One of the most serious forms of gastric cancer.
A subtype of gastric adenocarcinoma that represents up to 20% of such cancers and is typically defined by its signet ring forms seen on biopsy.
Associated with a diffuse involvement of the stomach and, frequently, there is evidence of metastasis on clinical exam.
Associated with a poor prognosis, with a five-year survival of less than 10%. Early diagnosis is critical to outcome.
Patients present with a abdominal pain and weight loss in more than 50% of cases.
Additional symptoms on presentation include nausea, dysphagia, G.I. bleeding, and early satiety.
Early satiety is due to diffuse stomach involvement, which causes limited distensibility.
Patients frequently present with metastases, with liver involvement and peritoneal involvement leading to right upper quadrant pain, elevated liver functions and inability to tolerate oral intake.
Nonspecific symptoms make delay in diagnosis common.
Upper G.I. studies show stomach’s inability to distend and frequently show a leather flask shape.
Patients often present with a gastric outlet obstruction based on diffuse infiltration of the gastric wall.
Esophagoduodenoscopy shows impaired insufflation with air based on diffuse involvement of multiple layers of the gastric wall.
Esophagoduodenoscopy may indicate friable mucosa, with thickened nodular folds.
Gastric mucosa may appear visually normal and requires a high clinical suspicion and biopsy confirmation.
The antrum and pylorus are most commonly involved, while the fundus is least commonly involved
Endoscopic ultrasound can be used to visualize different layers of the stomach, and can assess the depth of involvement of the cancer.
Suspicious mucosal lesions should be biopsied multiple times to increase diagnostic yield.