GI Radiology > Stomach > Neoplasms

Neoplasms

Gastric Carcinoma

Gastric carcinoma is the third most common GI malignancy after colorectal and pancreatic cancer, and represents the 6th leading cause of cancer deaths. The prevalence in the U.S. is approximately 24,000 cases per year. Predisposing factors for the development of gastric cancer include gastritis, adenomatous and villous polyp formation, gastrojejunostomy, partial gastrectomy, and pernicious anemia. Although they may present anywhere within the stomach, gastric carcinomas are most commonly located in the antrum or pylorus (50%); 60% are on the lesser curvature and 30% occur at the GE junction. Transpyloric spread to the duodenum rarely occurs (vs. 40% for lymphoma). Histologically, adenocarcinoma is most common making up 95% of gastric malignancies.

Carcinoma Features:

  • Clinically patients present with abdominal pain, GI bleeding, and weight loss
  • May infiltrate or spread superficially
  • 70% are ulcerating and infiltrating at the time of diagnosis
  • Size correlates to prognosis:

Tumor Size

Probability of Metastases

5-yr Survival

1 cm

0.11

87%

2 cm

0.25

67%

3 cm

0.45

35%

4 cm

0.59

33%

> 4 cm

0.72

-

The diagnosis is usually suggested by UGIS with confirmation by endoscopic biopsy. CT is useful in defining the extent of disease as hepatic or peritoneal metastases may be present.

Radiographic Findings: UGIS

  • Wall rigidity

  • Mass

  • Possible tumor ulceration. If an ulcer is present, radiating folds may be blunted or fused

  • Punctate calcifications

Radiographic Findings: CT

  • Irregular nodular luminal surface

  • Asymmetric fold thickening

  • Wall thickness > 6mm with gas distension; > 13mm with contrast distension

 
A. UGIS double contrast study. The arrows outline the area of irregular mucosa which was caused by an invasive gastric carcinoma.   B. Single contrast study from the same patient showing the apple core appearance of the stomach due to the invasive gastric adenocarcinoma.
 

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