcer and thickening of the mucous membrane around the ulcer. Histologically it looks like adenocarcinoma, less often undifferentiated cancer. Infiltrative-ulcerative cancer is characterized by pronounced cancrosis infiltration of the wall and ulceration of the tumor, and is histologically represented by adenocarcinoma or undifferentiated cancer. Diffuse cancer is manifested by thickening of the stomach wall, the tumor is dense, whitish and immobile.

The mucous membrane has an uneven surface, and folds of uneven thickness with erosions. Lesions can be limited or total. As the tumor grows, the stomach wall shrinks. Histologically, the cancer is represented by an undifferentiated form of carcinoma. Transitional forms have different clinical and morphological forms.

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  Cancer stomach cancer stomach


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  Cancer stomach. There is the following classification cancer stomach. 1. According to localization, they are distinguished: pyloric, lesser curvature of the body with transition to the walls, cardiac, greater...


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  Cancer stomach. There is the following classification cancer stomach. 1. According to localization, they are distinguished: pyloric, lesser curvature of the body with transition to the walls, cardiac, greater...


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  Cancer stomach. There is the following classification cancer stomach. 1. According to localization, they are distinguished: pyloric, lesser curvature of the body with transition to the walls, cardiac, greater...


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  Cancer stomach. There is the following classification cancer stomach. 1. According to localization, they are distinguished: pyloric, lesser curvature of the body with transition to the walls, cardiac, greater...


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  cancer stomach


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  The most common are gastritis, peptic ulcer and cancer. Gastritis is an inflammation of the mucous membrane stomach. There are acute and chronic gastritis.

There are three forms of stomach cancer: circumscribed (mushroom-shaped and saucer-shaped), ifiltrative (diffuse) and mixed, which develops partly exophytically, at the same time infiltrating the wall of the stomach. With delineated forms, the visible border of the tumor, as a rule, coincides with the histologically established border. Mushroom-shaped and saucer-shaped forms are distinguished by relatively slow development and late metastasis. If a radical operation is performed, the prognosis for them is more favorable than for mixed and infiltrative forms.

For infiltrative and mixed forms It is often very difficult to establish the boundary between a tumor and healthy tissue. In addition to the mentioned forms of stomach cancer, one should also distinguish between ulcerative cancer (cancer ulceriforme), which develops immediately as an ulcer-like tumor with disintegration in the center and metastasizes much earlier than saucer-shaped cancer. Cancer from a stomach ulcer (cancer ex ulcere) is very malignant, often taking the form of a saucer-shaped tumor. It is also advisable to call cancer from a polyp of the stomach (cancer ex polipo) as a separate form.

Features of all forms of stomach cancer their tendency to spread towards the cardia and esophagus should be considered. Cancer of the lower third of the stomach is also distinguished by its tendency to grow circularly. Tumors rarely spread to the duodenum; at the same time, they infiltrate the wall of the duodenum without involving the mucous membrane. According to the histological structure, adenocarcinoma, solid, fibrous cancer and a mixed form are distinguished, in which part of the tumor may have, for example, the structure of adenocarcinoma, and part of solid cancer.

Spread of stomach cancer

As the tumor grows Not only all layers of the stomach wall can grow, but also neighboring organs (liver, pancreas, spleen, transverse colon, diaphragm). The tumor can metastasize. There are three ways of metastasis: through the lymphatic, circulatory pathways and implantation metastasis through the peritoneum (the tumor grows into the serous membrane).

Greatest practical value has spread of metastases along the lymphatic pathways. Three main pathways of lymph flow should be distinguished. The first collector collects lymph into nodes located along the lesser curvature, lesser omentum and gastropancreatic ligament, especially in the area of ​​the left gastric artery. Further metastases from this area can spread to the area of ​​the celiac artery and aorta (inoperable cases). Lymph from almost the entire right half of the stomach collects here.

Second collector collects lymph from the lower part of the stomach (the greater curvature of the stomach below the spleen and the initial part of the duodenum) into the lymph nodes located along the a. gastrocpiloica dextra. Metastases into the space between the initial part of the duodenum and the head of the pancreas are also of practical importance. With advanced cancer, metastases from this collector can spread to the lymph nodes of the mesentery of the small intestine and para-aortically. The third collector collects lymph from the remaining part of the stomach (the fundus, part of the greater curvature, part of the anterior and posterior walls) into the lymph nodes located in the gastrosplenic ligament, the hilum of the spleen and along the splenic artery.

Knowledge of metastasis pathways mandatory to perform a radical operation, the meaning of which is to remove not only the stomach tumor, but also the ligamentous apparatus with fiber, in which the regional lymph nodes are located. The operation should always be performed on the assumption that metastases are already present; only then will it be radical enough.

Metastases to internal organs(liver, pancreas, kidneys, adrenal glands, etc.) are important in the sense that. As a rule, such patients are inoperable. For preoperative diagnosis of stage IV cancer, you need to know some typical metastases: Virchow - to the left supraclavicular space, Krukenberg - to the ovaries, Schnitzler - to the pouch of Douglas. In some cases, in the presence of solitary metastasis to the liver or pancreas, a combined conditionally radical operation is performed - resection stomach and liver or resection of the stomach and pancreas.

Precancerous diseases. It has now been proven that people with gastritis, especially Achilles, develop stomach cancer more often than healthy people. Such patients require clinical observation in order to timely diagnose the development of stomach cancer.

Stomach polyps are always a potential source of cancer. Malignancy of polyps, according to various statistics, can reach 40% of cases. The best prevention of cancer in these patients is timely treatment of polyposis. Stomach ulcers very often (according to some statistics, in 10-50% of cases) turn into cancer. It is clear how important timely detection and treatment (conservative and surgical) of patients with gastric ulcers are.

Pathological anatomy Marina Aleksandrovna Kolesnikova

36. Stomach cancer

36. Stomach cancer

There is the following classification of stomach cancer.

1. According to localization, they are distinguished: pyloric, lesser curvature of the body with transition to the walls, cardiac, greater curvature, fundal and total.

2. According to the nature of growth, three forms are distinguished:

1) with predominantly exophytic growth (plaque-like, polypous, fungoid, or mushroom-shaped, and ulcerated);

2) with predominantly endophytic infiltrating growth (infiltrative-ulcerative, diffuse);

3) with exoendophytic growth, or mixed.

3. Microscopically, adenocarcinoma is distinguished (tubular, papillary, mucinous), undifferentiated (solid, scirrhous, mural cell), squamous cell, glandular squamous cell (adenocancroid) and unclassified cancer.

Pathological anatomy. Plaque cancer affects the submucosal layer. Polypous cancer is gray-pink or gray-red in color and is rich in blood vessels. These two forms of cancer have the histological structure of adenocarcinoma or undifferentiated cancer. Fungal cancer is a nodular formation with erosions on the surface, as well as hemorrhages or fibrinous-purulent overlays. The tumor is soft, gray-pink or gray-red and well circumscribed; histologically it is represented by adenocarcinoma. Ulcerated cancer by genesis is a malignant tumor; it is represented by primary ulcerative, saucer-shaped cancer and cancer from a chronic ulcer (ulcer-cancer). Primary ulcerative cancer is microscopically represented as undifferentiated cancer. Saucer-shaped cancer is a round formation, reaching large sizes, with roller-like whitish edges and ulceration in the center. The bottom of the ulcer may be represented by other (adjacent) organs. Histologically it is represented by adenocarcinoma. Ulcer-cancer is characterized by the formation of an ulcer at the site and is manifested by the proliferation of scar tissue, sclerosis and thrombosis of blood vessels, destruction of the muscle layer at the bottom of the ulcer and thickening of the mucous membrane around the ulcer. Histologically it looks like adenocarcinoma, less often undifferentiated cancer. Infiltrative-ulcerative cancer is characterized by pronounced cancrosis infiltration of the wall and ulceration of the tumor, and is histologically represented by adenocarcinoma or undifferentiated cancer. Diffuse cancer is manifested by thickening of the stomach wall, the tumor is dense, whitish and immobile.

The mucous membrane has an uneven surface, and folds of uneven thickness with erosions. Lesions can be limited or total. As the tumor grows, the stomach wall shrinks. Histologically, the cancer is represented by an undifferentiated form of carcinoma. Transitional forms have different clinical and morphological forms.

Stomach cancer Stomach cancer accounts for 10-11% of all malignant diseases, ranking second in morbidity and mortality after lung cancer. According to statistics, it affects men twice as often. Most diseases occur between 50 and 70 years of life,

9. Stomach cancer Of the entire gastrointestinal tract, cancer most often affects the stomach. According to statistics, it occurs in approximately 40% of all cancer sites. Currently, the possibilities of X-ray examination in