Gastric cancer classification in simple words
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gastric cancer classification Lauren WHO simple overview
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Borrmann classification gastric cancer gross types
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Here is a clear, structured overview of gastric cancer classification from the ground up.
Gastric Cancer Classification — Simple Overview
Almost all gastric cancers (>90%) are adenocarcinomas (cancer of gland-forming cells). They are classified in several overlapping ways:
1. By Depth of Invasion (Stage)
The most clinically important split:
| Stage | What it means | Prognosis |
|---|---|---|
| Early gastric cancer (EGC) | Cancer stays in mucosa/submucosa — regardless of lymph node spread | Excellent — ~90% 5-year survival |
| Advanced gastric cancer | Cancer invades into the muscle layer and beyond | Poor — <20% 5-year survival in the West |
2. By Gross (Visible) Appearance — The Japanese & Borrmann Classifications
Early Gastric Cancer (Japanese Classification)
| Type | Appearance |
|---|---|
| Type I | Protruding / polypoid bump |
| Type IIa | Slightly raised |
| Type IIb | Flat |
| Type IIc | Slightly depressed |
| Type III | Ulcerated crater |
Advanced Gastric Cancer (Borrmann Classification, 1926)
| Type | What it looks like | Key point |
|---|---|---|
| I | Polypoid — mushroom-like mass | Best prognosis |
| II | Ulcerating — deep ulcer with sharp edges | Clearly defined |
| III | Ulcerating + infiltrating — ragged edges | Most common |
| IV | Diffusely infiltrating — "linitis plastica" (leather-bottle stomach) | Worst prognosis |
Types III and IV are usually incurable at diagnosis.
3. By Microscopic Appearance — Laurén Classification (1965)
The most clinically used histological system:
| Feature | Intestinal Type | Diffuse Type |
|---|---|---|
| Cell arrangement | Forms glands (organized) | Loose single cells, no glands |
| Look under microscope | Well-differentiated | Poorly differentiated; signet ring cells (mucin pushes nucleus to side) |
| How it grows | Polypoid or ulcerated mass | Spreads through stomach wall silently |
| Who gets it | Older men, high-incidence areas (Asia, S. America) | Both sexes, younger patients |
| Associated with | H. pylori, intestinal metaplasia, atrophic gastritis | CDH1 mutation; blood type A |
| Metastasis pattern | Tends to go to liver | Tends to go to peritoneum |
| Prognosis | Better | Worse |
There is also a Mixed type (both components → intermediate-poor prognosis) and an Indeterminate type.
4. By WHO Microscopic Subtypes (2019)
The WHO gives more detail, but roughly maps back to Laurén:
| WHO Subtype | Frequency | Corresponds to Laurén |
|---|---|---|
| Tubular adenocarcinoma | Most common (45–64%) | Intestinal |
| Papillary adenocarcinoma | 3–10%; higher liver mets risk | Intestinal |
| Poorly cohesive (incl. signet ring cell) | 20–54% | Diffuse |
| Mucinous adenocarcinoma | 2–8% | Mixed |
| Mixed-pattern | 6–22%; poor prognosis | Mixed |
5. By Location in the Stomach
| Location | Notes |
|---|---|
| Cardia / proximal | Common in low-incidence regions (UK, N. America); linked to GERD |
| Distal (antrum/body) | Common in high-incidence regions (Asia, Eastern Europe); linked to H. pylori |
In high-incidence areas, 80% are distal. In the West, 50–60% are proximal/cardia.
6. By Molecular Subtype — TCGA Classification (2014)
The Cancer Genome Atlas divided gastric cancer into 4 molecular subtypes with different drivers and treatment implications:
| Subtype | Key feature | Histology link |
|---|---|---|
| EBV-positive | Epstein-Barr virus in tumor cells; good response to immunotherapy | Good prognosis |
| MSI (Microsatellite unstable) | DNA mismatch repair defects; responds well to checkpoint inhibitors | Intestinal-like |
| CIN (Chromosomal instability) | TP53 mutations; most common | Intestinal type |
| GS (Genomically stable) | CDH1 / RHOA mutations | Diffuse type; worst prognosis |
Quick Summary Table
| System | What it tells you |
|---|---|
| Early vs Advanced | Depth of wall invasion → prognosis & curability |
| Japanese classification | Shape of early lesions → guides endoscopic treatment |
| Borrmann | Shape of advanced lesions → gross surgical/endoscopic description |
| Laurén | Intestinal vs diffuse → biology, epidemiology, spread pattern |
| WHO | Detailed microscopic subtypes |
| TCGA molecular | Genetic drivers → targeted therapies, immunotherapy eligibility |
Sources: Bailey & Love's Short Practice of Surgery (28th ed.), Sabiston Textbook of Surgery, Yamada's Textbook of Gastroenterology (7th ed.)
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