OTHER CLINICAL FEATURES OF GASTRIC

CARCINOMA

ARNAB DAS

ROLL NO – 27

8TH SEMESTER

INTRODUCTION

• Stomach or gastric carcinoma, refers to  malignant tumor arising from any part of the stomach epithelium.

• Gastric cancer is one of the most common cancers and the second most common cause of cancer deaths which is, about 800,000 deaths worldwide per year, mainly due to late diagnosis.

• Early symptoms of gastric cancer are independently related to survival and an increased number, as well as specific alarm symptoms, are closely correlated to the prognosis.

• So early detection of clinical features is the first step of better management.

CLINICAL FEATURESOF GASTRIC CARCINOMA

The patient may be asymptomatic in early stage of gastric carcinoma.

Most patients are diagnosed at an advanced stage of the disease with poor prognosis ( <5 year survival ).

THE CLINICAL FEATURES MAY BE DIVIDED INTO :

• Non-specific clinical features

• General symptoms of cancer

• Specific clinical features

• Signs of metastases to other organs

• Other presentations

NON-SPECIFIC CLINICAL FEATURES

(found at an early stage)

Indigestion, heartburn, bloating of the stomach after meal or vague epigastric

discomfort

Constant, non-radiating upper abdominal pain (usually not severe) which is not

related to food intake

GENERAL SYMPTOMS OF CANCER

Weight loss

Weakness and fatigue

Loss of appetite

Early satiety

SPECIFIC CLINICAL FEATURES

(found at mid and late stage)

Acute GI bleeding, presenting as haematemesis or melaena, is somewhat unusual (<15%), but

chronic occult blood loss is common (>40%) and manifests as microcytic, hypochromic (iron

deficiency) anaemia and haeme positive stool.

If the tumour involves the cardia or fundus of the stomach (10% cases), the

features are :

• Firm mass in upper epigastrium

• Dysphagia

If the tumour involves the body of the stomach (25 % cases)

• May present only with firm, well defined, mobile mass in abdomen

If the tumour involves the pylorus part of the stomach (65 % cases), the features

are :• Mass abdomen above the

umbilicus

• Features of gastric outlet obstruction like, nausea; projectile vomiting (of undigested food, devoid of any bile); Visible Peristalsis from left to right; Succussion splash; positive ausculto-percussion test etc.

gastric outlet obstruction due to ca pylorus

Distended stomach

CLINICAL FEATURES DUE TO METASTASES TO OTHER ORGANS

(found at an advanced stage)

Metastases to lymph node in left supraclavicular fossa also known as Virchow’s

node (or signal node) giving positive Troisier’s sign, is one of the first visible

metastatic manifestation

AscitesDue to,•peritoneal carcinomatosis.•malignant obstruction of draining lymphatics.•Obstruction of portal circulation by tumour.

With features of,

•Shifting dullness

•Fluid thrill

Liver metastases

With features of,•Jaundice•Multiple, hard nodules with umbilications due to central necrosis•Ascites

Lung metastases

Presenting as,•Metastatic pleural effusion•Aspiration pneumonitis

Transperitoneal spread :

Metastases in umbilicus as Sister Mary Joseph’s nodule

Krukenberg tumor

Rectovesical metastases or ‘‘drop metastases” causing rectal shelf of

Blumer in the pouch of Douglas found on per rectal examination

OTHER PRESENTATIONS

•Positive Trousseau sign i.e. thrombophlebitis migrans.

•Enlarged Left anterior axillary lymph nodes or Irish nodes.

•Acanthosis nigricans

Differential diagnosis

• Peptic ulcer disease • Congenital pyloric stenosis• Gastritis• Lymphoma of stomach• Carcinoma head of pancreas • Pancreatic pseudo-cyst • Infections like tuberculosis • Colon carcinoma• Trichobezoar • Gastrointestinal stromal tumour

THANK YOU