A 58-year-old Indian man with a 10-year history of chronic epigastric pain and H. pylori infection presents with progressive dysphagia and weight loss. Endoscopy reveals a large ulcerated lesion in the antrum. What is the most common site of gastric carcinoma in this patient?
A. Body of stomach along the greater curvature
B. Fundus and greater curvature
C. Cardia and gastroesophageal junction
D. Antrum and lesser curvature (pyloric region)
Explanation
Anatomical Distribution of Gastric Carcinoma
Key Point
The antrum and lesser curvature (pyloric region) are the most common sites of gastric carcinoma, accounting for 50–60% of all gastric cancers.
Frequency by Site
Table
Site
Frequency
Clinical Notes
Antrum and lesser curvature (pyloric region)
50–60%
Most common; often associated with H. pylori and chronic gastritis
Fundus and greater curvature
20–25%
Second most common; often associated with intestinal-type adenocarcinoma
Cardia and GE junction
10–15%
Associated with Barrett's esophagus and reflux; adenocarcinoma predominates
Body of stomach
5–10%
Least common; variable histology
High-YieldNEET PG
The antrum is the most common site because:
1.
It is the site of maximal H. pylori colonization and chronic inflammation.
2.
The lesser curvature has the richest lymphatic drainage, facilitating early spread.
3.
The antral mucosa is most susceptible to intestinal metaplasia and dysplasia following chronic gastritis.
Clinical Correlation
Clinical Pearl
Antral cancers often present with:
Pyloric obstruction → early satiety, vomiting, weight loss
Ulceration → chronic blood loss → iron-deficiency anemia
Advanced stage at diagnosis (due to late presentation)
The patient in this vignette has classic features of antral gastric cancer: chronic H. pylori infection, dysphagia (from pyloric involvement), weight loss, and an ulcerated lesion in the antrum on endoscopy.
