Clinical Manifestations
Gastric carcinoma usually presents with nonÂspecific symptoms and signs. Epigastric pain is highly variable. In about one quarter of patients it may resemble the pain of peptic ulcer. More frequently it is a dull epigastric discomfort that may be exacerbated rather than relieved by food and may be associated with nausea and early saÂtiety. Almost all patients have anorexia and weight loss.
Vomiting may be prominent, espeÂcially with distal tumors leading to pyloric obÂstruction. Tumors arising in the cardia may infilÂtrate into the gastroesophageal junction and cause dysphagia. The tumors commonly bleed, producÂing iron deficiency anemia and more rarely hematemesis with corresponding symptoms of weakness, fatigue, and shortness of breath. More rarely the patient may present when symptoms and signs relating to metastases, direct extension, or paraneoplastic syndromes are prominent. These include, for example, obstructive jaundice, malignant ascites, a gastrocolic fistula. TrousÂseau’s syndrome (thrombophlebitis), dermatomyositis, and acanthosis nigricans.
Physical examination may reveal an epigastric mass, evidence of one or more of the complicaÂtions noted above, or other evidence of metastasis, such as a left supraclavicular Virchow’s node, a Blumer’s shelf (a mass in the perirectal pouch), or Rrukenberg tumors (metastases to the ovaries) on pelvic examination.