Pathology

90% of stomach tumours are adenocarcinomas, that are further divided into 'intestinal' and 'diffuse' types. The remainder are mainly lymphomas (up to 8%) and leiomyosaromas (1-3%). Intestinal type gastric cancers are ulcerative and occur more often in the distal stomach than diffuse types, including linitis plastica, which occur through out the stomach. Gastric cancers are evaluated according to the TNM staging system. This system stages tumours according to:

♦ Depth of invasion of the primary tumour

♦ Degree of lymph node involvement

♦ The absence (M0) or presence (M1) of distant metastases Endoscopy with biopsy is the optimal means of diagnosis of gastric cancer. CT scanning detects spread to regional lymph nodes and distant metastases. Endoluminal ultrasound is superior to CT in determining the depth of invasion of the primary tumour and presence of local adenopathy. Laparoscopy should be used in patients being considered for curative surgery to confirm operability and exclude peritoneal metastases.

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