Other clinical features of gastric carcinoma

1. OTHER CLINICAL
FEATURES OF GASTRIC
CARCINOMA
ARNAB DAS
ROLL NO – 27
8TH
SEMESTER

2. INTRODUCTION

3. • 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.

4. CLINICAL FEATURES
OF GASTRIC CARCINOMA

5. 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 ).

6. 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

7. NON-SPECIFIC CLINICAL FEATURES
(found at an early stage)

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

9. Constant, non-radiating upper abdominal
pain (usually not severe) which is not
related to food intake

10. GENERAL SYMPTOMS OF CANCER

11. Weight loss
Weakness and fatigue
Loss of appetite
Early satiety

12. SPECIFIC CLINICAL FEATURES
(found at mid and late stage)

13. 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.

14. If the tumour involves the cardia or
fundus of the stomach (10% cases), the
features are :
• Firm mass in upper
epigastrium
• Dysphagia

15. If the tumour involves the body of the
stomach (25 % cases)
• May present only
with firm, well
defined, mobile
mass in abdomen

16. 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

17. CLINICAL FEATURES DUE TO
METASTASES TO OTHER ORGANS
(found at an advanced stage)

18. 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

19. Ascites
Due to,
•peritoneal carcinomatosis.
•malignant obstruction of draining lymphatics.
•Obstruction of portal circulation by tumour.
With features of,
•Shifting dullness
•Fluid thrill

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

21. Lung metastases
Presenting as,
•Metastatic pleural
effusion
•Aspiration pneumonitis

22. Transperitoneal
spread :
Metastases in umbilicus
as Sister Mary Joseph’s
nodule
Krukenberg tumor

23. Rectovesical metastases or ‘‘drop
metastases” causing rectal shelf of
Blumer in the pouch of Douglas found
on per rectal examination

24. OTHER PRESENTATIONS

25. •Positive Trousseau sign i.e.
thrombophlebitis migrans.
•Enlarged Left anterior axillary
lymph nodes or Irish nodes.
•Acanthosis nigricans

26. 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

27. THANK YOU