ACD 8/12/14

elderly womanCC: “I can’t keep anything down”

Adenocarcinoma, at least intramucosal, with prominent signet ring cell features

PATH

DYSPHAGIA

Intrinsic

Esophageal strictureEosinophilic

esophagitisEsophageal webs/ringsCarcinomaRadiation InjuryLymphocytic

esophagitisInfectious esophagitis

Extrinsic

CV abnormalities

Motility D/o• Achalasia• Spastic d/o• Scleroderma• Sjogren’s

Pseudoachalasia – described in pts with adenocarcinoma of the cardia due to microscopic infiltration of the myenteric plexus or vagus nerve More likely to be due to malignancy if short duration of symptoms

(< 6 months), presentation after age 60, excessive weight loss, and difficult passage of endoscope through GE junction

Weight loss and persistent abdominal pain are the most common symptoms

Dysphagia is common with proximal stomach or GE junction cancers

Palpable abdominal mass is the most common physical exam finding

Most common met sites: liver, peritoneal surfaces, nonregional or distant lymph nodes

Virchow’s Node: L supraclavicular adenopathySister Mary Joesph’s Node: periumbilical nodule Irish Node: L axillary NodeKrukenburg Tumor – mets to ovary

GASTRIC CANCER

GastrectomyEndoscopic resectionH. pylori treatmentAdjuvant or neoadjuvant chemo based on stagingCombination of chemo and radiationPalliative measures: chemo, palliative resection, stent for

obstructive symptoms, external beam radiation therapy, endoscopic laser ablation

TREATMENT OPTIONS

Harrison’s Internal MedicineUptodate.comTrate DM, Parkman HP, Fisher RS. Dysphagia. Evaluation,

diagnosis, and treatment. Prim Care 1996; 23:417.Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the

stomach. A patient care study by the American College of Surgeons. Ann Surg 1993; 218:583

REFERENCES