## Histological Classification of Gastric Cancer **Key Point:** The intestinal type (well-differentiated adenocarcinoma) is the most common histological variant of gastric cancer, accounting for approximately 50–70% of cases globally and in India. ### Lauren Classification The Lauren classification divides gastric adenocarcinoma into two main types: | Feature | Intestinal Type | Diffuse Type | |---------|-----------------|---------------| | **Frequency** | 50–70% (most common) | 20–30% | | **Differentiation** | Well to moderately differentiated | Poorly differentiated | | **Cell morphology** | Cohesive glandular structures | Individual signet-ring cells | | **Associated factors** | H. pylori, intestinal metaplasia, chronic gastritis | CDH1 mutation, hereditary diffuse gastric cancer (HDGC) | | **Prognosis** | Relatively better | Worse (earlier invasion, diffuse spread) | | **Geographic pattern** | More common in high-incidence areas (Japan, Korea, India) | More common in low-incidence areas (Western countries) | **High-Yield:** In India and other high-incidence regions, the intestinal type predominates due to the high prevalence of H. pylori infection and chronic atrophic gastritis leading to intestinal metaplasia and dysplasia. ### Clinical Pearl The intestinal type typically presents as an ulcerating or fungating mass (often in the antrum or lesser curvature), whereas the diffuse type infiltrates the gastric wall diffusely, causing linitis plastica ("leather bottle stomach"). ### Mnemonic **INTESTINAL = Incidence (70%), Integrated glands, India-endemic** — remembering that intestinal type is the most common globally and especially in high-incidence countries.
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