Stomach cancer physical examination: Difference between revisions
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{{Stomach cancer}} | {{Stomach cancer}} | ||
==Overview== | ==Overview== | ||
Patients with stomach cancer generally appear | Patients with stomach cancer generally appear weak. Common [[physical examination]] findings include [[abdominal distention]], [[palpation]] of an [[abdominal mass]], and [[pallor]]. [[Leser-Trelat sign]] and presence of [[Virchow's node]] (left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]]), [[Sister Mary Joseph nodule]] (visible periumbilical nodule), Blumer's shelf ([[rectal]] mass/shelf on [[Rectal examination|rectal exam]]) and/or [[Trousseau's syndrome]] ([[Migratory thrombophlebitis|migratory phlebitis]]) on [[physical examination]] are highly suggestive of stomach cancer. | ||
==Physical Examination== | ==Physical Examination== | ||
===General Appearance=== | ===General Appearance=== | ||
*Patients with gastric cancer are generally | *Patients with gastric cancer are generally weak due to [[weight loss]]. | ||
===Skin=== | ===Skin=== | ||
*[[Pallor]] | *[[Pallor]] | ||
*[[Jaundice]] may appear if | *[[Jaundice]] may appear if [[bile duct]] [[obstruction]] occurs<ref name="pmid7776992">{{cite journal| author=Fuchs CS, Mayer RJ| title=Gastric carcinoma. | journal=N Engl J Med | year= 1995 | volume= 333 | issue= 1 | pages= 32-41 | pmid=7776992 | doi=10.1056/NEJM199507063330107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7776992 }}</ref> | ||
*[[Acanthosis nigricans]]: velvety and | *[[Acanthosis nigricans]]: velvety and [[Hyperpigmentation|hyperpigmented]] patches on [[Skin fold|skin folds]]<ref name="pmid11889063">{{cite journal| author=Muehldorfer SM, Stolte M, Martus P, Hahn EG, Ell C, Multicenter Study Group "Gastric Polyps"| title=Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: a prospective multicentre study. | journal=Gut | year= 2002 | volume= 50 | issue= 4 | pages= 465-70 | pmid=11889063 | doi= | pmc=1773183 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11889063 }}</ref> | ||
*[[Leser-Trelat sign]]: acute-onset multiple [[seborrheic keratosis]] lesions that are usually located on the patient's back<ref name="pmid4270762">{{cite journal| author=Dantzig PI| title=Sign of Leser-Trélat. | journal=Arch Dermatol | year= 1973 | volume= 108 | issue= 5 | pages= 700-1 | pmid=4270762 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4270762 }}</ref> | *[[Leser-Trelat sign]]: acute-onset multiple [[seborrheic keratosis]] lesions that are usually located on the patient's back<ref name="pmid4270762">{{cite journal| author=Dantzig PI| title=Sign of Leser-Trélat. | journal=Arch Dermatol | year= 1973 | volume= 108 | issue= 5 | pages= 700-1 | pmid=4270762 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4270762 }}</ref> | ||
===Neck=== | ===Neck=== | ||
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*[[Abdominal distention]] | *[[Abdominal distention]] | ||
*[[Sister Mary Joseph nodule]]: a visible periumbilical nodule that is highly suggestive of umbilical metastasis | *[[Sister Mary Joseph nodule]]: a visible periumbilical nodule that is highly suggestive of [[umbilical]] [[metastasis]] | ||
*[[Splenomegaly]] | *[[Splenomegaly]] | ||
*[[Ascites]]: It can be the first indication of [[peritoneal carcinomatosis]] | *[[Ascites]]: It can be the first indication of [[peritoneal carcinomatosis]] | ||
*A palpable [[liver mass]]: it is often multifocal or diffuse, usually associated with an elevation in the serum alkaline phosphatase concentration. | *A palpable [[liver mass]]: it is often multifocal or diffuse, usually associated with an elevation in the [[serum]] [[alkaline phosphatase]] concentration. | ||
===Rectum=== | ===Rectum=== | ||
*Blood on [[rectal exam]] | *Blood on [[rectal exam]] | ||
*Blumer's shelf: Rectal mass/shelf palpable on rectal exam<ref name="pmid5828299">{{cite journal| author=Winne BURCHARD BE| title=Blumer's shelf tumor with primary carcinoma of the lung. A case report. | journal=J Int Coll Surg | year= 1965 | volume= 44 | issue= 5 | pages= 477-81 | pmid=5828299 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5828299 }}</ref> | *Blumer's shelf: [[Rectal]] mass/shelf [[palpable]] on [[Rectal examination|rectal exam]]<ref name="pmid5828299">{{cite journal| author=Winne BURCHARD BE| title=Blumer's shelf tumor with primary carcinoma of the lung. A case report. | journal=J Int Coll Surg | year= 1965 | volume= 44 | issue= 5 | pages= 477-81 | pmid=5828299 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5828299 }}</ref> | ||
===Genitourinary=== | ===Genitourinary=== | ||
*Ovarian mass may be suggestive of [[Krukenberg tumor|Krukenberg syndome]]<ref name="pmid1336701">{{cite journal| author=Gilliland R, Gill PJ| title=Incidence and prognosis of Krukenberg tumour in Northern Ireland. | journal=Br J Surg | year= 1992 | volume= 79 | issue= 12 | pages= 1364-6 | pmid=1336701 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1336701 }}</ref> | *[[Ovarian mass]] may be suggestive of [[Krukenberg tumor|Krukenberg syndome]]<ref name="pmid1336701">{{cite journal| author=Gilliland R, Gill PJ| title=Incidence and prognosis of Krukenberg tumour in Northern Ireland. | journal=Br J Surg | year= 1992 | volume= 79 | issue= 12 | pages= 1364-6 | pmid=1336701 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1336701 }}</ref> | ||
=== Extremities === | |||
*[[Muscle weakness]] | *[[Muscle weakness]] | ||
Revision as of 18:42, 20 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Parminder Dhingra, M.D. [2]
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Overview
Patients with stomach cancer generally appear weak. Common physical examination findings include abdominal distention, palpation of an abdominal mass, and pallor. Leser-Trelat sign and presence of Virchow's node (left supraclavicular lymphadenopathy), Sister Mary Joseph nodule (visible periumbilical nodule), Blumer's shelf (rectal mass/shelf on rectal exam) and/or Trousseau's syndrome (migratory phlebitis) on physical examination are highly suggestive of stomach cancer.
Physical Examination
General Appearance
- Patients with gastric cancer are generally weak due to weight loss.
Skin
- Pallor
- Jaundice may appear if bile duct obstruction occurs[1]
- Acanthosis nigricans: velvety and hyperpigmented patches on skin folds[2]
- Leser-Trelat sign: acute-onset multiple seborrheic keratosis lesions that are usually located on the patient's back[3]
Neck
Abdomen
- The presence of a palpable abdominal mass is the most common physical finding[5]
- Abdominal distention
- Sister Mary Joseph nodule: a visible periumbilical nodule that is highly suggestive of umbilical metastasis
- Splenomegaly
- Ascites: It can be the first indication of peritoneal carcinomatosis
- A palpable liver mass: it is often multifocal or diffuse, usually associated with an elevation in the serum alkaline phosphatase concentration.
Rectum
- Blood on rectal exam
- Blumer's shelf: Rectal mass/shelf palpable on rectal exam[6]
Genitourinary
- Ovarian mass may be suggestive of Krukenberg syndome[7]
Extremities
Paraneoplastic syndrome manifestations
- Microangiopathic hemolytic anemia[8]
- Membranous nephropathy[9]
- Trousseau's syndrome: hypercoagulable states[10]
- Polyarteritis nodosa[11]
References
- ↑ Fuchs CS, Mayer RJ (1995). "Gastric carcinoma". N Engl J Med. 333 (1): 32–41. doi:10.1056/NEJM199507063330107. PMID 7776992.
- ↑ Muehldorfer SM, Stolte M, Martus P, Hahn EG, Ell C, Multicenter Study Group "Gastric Polyps" (2002). "Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: a prospective multicentre study". Gut. 50 (4): 465–70. PMC 1773183. PMID 11889063.
- ↑ Dantzig PI (1973). "Sign of Leser-Trélat". Arch Dermatol. 108 (5): 700–1. PMID 4270762.
- ↑ Morgenstern L (1979). "The Virchow-Troisier node: a historical note". Am J Surg. 138 (5): 703. PMID 386813.
- ↑ Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R (1993). "Cancer of the stomach. A patient care study by the American College of Surgeons". Ann Surg. 218 (5): 583–92. PMC 1243028. PMID 8239772.
- ↑ Winne BURCHARD BE (1965). "Blumer's shelf tumor with primary carcinoma of the lung. A case report". J Int Coll Surg. 44 (5): 477–81. PMID 5828299.
- ↑ Gilliland R, Gill PJ (1992). "Incidence and prognosis of Krukenberg tumour in Northern Ireland". Br J Surg. 79 (12): 1364–6. PMID 1336701.
- ↑ Antman KH, Skarin AT, Mayer RJ, Hargreaves HK, Canellos GP (1979). "Microangiopathic hemolytic anemia and cancer: a review". Medicine (Baltimore). 58 (5): 377–84. PMID 481196.
- ↑ Wakashin M, Wakashin Y, Iesato K, Ueda S, Mori Y, Tsuchida H; et al. (1980). "Association of gastric cancer and nephrotic syndrome. An immunologic study in three patients". Gastroenterology. 78 (4): 749–56. PMID 6986318.
- ↑ Carmack SW, Genta RM, Graham DY, Lauwers GY (2009). "Management of gastric polyps: a pathology-based guide for gastroenterologists". Nat Rev Gastroenterol Hepatol. 6 (6): 331–41. doi:10.1038/nrgastro.2009.70. PMID 19421245.
- ↑ Rugge M, Meggio A, Pennelli G, Piscioli F, Giacomelli L, De Pretis G; et al. (2007). "Gastritis staging in clinical practice: the OLGA staging system". Gut. 56 (5): 631–6. doi:10.1136/gut.2006.106666. PMC 1942143. PMID 17142647.