Hello,
My name is Dr. Tamer Fouad. I am a medical oncologist and I have treated gastric cancer patients but not specifically those with linitis plastica.
Let me try to explain a bit about this diagnosis:
Adenocarcinoma of the stomach is the most common type of cancer of the stomach. It is classified according to microscopic criteria. Classification is based on the most unfavorable microscopic element present, which are, in order of increasing danger, tubular, papillary, mucinous, or signet-ring cells, and undifferentiated lesions.
Pathology specimens also are classified by gross appearance (non-microscopic outer appearance). In general, researchers consider gastric cancers ulcerative, polypoid, scirrhous (ie, diffuse linitis plastica), superficial spreading, multicentric, or Barrett ectopic adenocarcinoma.
Scirrhous carcinoma (linitis plastica) is a poorly differentiated mixture of mucin-producing carcinoma cells that infiltrates the muscle wall and turns it into rigid, leatherlike scar tissue that cannot stretch or move during the normal digestive process (peristalsis).
Researchers also employ a variety of other classification schemes.
The Borrmann system has 5 categories: type I tumors are polypoid or fungating; type II are ulcerating lesions surrounded by elevated borders; type III have ulceration with invasion of the gastric wall; type IV are diffusely infiltrating (ie, linitis plastica); and type V cannot be classified.
Another classification system, the Lauren system, classifies gastric cancer pathology as either an epidemic form or an endemic form. An appealing feature of classifying patients according to the Lauren system is that the descriptive pathologic entities have clinically relevant differences. The intestinal, expansive, epidemic-type gastric cancer is associated with chronic atrophic
gastritis, retained glandular structure, little invasiveness, and a sharp margin. This type also is classified as Borrmann I or II.
The pathologic presentation classified as epidemic by the Lauren system or Borrmann I or II is associated with most environmental risk factors, carries a better prognosis, and shows no familial history.
From the pathological classifications it becomes apparent that linitis plastica carries a worse prognosis than some of the more common subtypes. That said however the most important prognostic factor would resectability, if the cancer is still at the stage when it can be removed surgically this carries the best prognosis. If however, it can't be removed then the options for
chemotherapy are rather limited. Depending on his performance and the details of his case
chemotherapy may be of use.
I would like to refer you to this forum for posts related to linitis plastica.
Click here!.
Best of luck!
Dr. Tamer Fouad, MD
MB, BCh, MSc Internal Medicine.
Consultant of Hematology - Oncology.
