Carcinoma stomach

Carcinoma stomach

We have described in article :

Management of carcinoma stomach

Clinical features of carcinoma stomach

Investigation of carcinoma stomach

Treatment of carcinoma stomach

Carcinoma stomach

Clinical features of carcinoma stomach:

1) Early gastric cancer is asymptomatic.

2) Weight loss.

3) Anaemia.

4) Ulcer-like pain (in 50% case).

5) Anorexia and nausea.

6) Early satiety.

7) Less common features. Haematemesis, melaena, dyspepsia alone.

8) Palpable epigastric mass.

9) Jaundice or ascites (if metastatic spread).

10) Tumour spread can cause (metastases occur most commonly in the liver, lungs, peritoneum bone marrow):

  • Supraclavicular lymph nodes (Troisier’s sign).
  • Umbilicus (Sister Joseph’s nodule”)
  • Ovaries (Krukenberg tumour)
  • Paraneoplastic phenomena:
  • Acanthosis nigricans
  • Thrombophlebitis (Trousseau’s sign)
  • Dermatomyositis

Investigations of carcinoma stomach:

1) Upper GIT endoscopy in any dyspeptic patient with ‘alarm features”.

2) Multiple biopsies from the edge and base of a gastric ulcer are required.

3) Exfoliative brush cytology.

4) Barium meal study.

5) Once the diagnosis is made, further imaging is necessary for accurate staging and assessment of resectability.

Treatment of carcinoma stomach : 

1) Surgery:

  • Resection offers the only hope of cure and this can be achieved in about 90% of with early gastric cancer. 
  • Radical and total gastrectomy with lymphadenectomy is the operation of choice, patients preserving, the spleen if possible.
  • Perioperative chemotherapy with epirubicin, cisplatin and florouracil (ECF) improves survival rates.

2) Palliative treatment : 

  • 5-fluorouracil, cisplatin.
  • The biological agent trastuzumab.
  • Carcinomas at the cardia or pylorus may require endoscopic dilatation or insertion of expandable metallic stents for relief of dysphagia or vomiting.
  • A nasogastric tube may offer temporary relief of vomiting due to gastric outlet obstruction. Read more about carcinoma of stomach

QA 55 year old farmer presented with dyspepsia, anorexia, upper abdominal and weight loss.

a) What is your probable diagnosis?

b) Mention the investigations to confirm your diagnosis.


a) Probable diagnosis: Carcinoma stomach.

b) Investigations: Please see above.

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