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n Striving to educate our members to be more ProActive towards a healthier lifestyle. Volume 4 Stomach Cancer April 2018 A MONTHLY NEWSLETTER MUSCULARIS Understanding the Stomach PROPRIA SEROSA The stomach is a muscular organ, located MUCOSA on the left side of the upper abdomen which receives and digests food that we ingest. The stomach consists of 5 layers: • Mucosa is the innermost layer of the stomach where acid and digestive enzymes are made. Most stomach SUBSEROSA cancers start here. • Submucosa is the next supporting STOMACH layer. SUBMUCOSA • Outside of the submucosa is the layer called the muscularis proria. This The American Cancer Society estimates that there will be 26,240 cases of stomach cancer layer is thick muscle that moves and diagnosed in the United States in 2018. Of those, the ACS estimates approximately 10,800 will mixes the contents of the stomach. lose their battle. So what exactly is stomach cancer? • Lastly are the 2 outer layers, the subserosa and the serosa, which wrap the stomach. What You Should Know . The layers are vital in determining the Stomach cancer, also called gastric cancer, • Other: stage of the cancer and the patient’s starts in the stomach. The development of There are a few other types of cancers that prognosis. As cancer grows from the stomach cancers are slow paced and extend can be found in the stomach, but are very mucosa into the deeper layers, the stage over a period of time, sometimes over years. rare; squamous cell carcinoma, small cell (extent) of the cancer is considered Cancerous cells will begin to form within the carcinoma and leiomyosarcoma. more advanced and will ultimately be layers of the stomach. harder to treat. Cancers that are found Statistically, stomach cancer affects the in different sections of the stomach may There are four main types of stomach cancer: population of those in their late 60’s; result in different symptoms. • Adenocarcinoma: average age being 68. The risk that a man Adenocarcinoma is the most common type will develop stomach cancer is more likely of stomach cancer diagnosed (90-95%). than a woman; 1 in 95 are diagnosed versus Symptoms of Stomach Cancer This cancer develops from the cells in 1 in 154 respectively. New cases of stomach the innermost lining of the stomach, the cancers have decreased by 1.5% over the last Often, stomach cancer goes untreated for mucosa. 10 years. many years, and is typically not caught • Lymphoma: until it has spread to another part of the Lymphoma is cancer of the immune Treatment body. It is important to speak with your system tissue that is found in the wall of Treatment will depend on the type and doctor if you have severe, persistent the stomach. location of the cancer, as well as the symptoms affecting your abdominal recommendations of your physician. region. Some signs and symptoms of • Gastrointestinal Stromal Tumor: The most common forms of treatment stomach cancer to be aware of include, GISTs can be found anywhere in the include: but are not limited to: digestive tract, but are mostly found in • Chemotherapy • Stomach pain cells of the stomach wall called interstitial • Radiation Therapy • Feeling bloated after eating cells of Cajal. Some GISTs found are benign. • Surgery • Fatigue • Targeted Therapies • • Severe, persistent heartburn Carcinoid Tumor: These tumors start in the hormone-making • Severe indigestion If you have been diagnosed with stomach cells of the stomach. • Persistent nausea and/or vomiting cancer, be sure to review all treatment options with your physician. • Unintentional weight loss Source: American Cancer Society ProAct, Inc. | Your Fully Integrated Pharmacy Benefit Manager | Questions? Please call: 1—877—635—9545.

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Appendiceal GCC and LAMN Navigating the Alphabet Soup in the Appendix
2018 Park City AP Update Appendiceal GCC and LAMN Navigating the Alphabet Soup in the Appendix Sanjay Kakar, MD University of California, San Francisco Appendiceal tumors Low grade appendiceal mucinous neoplasm • Peritoneal spread, chemotherapy • But not called ‘adenocarcinoma’ Goblet cell carcinoid • Not a neuroendocrine tumor • Staged and treated like adenocarcinoma • But called ‘carcinoid’ Outline • Appendiceal LAMN • Peritoneal involvement by mucinous neoplasms • Goblet cell carcinoid -Terminology -Grading and staging -Important elements for reporting LAMN WHO 2010: Low grade carcinoma • Low grade • ‘Pushing invasion’ LAMN vs. adenoma LAMN Appendiceal adenoma Low grade cytologic atypia Low grade cytologic atypia At minimum, muscularis Muscularis mucosa is mucosa is obliterated intact Can extend through the Confined to lumen wall Appendiceal adenoma: intact muscularis mucosa LAMN: Pushing invasion, obliteration of m mucosa LAMN vs adenocarcinoma LAMN Mucinous adenocarcinoma Low grade High grade Pushing invasion Destructive invasion -No desmoplasia or -Complex growth pattern destructive invasion -Angulated infiltrative glands or single cells -Desmoplasia -Tumor cells floating in mucin WHO 2010 Davison, Mod Pathol 2014 Carr, AJSP 2016 Complex growth pattern Complex growth pattern Angulated infiltrative glands, desmoplasia Tumor cells in extracellular mucin Few floating cells common in LAMN Few floating cells common in LAMN Implications of diagnosis LAMN Mucinous adenocarcinoma LN metastasis Rare Common Hematogenous Rare Can occur spread
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Nomina Histologica Veterinaria, First Edition
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