X-ray barium meal examination findings of advanced gastric cancer

The general classification of advanced gastric cancer is generally based on the Borrmann classification, which includes Borrmann type I, Borrmann type II, Borrmann type III and Borrmann type IV. The X-ray findings of each type are described as follows:

1. Borrmann type I (polyp type or mushroom type)

The tumor grows into the cavity, showing irregular filling defects. Double contrast phase and moderate pressure phase can more specifically show the beginning of the mass and the abnormal characteristics of its surface structure. Because the local mucosa is destroyed and disappears, its surface is often rough and uneven, like cauliflower, with small ulcer niches and defects. The mucosal patterns adjacent to the defect area are suddenly interrupted, and the local gastric wall where the raised lesion is attached is stiff, resulting in a clear boundary between the lesion area and the normal area.

2. Borrmann type II (ulcerative type)

The mass grows in a localized manner, with a large ulcer in the center and a prominent bulge at the edge of the ulcer, like a crater; ulcerative gastric cancer mainly occurs above the mass, with the niche located within the stomach contour, irregular in shape, and the lateral edge showing a typical "half-moon sign". The outer edge is straight, the inner edge is irregular and has multiple sharp corners, and the niche is surrounded by a transparent band, namely the "ring embankment sign", which is uneven in width and has an irregular and sharp outline.

3. Borrmann type III (ulcer infiltrative type)

The bulge with nodular edges infiltrates to the surrounding area. The mucosal folds are destroyed, disappeared or interrupted, and the adjacent gastric mucosa is stiff and peristalsis disappears. It is difficult to distinguish between type II and type III in X-ray manifestations. Both can show a half-moon sign, while the mass of type III grows diffusely. Although there is also ulceration in the center, the bulge around it is relatively flat.

Cancerous tissue diffuses and spreads in the stomach wall, affecting a wide area. X-rays show that part or the entire stomach cavity becomes stiff and shrunken, with no peristalsis, and looks like a leathery cyst.