Gastric neoplasms – An endoscopic biopsy study with review of literature

Abstract

Background: Gastric cancer is the 2nd leading cause of cancer related deaths worldwide as most of the patients present very late during the course of the disease due to non-specific symptoms. Aims: To study the gastric neoplasms with reference to the age and sex occurrence, endoscopic presentation and histomorphology. Settings and Design: Descriptive study Methods and Material: The present study included biopsies of patients with suspected gastric malignancy at Kempegowda Institute of Medical Sciences, Bangalore, from January 2003 to January 2011. Brief clinical data were collected. Sections studied were diagnosed as per W.H.O classification and The Revised Vienna Classification of Gastrointestinal Neoplasia and the presence of any associated lesions noted. Results: The study included 163 gastric biopsies of which 157 were neoplastic. There was a male predominance with a peak in the 5th to 7th decade. The commonest site of origin was antrum and prepylorus (59.87%) and commonest endoscopic presentation observed was ulcerative growth (62.42%). Of the 157 neoplasms, 153 (97.45%) were adenocarcinomas. The other 4 cases comprised of 2 cases of gastric carcinoid, one case each of gastric lymphoma and GIST. The associated findings noted were H. pylori infection (22.87% adenocarcinomas), chronic atrophic gastritis (23.52% adenocarcinomas), intestinal metaplasia (9.15% adenocarcinomas), fungal infection and a hyperplastic polyp. Of the 163 biopsies, majority were grouped under categories 4 and 5 (61.34% and 29.44% respectively) of The Revised Vienna classification. Conclusions: Endoscopy with assisted biopsy is the gold standard for diagnosis of gastric cancer. A team approach towards treatment involving the pathologist and clinicians becomes crucial.