Regarding carcinoma of the stomach, the Lauren classification divides gastric cancer into intestinal and diffuse types. Which statement correctly differentiates the two types regarding epidemiology, pathology, and prognosis?

• A Diffuse type: well-differentiated, gland-forming, associated with H. pylori, better prognosis; Intestinal type: signet ring cells, hereditary (CDH1 mutation), worse prognosis
• B Intestinal type: gland-forming, H. pylori associated, older males, distal stomach, better prognosis; Diffuse type: signet ring cells, CDH1 mutation, younger patients, entire stomach (linitis plastica), worse prognosis ✓
• C Both types have equal prognosis; the distinction is histological only
• D Intestinal type: signet ring cells, hereditary, located in the fundus; Diffuse type: adenocarcinoma, antral, H. pylori associated

Explanation

Lauren's intestinal type gastric carcinoma forms glandular structures, is strongly associated with H. pylori, dietary carcinogens, and atrophic gastritis/intestinal metaplasia; it typically affects older males, is located in the antrum/lesser curve, and carries a better prognosis. The diffuse type consists of poorly cohesive cells (signet ring cells), is associated with germline CDH1 mutations (hereditary diffuse gastric cancer), affects younger patients, spreads throughout the stomach wall (linitis plastica), and has a significantly worse prognosis.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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