Gastric Cancer, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.                                                                                                                                                                                               J. Murra Saca, MD.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Catempranoxcz1

Video Endoscopic Sequence 1 of 2.

Early Gastric Cancer

This is a case of a 72 year-old lady that underwent an upper endoscopy due to Epigastric Pain

 The definition of early gastric cancer is that of a cancer in
 which tumor invasion is confined to the mucosa or
 submucosa regardless of the presence of lymph node
 metastasis.

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Video Endoscopic Sequence 1 of 2.

Early Gastric Cancer

 Early gastric cancer is defined as remaining confined to the
 mucosa or submucosa, regardless of lymph node metastasis
 Japanese macroscopic classifications for gastric cancer are
 well known and divide early gastric cancer into three
 macroscopic types (0-I, 0-II, and 0-III) of which 0-II is then
 subclassified into 0-IIa, 0-IIb, and 0-IIc (The most common
 type of early gastric cancer is 0-IIc If two or more
 macroscopic types are mixed, the type that has spread
 further is recorded first. At an international workshop held
 in 2002, the Paris classification, which is based on the
 Japanese classification, was proposed and subsequently
 adopted as a simple and internationally unified
 classification for superficial gastrointestinal tumors.

Gastric Adenocarcinoma of large size.   This 63 year old lady presented with this mass at the corpus and gastric fundus.

Video Endoscopic Sequence 1 of 4.

Gastric Adenocarcinoma of large size

This 63 year old lady presented with this mass at the corpus and gastric fundus.

 

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter that you can appreciate
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.
We recommend seeing the video clips in full
 screen mode.

An enormous mass is observed in the retroflexed maneuver.  The most common type is Gastric Adenocarcinoma.  It is actually the most common type of cancer (other than skin cancer) worldwide.  Gastric Adenocarcinoma is more common in men, Asians, Africans, and Hispanics.  There is a very high incidence in Japan, Chile, Colombia, and Central America.  The second leading cause of stomach disease is non-Hodgkin's Lymphoma.

Video Endoscopic Sequence 2 of 4.

An enormous mass is observed in the retroflexed maneuver

 The most common type is Gastric Adenocarcinoma.  It is
 actually the most common type of cancer (other than skin
 cancer) worldwide.  Gastric Adenocarcinoma is more
 common in men, Asians, Africans, and Hispanics.  There is
 a very high incidence in Japan, Chile, Colombia, and
 Central America.  The second leading cause of stomach
 disease is non-Hodgkin's Lymphoma.

 Endoscopic view of Gastric Cáncer. "	Gastric cancer remains a difficult disease to cure in Western countries, primarily because most patients present with advanced disease. Even patients who present in the most favorable condition and who undergo curative surgical resection often die of recurrent disease.

Video Endoscopic Sequence 3 of 4.

 Endoscopic view of Gastric Cáncer

  • Gastric cancer remains a difficult disease to cure in Western countries, primarily because most patients present with advanced disease. Even patients who present in the most favorable condition and who undergo curative surgical resection often die of recurrent disease.
More image and video clips.

Video Endoscopic Sequence 4 of 4.

  • The site of the cancer is classified on the basis of its relationship to the long axis of the stomach. Approximately 40% of cancers develop in the lower part, 40% in the middle part, and 15% in the upper part, and 10% involve more than one part of the organ. Over the past half century or so, there has been a steady decline in gastric cancer incidence and gastric cancer deaths in men and women in the United States. Most of this decrease has occurred in the intestinal type of gastric cancer. In addition, the incidence of gastric cardia adenocarcinoma has actually gradually increased.
This 82 year-old lady, presented this large infiltrating adenocarciona of the gastric antrum and corpus

Video Endoscopic Sequence 1 of 5.

Ulcerated Gastric Adenocarcinoma

 This 82 year-old lady, presented this large infiltrating
 adenocarciona of the gastric antrum and corpus.

Gastric carcinoma is the most common gastrointestinal malignancies worldwide

Video Endoscopic Sequence 2 of 5.

Gastric carcinoma is the most common gastrointestinal malignancies worldwide.

 Causes

 Several factors are implicated in the development of
 gastric cancer, including diet, Helicobacter pylori infection,
 previous gastric surgery, pernicious anemia, adenomatous
 polyps, chronic atrophic gastritis, prior radiation exposure
 or inherited syndromes. Gastric cancer may often be
 multifactorial involving both inherited predisposition and
 environmental factors.

 

Video Endoscopic Sequence 3 of 5.

Causes

  • Diet
    • A diet rich in pickled vegetables, salted fish, excessive dietary salt, and smoked meats correlates with an increased incidence of gastric cancer.
    • A diet that includes fruits and vegetables rich in vitamin C may have a protective effect.

.

Video Endoscopic Sequence 4 of 5.

 Causes

    • Smoking
      • Smoking is associated with an increased incidence of stomach cancer in a dose-dependent manner, both for number of cigarettes and duration of smoking.
      • Smoking increases the risk of cardiac and noncardiac forms of stomach cancer. Cessation of smoking reduces the risk.
      • A meta-analysis of 40 studies estimated that the risk was increased by approximately 1.5- to 1.6-fold and was higher in men.
 Endoscopic view of Gastric Cáncer.

Video Endoscopic Sequence 5 of 5.

  Endoscopic view of Gastric Cáncer

  • Helicobacter pylori infection
    • Chronic bacterial infection with H pylori is the strongest risk factor for stomach cancer.
    • H pylori may infect 50% of the world's population, but much less than 5% of infected individuals develop cancer. It may be that only a particular strain of H pylori, one of which is capable of producing the greatest amount of inflammation, is especially associated with the risk of malignancy. The full malignant transformation of affected parts of the stomach may require that the human host have a particular genotype of interleukin-Iβ to cause the increased inflammation and an increased suppression of gastric acid secretion.
    • H pylori infection is associated with chronic atrophic gastritis, and patients with a history of prolonged gastritis have a 6-fold increase in their risk of developing gastric cancer. Interestingly, this association is particularly strong for tumors located in the antrum, body, and fundus of the stomach but does not seem to hold for tumors originating in the cardia.
  • Previous gastric surgery
    • Previous surgery is implicated as a risk factor. The rationale is that surgery alters the normal pH of the stomach, which may in turn lead to metaplastic and dysplastic changes in luminal cells.
    • Retrospective studies demonstrate that a small percentage of patients who undergo gastric polyp removal have evidence of invasive carcinoma within the polyp. This discovery has led some researchers to conclude that polyps might represent premalignant conditions.
Ulcerated Gastric Adenocarcinoma with Signet Ring Cells. This 47 year-old male, presented with weight loss of 50 pounds with no prior gastrointestinal symptoms, has a ulcerated gastric adenocarcinoma, immediately after the gastroesophagic junction.

Video Endoscopic Sequence 1 of 6.

Ulcerated Gastric Adenocarcinoma with Signet Ring Cells.

 This 47 year-old male, presented with weight loss of 50
 pounds with no prior gastrointestinal symptoms, has a
 ulcerated gastric adenocarcinoma, immediately after the
 gastroesophagic junction.

 Gastric carcinoma is a common malignancy in El Salvador
 and is one of the leading causes of morbidity and mortality.

 

Extending from the GE junction along the lesser curve and posteriorly was a poorly defined non-ulcerative irregular mucosa. This measured approximately 2 x 3cm.

Video Endoscopic Sequence 2 of 6.

 Extending from the GE junction along the lesser curve and
 posteriorly was a poorly defined non-ulcerative irregular
 mucosa. This measured approximately 2 x 3 cm.

Gastric cancer remains a difficult disease to cure in Western countries, primarily because most patients present with advanced disease. Even patients who present in the most favorable condition and who undergo curative surgical resection often die of recurrent disease.

Video Endoscopic Sequence 3 of 6.

 Gastric cancer remains a difficult disease to cure in
 Western countries, primarily because most patients
 present with advanced disease. Even patients who present
 in the most favorable condition and who undergo curative
 surgical resection often die of recurrent disease.

 

The narrow band imaging (NBI) system consists of a sequential electronic endoscope system and a source of   light equipped with new narrow band filters, yielding very  clear images of microvessels on mucosal surfaces.

Video Endoscopic Sequence 4 of 6.

 The narrow band imaging (NBI) system consists of a
 sequential electronic endoscope system and a source of
 light equipped with new narrow band filters, yielding very
 clear images of microvessels on mucosal surfaces.

 

A newly developed narrow-band imaging (NBI) system, which uses modified optical filters, can yield clear images of microvessels and surface structure in gastric and colonic diseases.

Video Endoscopic Sequence 5 of 6.

 A newly developed narrow-band imaging (NBI) system,
 which uses modified optical filters, can yield clear images
 of microvessels and surface structure in gastric and colonic
 diseases.

 

NBI displays enhanced images of capillaries in the mucosal surface and detailed mucosal texture by irradiating two narrow wave bands (390–445 nm/530–550 nm) which are strongly absorbed by circulating hemoglobin. If signal processing is performed using a pseudo-narrow band image, the state of mucosa tissues and observation conditions influence the results and good effects cannot be obtained. However, with NBI, the wavelength of the irradiating light itself is altered, and capillaries in the mucosal surface and detailed mucosal texture can thus be processed effectively and stably.

Video Endoscopic Sequence 6 of 6.

 NBI displays enhanced images of capillaries in the
 mucosal surface and detailed mucosal texture by
 irradiating two narrow wave bands (390–445 nm/530–550
 nm) which are strongly absorbed by circulating hemoglobin.
 If signal processing is performed using a pseudo-narrow
 band image, the state of mucosa tissues and observation
 conditions influence the results and good effects cannot be
 obtained. However, with NBI, the wavelength of the
 irradiating light itself is altered, and capillaries in the
 mucosal surface and detailed mucosal texture can thus be
 processed effectively and stably.

This 67 year-old female presented with anorexia and weight loss of 10 pounds.

Video Endoscopic Sequence 1 of 6.

Ulcerated Gastric Adenocarcinoma at the distal body.

This 67 year-old female presented with anorexia and weight loss of 10 pounds.

 The images as well as the video clips display a small size
 neoplasia at the greater curvature in the distal body and
 posterior wall limiting with the antrum.


 

Most patients are elderly at diagnosis. The median age at diagnosis is 65 years (range 40-70 y). The gastric cancers that occur in younger patients may represent a more aggressive variant.

Video Endoscopic Sequence 2 of 6.

 Most patients are elderly at diagnosis. The median age at
 diagnosis is 65 years (range 40-70 y). The gastric cancers
 that occur in younger patients may represent a more
 aggressive variant.
 

 

Worldwide, stomach cancer (also referred to as gastric cancer) remains one of the most common forms of cancer, affecting approximately 800,000 new individuals annually. However, the rate of stomach cancer has been declining in the United States and western Europe over the past half-century, a trend which has been felt attributable in large part to changes in diet during this period of time. Interestingly, the incidence of cancers located in different portions of the stomach appear to be heading in opposite directions: while those located in the more distal (lower) portion of the stomach have been declining in incidence, there has actually been an increase in cases occurring in the proximal portion of the stomach (closer to the esophagus) and at the gastroesophageal junction.

Video Endoscopic Sequence 3 of 6.

 Worldwide, stomach cancer (also referred to as gastric
 cancer) remains one of the most common forms of cancer,
 affecting approximately 800,000 new individuals annually.
 However, the rate of stomach cancer has been declining in
 the United States and western Europe over the past
 half-century, a trend which has been felt attributable in
 large part to changes in diet during this period of time.
 Interestingly, the incidence of cancers located in different
 portions of the stomach appear to be heading in opposite
 directions: while those located in the more distal (lower)
 portion of the stomach have been declining in incidence,
 there has actually been an increase in cases occurring in
 the proximal portion of the stomach (closer to the
 esophagus) and at the gastroesophageal junction
.

Chromoscopy with indigo carmin.  The image shown here, is in the limit with the neoplasia, biopsies reveled intestinal metaplasia.

Video Endoscopic Sequence 4 of 6.

Chromoscopy with indigo carmine.

 The image shown here, is in the limit with the neoplasia,
 biopsies reveled intestinal metaplasia.

 

Chromoscopy with lugol´s.

Video Endoscopic Sequence 5 of 6.

Chromoscopy with lugol´s.

Retroflexed Image.

Video Endoscopic Sequence 6 of 6.

Retroflexed Image.

Extensive Gastric Adenocarcinoma.  This 56 year old lady, two months previously initiate with abdominal pain, nausea, early satiety and postprandial vomiting and  weight loss.   Endoscopy demonstrated this  large lesion.

Video Endoscopic Sequence 1 of 5.

Extensive Gastric Adenocarcinoma.

 This 56 year old lady, two months previously initiate with
 abdominal pain, nausea, early satiety and postprandial
 vomiting and weight loss. Endoscopy demonstrated this
 large lesion.

 

Endoscopy revealed adenocarcinoma, seen here from the antrum. The tumor extended into the lesser curvature near of the gastric fundus.

Video Endoscopic Sequence 2 of 5.

 Endoscopy revealed adenocarcinoma, seen here from the
 antrum. The tumor extended into the lesser curvature near
 of the gastric fundus.

 

Although the incidence of stomach cancer has declined dramatically in the United States and Western Europe in the last 50 years, the disease remains a serious problem in much of the rest of the world, where it's a leading cause of cancer death.

Video Endoscopic Sequence 3 of 5.

 Although the incidence of stomach cancer has declined
 dramatically in the United States and Western Europe in
 the last 50 years, the disease remains a serious problem in
 much of the rest of the world, where it's a leading cause of
 cancer death.

 

Endoscopic Image of Gastric Cáncer, This global variation is almost certainly linked to two factors that play a major role in the development of stomach cancer: Infection with Helicobacter pylori (H. pylori) bacteria and the type of diet.

Video Endoscopic Sequence 4 of 5.

 Endoscopic Image of Gastric Cáncer

 This global variation is almost certainly linked to two
 factors that play a major role in the development of
 stomach cancer: Infection with Helicobacter pylori
 (H. pylori) bacteria and the type of diet.

Stomach cancer is more readily treated when caught early. Unfortunately, by the time it causes symptoms, the disease is often at an advanced stage and may have spread beyond the stomach. Yet there is encouraging news. You can reduce your risk of this serious cancer by making a few changes in your lifestyle.

Video Endoscopic Sequence 5 of 5.

 Stomach cancer is more readily treated when caught early.
 Unfortunately, by the time it causes symptoms, the disease
 is often at an advanced stage and may have spread beyond
 the stomach. Yet there is encouraging news. You can
 reduce your risk of this serious cancer by making a few
 changes in your lifestyle.

Gastric Adenocarcinoma of the Lesser Curvature. This 83 year-old female, with no prior gastrointestinal symptoms, presented with one week of epigastric pain and one month of weight loss of more than 20 pounds.

Video Endoscopic Sequence 1 of 3.

Gastric Adenocarcinoma of the Lesser Curvature.

 This 83 year-old female, with no prior gastrointestinal
 symptoms,
presented with one week of epigastric pain and
 one month of weight loss of more than 20 pounds.

 Worldwide, gastric carcinoma is the most common cancer
 after lung cancer and a major cause of mortality and
 morbidity.

 

Gastric Adenocarcinoma of the Lesser Curvature. Enormous malign ulceration is seen.

Video Endoscopic Sequence 2 of 3.

Gastric Adenocarcinoma of the Lesser Curvature.

Enormous malign ulceration is seen.

 Advanced lesions have already invaded the muscularis propria.
 They are associated with metastases to regional lymph nodes or
 to local or distant structures.

 Early gastric lesions are confined to the mucosa or submucosa.
 Most reports are from Japan, as a result of mass screening there.
 Patients with these tumors have a 5-year survival rate of 90%.

 

Gastric Adenocarcinoma. Pathophysiology: The accepted pathway involves transitions from gastritis to gastric atrophy to metaplasia to dysplasia and,finally, to cancer. Several dietary and environmental factors may influence this pathway. Hypochlorhydria: This condition occurs in gastric atrophy and promotes bacterial colonization of the stomach. It leads to increased nitrite formation, which may have a mutagenic effect on the atrophic gastric mucosa.Helicobacter pylori: Antral gastritis caused by H pylori has been linked to the development of gastric cancer. Patients with H pylori gastritis are 3-6 times more likely to develop gastric cancer than individuals without the infection.Certain foods: Starch, pickled vegetables, salted fish and meat, smoked foods, and salt have all been implicated.Cigarette smoking: Those who smoke more than 30 cigarettes per day have a 5-fold increased risk of gastric carcinoma.Several precancerous conditions are recognized: Chronic atrophic gastritis Pernicious anemia Previous partial gastrectomy, Ménétrier disease Gastric dysplasia Adenomatous polyps (20% of all gastric polyps) Hereditary factors.

Video Endoscopic Sequence 3 of 3.

 Gastric Adenocarcinoma.

 Pathophysiology: The accepted pathway involves
 transitions from gastritis to gastric atrophy to metaplasia to
 dysplasia and, finally, to cancer.

 Several dietary and environmental factors may influence
 this pathway.

  • Hypochlorhydria: This condition occurs in gastric atrophy and promotes bacterial colonization of the stomach. It leads to increased nitrite formation, which may have a mutagenic effect on the atrophic gastric mucosa.
  • Helicobacter pylori: Antral gastritis caused by H pylori has been linked to the development of gastric cancer. Patients with H pylori gastritis are 3-6 times more likely to develop gastric cancer than individuals without the infection.
  • Certain foods: Starch, pickled vegetables, salted fish and meat, smoked foods, and salt have all been implicated.
  • Cigarette smoking: Those who smoke more than 30 cigarettes per day have a 5-fold increased risk of gastric carcinoma.
Gastric Adenocarcinoma with extensive duodenal infiltration This 69 year old male, presented with weight loss more than 20 pounds and severe abdominal pain with nocturnal  predominance.

Video Endoscopic Sequence 1 of 3.

 Gastric Adenocarcinoma with extensive duodenal
 infiltration.

 This 69 year old male, presented with loss of weight more
 than 20 pounds and severe abdominal pain with a nocturnal
 predominance.

 

This image displays the pylorus and the duodenal bulb that be infiltrated by the tumor.

Video Endoscopic Sequence 2 of 3.

 This image displays the pylorus and the duodenal bulb
 that be infiltrated by the tumor.

 

Extensive ulceration of the duodenal bulb. Biopsies proven to be a gastric adenocarcinoma of the antrum with duodenal infiltration.

Video Endoscopic Sequence 3 of 3.

Extensive infiltration into the duodenal bulb.

 Biopsies proven to be a gastric adenocarcinoma of the
 antrum with duodenal infiltration.

Obstructed adenocarcinoma of the gastric antrum. A 44 year-old man, who complained of weight loss and persisting  vomiting. An upper endoscopy was performed, a doughnut-shaped gastric cancer of the antrum was found  Extensive collection of gastric carcinoma is on display on this web site, this reflects the high incidence of stomach cancer in the republic of El Salvador. Gastric Cancer is the second most frequent cancer in this country,second only to carcinoma of the cervix. Many cases shown here are in a very advanced stage, since a large partof the population does not visit a physician until clinical symptoms are very advanced.

Obstructed adenocarcinoma of the Gastric Antrum.

 A 44 year-old man, who complained of weight loss and
 persisting vomiting.
 An upper endoscopy was performed, a doughnut-shaped
 gastric cancer of the antrum was found.


  Extensive collection of gastric carcinoma is on display
 on this web site, this reflects the high incidence of
 stomach cancer in the republic of El Salvador. Gastric
 Cancer is the second most frequent cancer in this country,
 second only to carcinoma of the cervix. Many cases
 shown here are in a very advanced stage, since a large part
 of the population does not visit a physician until clinical
 symptoms are very advanced.
 
 

A 74 year-old female with abdominal pain and nauseas. The an upper gastroscopy displays a nodular and ulcerated small mass at the gastric cardias. Esophageal cancer and cancer of the gastric cardia, in particular adenocarcinomas, have shown a rapid and largely unexplained increase in incidence in many developed countries around the world. These diseases have a poor prognosis and current therapies have a modest impact on survival.

Endoscopic Sequence 1 of 4.

Gastric Adenocarcinoma of the Gastric Cardias.

 A 74 year-old female with abdominal pain and nauseas.
 The an upper gastroscopy displays a nodular and ulcerated
 small mass at the gastric cardias.

 
Esophageal cancer and cancer of the gastric cardia, in
 particular adenocarcinomas, have shown a rapid and largely
 unexplained increase in incidence in many developed
 countries around the world. These diseases have a poor
 prognosis and current therapies have a modest impact on
 survival.
Tytgat GN, Bartelink H, Bernards R, Giaccone G, van Lanschot
 JJ, Offerhaus GJ, Peters GJ. Cancer of the esophagus and gastric cardia:
 recent advances. 
[Medline].

Another image and video of that small neoplasia, however The cat scan displays that the liver is infiltrated with metastases. CT is primarily used to preoperatively assess patients with gastric carcinoma. CT is to assess the presence and extent of extragastric spread. This information is vital in deciding between palliative surgery and curative radical surgery. Therefore, the main role of CT is to identify patients who would not benefit from radical surgery. Thus, CT is used to stage the tumor and also to monitor the response to treatment.

Video Endoscopic Sequence 2 of 4.

 Another image and video of that small neoplasia, however
 The cat scan displays that the liver is infiltrated with
 metastases.

 CT is primarily used to preoperatively assess patients with
 gastric carcinoma. CT is to assess the presence and extent
 of extragastric spread. This information is vital in deciding
 between palliative surgery and curative radical surgery.
 Therefore, the main role of CT is to identify patients who
 would not benefit from radical surgery. Thus, CT is used to
 stage the tumor and also to monitor the response to
 treatment.

This image and the video was taken with magnifying  endoscope. Irregular texture is observed some areas are ulcerated.

Video Endoscopic Sequence 3 of 4.

 This image and the video was taken with magnifying
 endoscope. Irregular texture is observed. Some areas are
 ulcerated.

This magnifying image displays a tiny irregular ulcer.

Video Endoscopic Sequence 4 of 4.

 This magnifying image displays a tiny irregular ulcer.

 

Ulcerated Submucosal Adenocarcinoma that produced extensive carcinomatosis.

       

 Ulcerated Submucosal Adenocarcinoma that produced
 extensive carcinomatosis.

This 84 year-old male, presented with dysphagia and    weight lost.

Endoscopic Sequence 1 of 2.

 This 84 year-old male, presented with dysphagia and
 weight lost.

The esophageal cardias is infiltrated.

Endoscopic Sequence 2 of 2.

The esophageal cardias is infiltrated.

Adenocarcinoma of the lower third of the esophagus and fornix.   This 72 year-old male was referred to our endoscopic unit for evaluation of dysphagia for solid and liquids.

Endoscopic Sequence 1 of 3.

Adenocarcinoma of the lower third of the esophagus and fornix.

This 72 year-old male was referred to our endoscopic unit for evaluation of dysphagia for solid and liquids.
 

Endoscopic Image of Gastric Cáncer. The rutinary biopsies are taken for the diagnosis.

Endoscopic Sequence 2 of 3.

Endoscopic Image of Gastric Cáncer

The rutinary biopsies are taken for the diagnosis.

The gastric fornix is infiltrated with this large mass.

Endoscopic Sequence 3 of 3.

The gastric fornix is infiltrated with this large mass.

Diffuse Adenocarcinoma with signet ring cells.    This 44 year-old woman had been suffering of epigastric pain since 2 months previously with nauseas and some occasion vomiting, at endoscopy a large  smooth  ulcer was found at the retroflexed some rigidity  was feel.

Video Endoscopic Sequence 1 of 18.

Diffuse Adenocarcinoma with signet ring cells.

 This 44 year-old woman had been suffering of epigastric
 pain since 2 months previously with nauseas and some
 occasion vomiting, at endoscopy a large smooth ulcer was
 found at the retroflexed some rigidity was feel.

Large Ulcer with  smooth surface is observed at the retroflexed maneuver some stiffness are noted.

Video Endoscopic Sequence 2 of 18.

Large Ulcer with smooth surface is observed at the retroflexed maneuver some stiffness are noted

 

 Biopsies in different quadrants are taken, is observed some rigidity and thickening around the ulcer.     Scirrhous carcinomas typically cause irregular narrowing and rigidity of the stomach, giving rise to the typical linitis plastica, or "leather bottle" appearance. Although some are lobulated lesions in the fundus or body, others consist of thickened, irregular mucosal folds and nodularity without significant narrowing.

Video Endoscopic Sequence 3 of 18.

 Biopsies in different quadrants are taken, is observed
 some rigidity and thickening around the ulcer.

 Scirrhous carcinomas typically cause irregular narrowing
 and rigidity of the stomach, giving rise to the typical linitis
 plastica, or "leather bottle" appearance. Although some
 are lobulated lesions in the fundus or body, others consist
 of thickened, irregular mucosal folds and nodularity
 without significant narrowing.

Macrocospic specimen.  Great size and deep ulcer is observed with  irregular folds.

Video Endoscopic Sequence 4 of 18.

Macrocospic specimen

 Great size and deep ulcer is observed with irregular folds

 

 

Click to enlarge image

 

Another macroscopic aspect.       Linitis plastica refers to the diffuse proliferation of the connective tissue, resulting in tissue thickening so that the stomach is constricted and rigid. Pathological exams reported a strong connective stroma-reaction associated with a malignant glandular proliferation of independent cells (signet-ring cells), invading all the layers of the digestive tract,

Video Endoscopic Sequence 5 of 18.

Another macroscopic aspect

 Linitis plastica refers to the diffuse proliferation of the
 connective tissue, resulting in tissue thickening so that the
 stomach is constricted and rigid. Pathological exams
 reported a strong connective stroma-reaction associated
 with a malignant glandular proliferation of independent
 cells (signet-ring cells), invading all the layers of the
 digestive tract.

Click Here to enlarge this picture

Macroscopic view of the stomach at the surgery, the lesion is infiltrating the serosa .

Video Endoscopic Sequence 6 of 18.

Macroscopic view of the stomach at the surgery, the lesion is infiltrating the serosa.

 

 

Click here to enlarge this picture

Macroscopic detail of the neoplasia

Video Endoscopic Sequence 7 of 18.

Macroscopic detail of the neoplasia

 

ALTHOUGH GASTRIC CARCINOMA occurs with reduced frequency, it is still a prevalent disease. Most gastric carcinomas are classified as adenocarcinomas due to glandular growth pattern and/or presumed occurrence of mucin intracellularly  Mucin is often identified by periodic acid-Schiff (PAS) and/or alcian blue (AB) positivity. However, neither of these histochemical methods is specific for mucins. Both methods are based upon the identification of glycoproteins. We have previously described that a proportion of gastric carcinomas, particularly of the diffuse type according to Laurén 1965 are neuroendocrine derived and probably of enterochromaffin-like (ECL) cell origin.  The so-called signet ring cell carcinomas belong to the diffuse type of gastric carcinomas.

Video Endoscopic Sequence 8 of 18.

 ALTHOUGH GASTRIC CARCINOMA occurs with
 reduced frequency, it is still a prevalent disease. Most
 gastric carcinomas are classified as adenocarcinomas due
 to glandular growth pattern and/or presumed occurrence of
 mucin intracellularly Mucin is often identified by periodic
 acid-Schiff (PAS) and/or alcian blue (AB) positivity.
 However, neither of these histochemical methods is
 specific for mucins. Both methods are based upon the
 identification of glycoproteins. We have previously
 described that a proportion of gastric carcinomas,
 particularly of the diffuse type according to Laurén 1965
 are neuroendocrine derived and probably of
 enterochromaffin-like (ECL) cell origin. The so-called
 signet ring cell carcinomas belong to the diffuse type of
 gastric carcinomas.

IIrregular infiltration is observed, penetration of the tumor through the serosa.

Video Endoscopic Sequence 9 of 18.

Irregular infiltration is observed, penetration of the tumor through the serosa.

 

Gastric linitis plastica is a very particular malignant gastric tumor different from the usual gastric adenocarcinoma. Linitis plastica refers to the diffuse proliferation of the connective tissue, resulting in tissue thickening so that the stomach is constricted and rigid. Pathological exams reported a strong connective stroma-reaction associated with a malignant glandular proliferation of independent cells (signet-ring cells), invading all the layers of the digestive tract, the mucosa being usually save not affected.Diagnosis is based on the association of pathological results findings revealed by endoscopic, endoscopic ultrasonography, radiological and surgical examinations. Opposed to the adenocarcinoma, Helicobacter Pylori seems not to be associated with the occurrence of gastric linitis.

Video Endoscopic Sequence 10 of 18.

 Gastric linitis plastica is a very particular malignant gastric
 tumor different from the usual gastric adenocarcinoma.
 Linitis plastica refers to the diffuse proliferation of the
 connective tissue, resulting in tissue thickening so that the
 stomach is constricted and rigid. Pathological exams
 reported a strong connective stroma-reaction associated
 with a malignant glandular proliferation of independent
 cells (signet-ring cells), invading all the layers of the
 digestive tract, the mucosa being usually save not
 affected. Diagnosis is based on the association of
 pathological results findings revealed by endoscopic,
 endoscopic ultrasonography, radiological and surgical
 examinations. Opposed to the adenocarcinoma,
 Helicobacter Pylori seems not to be associated with the
 occurrence of gastric linitis.

 

In this photography the diffuse thickening of the tumor around the ulcer with extension in the form of arm is observed.

Video Endoscopic Sequence 11 of 18.

 In this photography the diffuse thickening of the tumor
 around the ulcer with extension in the form of arm is
 observed.

 

 

Click Here to enlarge this picture

 

CagastricoUlceron12

Video Endoscopic Sequence 12 of 18.

Diet appears to play a major role in the development of stomach cancer. Nitroso compounds such as nitrites (found in smoked meats and fish) and nitrates (used in food preservatives), and high salt intake, likely contribute to this disease, whereas fresh vegetables are protective. The question of whether green tea also has any protective effects remains debatable.

 

Click Here to enlarge this picture

 

 

A bacteria called Helicobacter pylori represents an additional risk factor for gastric cancer, particularly those cancers occurring in the distal portion (antrum) of the stomach. This infection may lead to inflammation of the superficial layer of the stomach, inducing changes in the cells that line the stomach which eventually results in cancer. It should be stressed, however, that most patients with H. pylori infection do not develop gastric cancer. The independent association between peptic ulcer disease (PUD) and stomach cancer remains questionable, although H. pylori infection is known to be a risk factor for both. Autoimmune gastritis (associated with lack of hydrochloric acid secretion in the stomach and pernicious anemia), and adenomatous gastric polyps, represent other precursors that increase a person's risk of developing stomach cancer. Chronic GERD (gastroesophageal reflux disease) can cause damage to the tissue lining the lower portion of the esophagus and first portion of the stomach (cardia), resulting in the development of cancer at the G-E junction.

Video Endoscopic Sequence 13 of 18.

 A bacteria called Helicobacter pylori represents an
 additional risk factor for gastric cancer, particularly those
 cancers occurring in the distal portion (antrum) of the
 stomach. This infection may lead to inflammation of the
 superficial layer of the stomach, inducing changes in the
 cells that line the stomach which eventually results in
 cancer. It should be stressed, however, that most patients
 with H. pylori infection do not develop gastric cancer. The
 independent association between peptic ulcer disease
 (PUD) and stomach cancer remains questionable, although
 H. pylori infection is known to be a risk factor for both.
 Autoimmune gastritis (associated with lack of hydrochloric
 acid secretion in the stomach and pernicious anemia), and
 adenomatous gastric polyps, represent other precursors
 that increase a person's risk of developing stomach cancer.
 Chronic GERD (gastroesophageal reflux disease) can
 cause damage to the tissue lining the lower portion of the
 esophagus and first portion of the stomach (cardia),
 resulting in the development of cancer at the G-E junction.

 

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Video Endoscopic Sequence 14 of 18.

Gastric adenocarcinoma may spread via direct extension through the stomach wall into adjacent organs (spleen, pancreas, colon, esophagus, diaphragm). Alternatively, cancer cells may spread through lymphatic channels to lymph nodes in the abdomen or chest, and even rarely to the left supraclavicular (neck) lymph nodes. Metastases through the bloodstream can result in the cancer spreading to distant organs such as liver, lungs, and bones. Direct peritoneal seeding can produce malignant ascites (fluid accumulation in the abdomen). In women, stomach cancer can spread to the ovaries, referred to as a Krukenberg tumor.

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Endoscopic biopsy at high power showing the undifferentiated signet ring cells of the ulcer.  Finally, gastric cancers are seen at increased frequency in certain familial cancer syndromes, such as hereditary non-polyposis colon cancer (HNPCC) and the E-cadherin familial stomach cancer syndrome (associated with the diffuse form of stomach cancer).

Video Endoscopic Sequence 15 of 18.

 Endoscopic biopsy at high power showing
 the undifferentiated signet ring cells of the ulcer.

 Finally, gastric cancers are seen at increased frequency in
 certain familial cancer syndromes, such as hereditary
 non-polyposis colon cancer (HNPCC) and the
E-cadherin
 familial stomach cancer
syndrome (associated with the
 diffuse form of stomach cancer).

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Microscopic view at low power of the ulcer.

Video Endoscopic Sequence 16 of 18.

Microscopic view at low power of the ulcer.

 

 

 

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Video Endoscopic Sequence 17 of 18.

This picture shows the border of the ulcerated neoplasia.

 

 

 

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Video Endoscopic Sequence 18 of 18.

High power detail of malignant gastric tumor with signet ring cells.

 

 

 

   To observe this image enlarged click here.  

This 69 year-old female, 3 moths previous, presented gastroesophageal reflux disease weigh loss of 5 pounds, no nauseas as well as vomiting was reported, an upper endoscopy was achived, showing this ulcerated an irregular mass.

Video Endoscopic Sequence 1 of 28.

Gastric Ulcerated Adenocarcinoma of the Pre-pyloric Antrum.

 This 69 year-old female, 3 moths previous, presented
 gastroesophageal reflux disease weigh loss of 5 pounds,
 no nauseas as well as vomiting was reported, an upper
 endoscopy was achived, showing this ulcerated an irregular
 mass. The patient underwent laparoscopic subtotal
 gastrectomy.

Endoscopic Image of Gastric Cáncer.  Gastric Ulcerated Adenocarcinoma of the Pre-pyloric Antrum.

Video Endoscopic Sequence 2 of 28.

Endoscopic Image of Gastric Cáncer

Gastric Ulcerated Adenocarcinoma of the Pre-pyloric Antrum.

Endoscopic Image of Gastric Cáncer.

Video Endoscopic Sequence 3 of 28.

Gastric Ulcerated Adenocarcinoma of the Pre-pyloric Antrum.

Endoscopic Image of Gastric Cáncer.

Video Endoscopic Sequence 4 of 28.

Gastric Ulcerated Adenocarcinoma of the Pre-pyloric Antrum.

Some peristaltic wave are observed.

Laparoscopic Gastrectomy for Gastric Cancer. Laparoscopic gastrectomy is becoming widely used for the management of gastric cancer.

Video Endoscopic Sequence 5 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

The patient underwent a laparoscopic subtotal gastrectomy with lymph node dissection.

 Laparoscopic gastrectomy is becoming widely used for the
 management of gastric cancer.

 "treating patients with stomach cancer is to remove the
 cancer completely and safely, while preserving his or her
 quality of life"

 

laparoscopic gastrectomy for gastric cancer has become popular because of advances in surgical techniques.

Video Endoscopic Sequence 6 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 laparoscopic gastrectomy for gastric cancer has become
 popular because of advances in surgical techniques.

"Laparoscopic gastrectomy is a technically advanced surgical procedure,"A novel, minimally invasive surgical approach to treat stomach cancer has been shown to have advantages that may make it a preferable treatment for some patients.

Video Endoscopic Sequence 7 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 "Laparoscopic gastrectomy is a technically advanced
 surgical procedure,"

 A novel, minimally invasive surgical approach to treat
 stomach cancer has been shown to have advantages that
 may make it a preferable treatment for some patients.

Video Endoscopic Sequence 8 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 

Video Endoscopic Sequence 9 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 

Video Endoscopic Sequence 10 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 

Video Endoscopic Sequence 11 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 

Video Endoscopic Sequence 12 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 

Video Endoscopic Sequence 13 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 

Video Endoscopic Sequence 14 of 28.

Laparoscopic Gastrectomy for Gastric Cancer

 Extraction of the surgical specimen is achived through small incision.

Video Endoscopic Sequence 15 of 28.

 Extraction of the surgical specimen is achived through a small incision.

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Video Endoscopic Sequence 16 of 28.

The surgical specimen

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Video Endoscopic Sequence 17 of 28.

The surgical specimen

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Video Endoscopic Sequence 18 of 28.

 

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Video Endoscopic Sequence 19 of 28.

 

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Video Endoscopic Sequence 20 of 28.

 

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Video Endoscopic Sequence 21 of 28.

 

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Video Endoscopic Sequence 22 of 28.

The surgical specimen has been opened showing the antral tumor.

 

 

 

 

 

 

 

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Video Endoscopic Sequence 23 of 28.

A close up

 

 

 

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Video Endoscopic Sequence 24 of 28.

 

 

 

 

 

 

 

 

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Video Endoscopic Sequence 25 of 28.

 

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Video Endoscopic Sequence 26 of 28.

 

 

 

 

 

 

 

 

 

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Video Endoscopic Sequence 27 of 28.

 

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Video Endoscopic Sequence 28 of 28.

 

 

 

 

 

 

 

 

 

 

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The Gastric Cancer Gran Concerto