What are the features of spread patterns in gastric cancer?

Updated: Feb 23, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Cancer of the stomach can spread directly, via lymphatics, or hematogenously. Features of spread include the following:

  • Direct extension into the omenta, pancreas, diaphragm, transverse colon or mesocolon, and duodenum is common
  • If the lesion extends beyond the gastric wall to a free peritoneal (ie, serosal) surface, then peritoneal involvement is frequent
  • The visible gross lesion frequently underestimates the true extent of the disease
  • The abundant lymphatic channels within the submucosal and subserosal layers of the gastric wall allow for easy microscopic spread
  • The submucosal plexus is prominent in the esophagus and the subserosal plexus is prominent in the duodenum, allowing proximal and distal spread
  • Lymphatic drainage is through numerous pathways and can involve multiple nodal groups (eg, gastric, gastroepiploic, celiac, porta hepatic, splenic, suprapancreatic, pancreaticoduodenal, paraesophageal, and paraaortic lymph nodes)
  • Hematogenous spread commonly results in liver metastases

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