Linitis Plastica: Symptoms and Treatment

Linitis plastica is a rare and aggressive form of stomach cancer, characterized by the thickening and hardening of the stomach walls. This condition leads to a significant reduction in the stomach's flexibility, making it difficult for the organ to expand and contract as needed. Understanding this disease, from its symptoms to its treatment options, is crucial for both patients and healthcare professionals.

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What is Linitis Plastica?

Linitis plastica, often referred to as "leather bottle stomach," derives its name from the Latin word "linitis," meaning inflammation, and "plastica," implying formation. This pathology involves the infiltration of the stomach wall by malignant cells, leading to a rigid, non-distensible stomach. Gastric linitis plastica is typically diagnosed at an advanced stage, which complicates treatment efforts and affects prognosis adversely.

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Causes of Linitis Plastica

The exact causes of linitis plastica remain uncertain. However, it is often associated with diffuse-type gastric adenocarcinoma. Genetic factors, such as mutations in the CDH1 gene, have been implicated in hereditary diffuse gastric cancer, a condition that can lead to linitis plastica. Environmental factors, including diet, Helicobacter pylori infection, and smoking, may also play a role in the development of gastric linitis plastica.

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Recognizing Linitis Plastica Symptoms

Linitis plastica symptoms are often nonspecific and can be mistaken for other gastrointestinal disorders. Understanding these symptoms is vital for early diagnosis and treatment.

Common Symptoms

Advanced Symptoms

In more advanced stages, patients may experience symptoms such as jaundice, anaemia, and ascites due to metastasis to other organs. These symptoms necessitate urgent medical evaluation and intervention.

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Diagnosing Linitis Plastica

Diagnosing linitis plastica can be challenging due to its nonspecific symptoms and the diffuse nature of the disease. Several diagnostic tools are employed to confirm its presence.

Radiological and Endoscopic Evaluation

Radiology plays a crucial role in identifying linitis plastica. Techniques like a barium swallow X-ray can reveal the characteristic narrowing of the stomach. Endoscopy allows for direct visualization of the stomach lining and the opportunity to obtain biopsy samples for histological examination.

Pathological and Histological Analysis

A definitive diagnosis is often made through pathological examination of biopsy samples. The presence of signet ring cells and diffuse infiltration of the stomach wall are indicative of linitis plastica.

Genetic Testing

For patients with a family history of gastric cancer, genetic testing for CDH1 mutations may be recommended to assess the risk of hereditary diffuse gastric cancer.

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Treatment Options for Linitis Plastica

Treatment for linitis plastica requires a multimodal approach due to the aggressive nature of the disease.

Surgical Intervention

Surgery is often the primary treatment, although it is only feasible in cases where the cancer is detected at an early stage. Total gastrectomy, the removal of the entire stomach, is the most common surgical procedure.

Chemotherapy and Radiation

In advanced cases, chemotherapy and radiation therapy are employed to manage symptoms and control the spread of the disease. Neoadjuvant chemotherapy, administered before surgery, aims to reduce tumour size and improve surgical outcomes. Palliative care is also crucial to enhance the quality of life for patients with advanced disease.

Targeted Therapy

Recent advances in targeted therapies offer new hope for patients with linitis plastica. Treatments targeting specific genetic mutations, such as HER2 and PD-L1, are being explored in clinical trials and have shown promise in managing the disease.

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Linitis Plastica Prognosis

The prognosis for linitis plastica remains poor, largely due to late-stage diagnosis and the diffuse spread of the cancer. The five-year survival rate is significantly lower compared to other types of gastric cancer. However, advancements in treatment modalities and early detection methods offer a glimmer of hope for improving outcomes.

Factors Influencing Prognosis

Several factors influence the prognosis of linitis plastica, including the stage at diagnosis, the patient's overall health, and the presence of genetic mutations. Early detection and a comprehensive treatment plan tailored to the individual's needs are crucial for improving survival rates.