This document discusses precancerous conditions of the stomach, classification of stomach cancer, histological classification, risk factors, methods of diagnosis, surgical treatment methods, symptoms of stomach cancer, and typical sites of metastasis. Stomach cancer is often preceded by conditions like chronic gastritis or ulcers. It can be classified based on location in the stomach or growth pattern. Diagnosis involves endoscopy with biopsy and other imaging tests. Surgical options range from endoscopic resection for early cancers to gastrectomy or palliative procedures for later stages. Common symptoms include dysphagia, fullness, and weight loss. The liver, lungs, and peritoneum are frequent sites of metastasis.

1. Precancerous conditions of the stomach
 Cancer is preceded by various structural disorders of the
gastric mucosa:
• adenomatous polyp,
• chronic atrophic gastritis,
• chronic ulcer
• pernicious anemia,
• stump of the stomach (after resections of the body for ulcer
disease and other diseases),
Menetrie disease

2. Classification of stomach cancer
• By localization:
• Pyloric cancer
• Cancer of small curvature of the body with the transition to the back and front walls,
• Cardiac cancer,
• Cancer of large curvature,
• cancer of the bottom of the stomach.
The prevalence of gastric cancer can be:
• Subtotal (more than one of the above departments is affected),
• Total (all departments of the organ are affected)
Depending on the growth (V.V. Serov, 1970):
I. Cancer with predominant exophytic growth:
• Plaque-shaped,
• Polyp-shaped,
• Mushroom-shape,
• Ulcerated, including:
primary-ulcerative,
saucer-shaped (cancer-ulcer),
cancer from a chronic ulcer (ulcer-cancer).
II. Cancer with predominant endophytic growth:
• Infiltrative-ulcerative,
• Diffuse.
III. Cancer with exo-endophytic, mixed growth:
• Transitional forms.

3. Histological classification of stomach cancer (WHO, 1999):
I. Adenocarcinoma:
• Papillary adenocarcinoma,
• Tubular adenocarcinoma,
• Mucinous (mucosal) adenocarcinoma,
• Ring-shaped cell carcinoma.
II. Adenosquamous (glandular-squamous) carcinoma.
III. Squamous cell carcinoma.
IV. Small cell carcinoma.
V. Undifferentiated carcinoma.
VI. Other carcinomas.
Histological classification of gastric cancer according to Lauren (1965)
• Intestinal type: the structure of the tumor is similar to colon cancer. Are characteristic distinct glandular
structures consisting of highly differentiated cylindrical epithelium with a developed brush border.
• Diffuse type: the tumor is represented by poorly organized groups or single cells with a high content of mucin
(cricoid cells). Diffuse infiltrative growth is characteristic.
• Mixed type: in the tumor there are areas of both intestinal and diffuse type.

4. Risk factors for stomach cancer
• Helicobacter pylori
• Gastroesophageal reflux disease
• Obesity
• A diet high in salty and smoked foods
• A diet low in fruits and vegetables
• Family history of stomach cancer
• Smoking
• Being overweight or obese
• Stomach surgery for an ulcer
• Type-A blood
• Epstein-Barr virus infection
• Certain genes
• Working in coal, metal, timber, or rubber industries
• Exposure to asbestos

5. Methods for diagnosing stomach cancer
• History and physical examination
• Upper GI endoscopy with biopsy
• Histological, cytological examination of biopsy material
• X-ray of the stomach (gastroscopy with barium)
• Ultrasound of the abdominal organs or CT scan of the abdominal organs with oral and intravenous
contrast
• Chest X-ray or chest CT with intravenous contrast
• Ultrasound of the cervico-supraclavicular regions
• Detailed clinical and biochemical blood tests
• ECG
• Tumor markers CEA, CA 72-4
• Assessment of nutritional status
• Analysis of tumor biopsy for HER2-neu, if diagnosed or distant metastases of adenocarcinoma are
suspected.
Additional studies performed if clinically indicated:
• Ultrasound / CT or MRI of the small pelvis
• Endosonography (mandatory when planning endoscopic treatment)
• Bone scintigraphy
• Biopsy of metastases under the control of ultrasound / CT
• Laparoscopy

6. Methods of surgical treatment for stomach cancer
1. Early cancer (carcinoma in situ and stage I)
• Endoscopic mucosal resection;
• Endoscopic Submucosal Dissection;
• Combined techniques with the addition of physical factors (argon plasma coagulation,
photodynamic therapy, etc.)
2. II-III stages:
• Gastrectomy,
• Subtotal proximal gastric resection
• Subtotal distal gastric resection
3. IV stage (palliative operations)
• Gastroenteroanastomosis
• Gastrostomy

7. Local and overall symptoms of stomach cancer
Local symptoms
Dysphagia (difficulty swallowing and may be pain while swallowing) - with cancer of the esophagus and cardiac
stomach
Clinic of stomach stenosis (with localization of the tumor in the pyloric or antrum of the stomach)
Feeling full after eating only a small meal
Nausea and vomiting
Vomiting coffee grounds
Melena
Abdominal pain
Vague discomfort in the abdomen, usually above the navel
Swelling or fluid build-up in the abdomen
Yellowing of the skin and eyes (jaundice), if the cancer spreads to the liver
Overall symptoms
Feeling tired or weak
Anemia
Poor appetite
Weight loss
An increase in temperature (usually to subfibril values)

8. Stomach cancer most commonly metastases in:
• Liver
• Lungs
• On the peritoneum
Typical distant metastases of gastric cancer
• Virchow's metastasis - to the supraclavicular lymph nodes
• Krutenberg metastasis - to the ovaries
• Schnitzler’s metastases - to pararectal tissue and lymph nodes
• Navel metastases