Presentation

Symptoms of gastric adenocarcinoma are generally vague and nonspecific. Epigastric pain is the most common symptom and is present in about 70% of patients. Pain is described as constant, nonradiating, and unrelieved by food. Temporary relief with antacids and antisecretory medications is sometimes observed. Dysphagia may be associated with more proximal gastric lesions. Frank upper GI bleeding occurs in about 10% of patients but up to one-third will be guiac positive. Perforation is an uncommon complication. The presence of cachexia, a palpable abdominal mass, hepatomegaly, or enlarged supraclavicular (Virchow's) nodes are ominous signs and suggest advanced disease.

The diagnosis of gastric carcinoma is generally made with upper endoscopy. Carcinomas may appear as polypoid, plaque-like, or ulcerative lesions. There are several features of malignant ulcers that differ from benign lesions. Malignant ulcers often have irregular, heaped-up borders. The ulcer base is more often irregular and necrotic. An underlying mass may be suggested. In addition, the surrounding gastric folds are often irregular and asymmetric in malignant ulcers. The diagnosis of gastric carcinoma is made in greater than 95% of cases if multiple biopsies are taken from the raised border of the ulcer. Mass population screening, while of value in Japan, has not been strongly advocated in the U.S. because of the lower incidence of the disease in this country.

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