Similar to an ulcerative lesion with clear raised margins
Commonly located on the lesser curvature
Must be differentiated from peptic gastric ulcers by biopsy
Diffuse type gastric carcinoma
No clear border
Spreads earlier in the course of disease
Infiltrative growth
Diffuse spread in the gastric wall
Linitis plastica: gastric wall thickening and leather bottle appearance
Composed of signet ring cells: round cells filled with mucin, with a flat nucleus in the cell periphery
Associated with E-cadherin mutation
E-cadherin is a family of calcium-dependent glycoproteins that facilitate cell-to-cell adhesion at adherens junctions. Link to the actin cytoskeleton via catenin and vinculin.
Due to its role in cell adhesion and differentiation, E-cadherin protects against tumor formation. Low expression is associated with poorer prognosis (e.g., increased depth of invasion or severe lymph node involvement).
Treatment
Complications
Postgastrectomy complications
Dumping syndrome
Definition: rapid gastric emptying as a result of defective gastric reservoir function, impaired pyloric emptying mechanisms, or anomalous postsurgery gastric motor function
Early dumping
Pathophysiology: dysfunctional or bypassed pyloric sphincter → rapid emptying of undiluted hyperosmolar chyme into the small intestine → fluid shift to the intestinal lumen → small bowel distention → vagal stimulation → increased intestinal motility
Vasomotor symptoms such as sweating, flushing, and palpitations
Management
Dietary modifications: small meals that include a combination of complex carbohydrates and foods rich in protein and fat
Late dumping
Pathophysiology: dysfunctional pyloric sphincter → rapid emptying of glucose-containing chyme into the small intestine → quick reabsorption of glucose → hyperglycemia → excessive release of insulin → hypoglycemia and release of catecholamines
