Stomach cancer differential diagnosis: Difference between revisions

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Revision as of 18:42, 19 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Stomach cancer must be differentiated from other diseases presenting with episodic abdominal pain, weight loss and loss of appetite such as gastric lymphoma, gastric metastasis, gastritis, benign gastric ulcer, Menetrier's disease.

Differential Diagnosis

Stomach cancer must be differentiated from other diseases presenting with episodic abdominal pain, weight loss and loss of appetite. The differentials include the following:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]


Differential Diagnosis
Disease	Cause	Symptoms									Diagnosis	Other findings
		Pain			Nausea & Vomiting	Heartburn	Belching or Bloating	Weight loss	Loss of Appetite	Stools	Endoscopy findings
		Location	Aggravating Factors	Alleviating Factors	Nausea & Vomiting	Heartburn	Belching or Bloating	Weight loss	Loss of Appetite	Stools	Endoscopy findings
Acute gastritis	H. pylori NSAIDS Corticosteroids Alcohol Spicy food Viral infections Crohn's disease Autoimmune diseases Bile reflux Cocaine use Breathing machine or ventilator Ingestion of corrosives	Epigastric pain	Food	Antacids	✔	✔	✔	-	✔	Black stools	Pangastritis or antral gastritis Erosive (Superficial, deep, hemorrhagic) Nonerosive (H. pylori)	-
Chronic gastritis	H. pylori Alcohol Medications Autoimmune diseases Chronic stress	Epigastric pain	Food	Antacids	✔	✔	✔	✔	✔	-	H. pylori gastritis Atrophy Intestinal metaplasia Lymphocytic gastritis Enlarged folds Aphthoid erosions	-
Atrophic gastritis	H. pylori Autoimmune disease	Epigastric pain	-	-	✔	-		✔	✔	-	H. pylori Mucosal atrophy Autoimmune Mucosal atrophy	Iron deficiency anemia Autoimmune gastritis diagnosis includes: Antiparietal and anti-IF antibodies Achlorhydria and hypergastrinemia Low serum cobalamine
Crohn's disease	Autoimmune disease	Abdominal pain	-	-	-	-	-	✔	✔	Chronic diarrhea often bloody with pus or mucus Rectal bleeding	Mucosal nodularity with cobblestoning Multiple aphthous ulcers Linier or serpiginous ulcerations Thickened antral folds Antral narrowing Hypoperistalsis Duodenal strictures	Fever Fatigue Anemia (pernicious anemia)
GERD	Lower esophageal sphincter abnormalities Hiatal hernia Abnormal esophageal contractions Prolonged emptying of stomach Gastrinomas	Epigastric pain	Spicy food Tight fitting clothing	Antacids Head elevation during sleep	✔ (Suspect delayed gastric emptying)	✔	-	-	-	-	Esophagitis Barrette's esophagus Strictures	Other symptoms: Dysphagia Regurgitation Nocturnal cough Hoarseness Complications Esophagitis Strictures Barrette esophagus
Peptic ulcer disease	H. pylori Smoking Alcohol Radiation therapy Medications Zollinger-ellison syndrome	Epigastric pain sometimes extending to back Right upper quadrant pain	Duodenal ulcer Pain aggravates with empty stomach Gastric ulcer Pain aggravates with food	Antacids Duodenal ulcer Pain alleviates with food	✔	✔	-	-	-	Black stools	Gastric ulcers Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base Most ulcers are at the junction of fundus and antrum 0.5-2.5cm Duodenal ulcers Well-demarcated break in the mucosa that may extend into the muscularis propria of the duodenum Found in the first part of duodenum <1cm	Other diagnostic tests Serum gastrin levels Secretin stimulation test Biopsy
Gastrinoma	Associated with MEN type 1	Abdominal pain	-	-	✔ (suspect gastric outlet obstruction)	✔	-	-	-	Black stools	Useful in collecting the tissue for biopsy	May present with symptoms of GERD or peptic ulcer disease Associated with MEN type 1 Diagnostic tests Serum gastrin levels Somatostatin receptor scintigraphy CT and MRI
Gastric Adenocarcinoma	H. pylori infection Smoked and salted food	Abdominal pain	-	-	✔	✔	✔	✔	✔	Black stools, or blood in stools	Esophagogastroduodenoscopy Multiple biopsies are taken to establish the diagnosis	Other symptoms Dysphagia Early satiety Frequent burping
Primary gastric lymphoma	H. pylori infection	Abdominal pain Chest pain	-	-	-	-	-	✔	-	-	Useful in collecting the tissue for biopsy	Other symptoms Painless swollen lymph nodes in neck and armpit Night sweats Fatigue Fever Cough or trouble breathing

References

↑ Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.
↑ Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.
↑ Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.
↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
↑ Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.
↑ Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.
↑ Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.

Template:WH Template:WS

[pmid6710074-1] Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.

[pmid25901896-2] Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.

[pmid16819502-3] Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.

[pmid2789799-4] Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.

[pmid25133039-5] Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.

[pmid17956071-6] Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.

[pmid17985090-7] Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.

[pmid15621988-8] Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.

[pmid21390139-9] Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.

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@@ Line 9: / Line 9: @@
 <div style="width: 85%;">
-{| class="wikitable"
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
-! rowspan="3" |Disease
+| colspan="13" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
-! rowspan="3" |Cause
+|+
-! colspan="9" |Symptoms
+| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Disease'''}}
-!Diagnosis
+| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Cause'''}}
-! rowspan="3" |Other findings
+| colspan="9" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Symptoms'''}}
+| style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Diagnosis'''}}
+| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Other findings'''}}
 |-
-! colspan="3" |Pain
+| colspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Pain'''}}
-! rowspan="2" |Nausea
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Nausea & Vomiting'''}}
-&
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Heartburn'''}}
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Belching or Bloating'''}}
-Vomiting
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Weight loss'''}}
-! rowspan="2" |Heartburn
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Loss of Appetite'''}}
-! rowspan="2" |Belching or
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Stools'''}}
-Bloating
+| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Endoscopy findings'''}}
-! rowspan="2" |Weight loss
-! rowspan="2" |Loss of
-Appetite
-! rowspan="2" |Stools
-! rowspan="2" |Endoscopy findings
 |-
-!Location
+| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Location'''}}
-!Aggravating Factors
+| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Aggravating Factors'''}}
-!Alleviating Factors
+| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Alleviating Factors'''}}
 |-
-![[Acute gastritis]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Acute gastritis]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * ''[[H. pylori]]''
 * [[NSAIDS]]
@@ Line 52: / Line 49: @@
 |Food
 |[[Antacids]]
-|?
+|✔
-|?
+|✔
-|?
+|✔
 |<nowiki>-</nowiki>
-|?
+|✔
 |[[Melena|Black stools]]
 |
-* Pangastritis or antral [[gastritis]]
+* [[Pangastritis]] or antral [[gastritis]]
 * [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
 * Nonerosive (''[[H. pylori]]'')
 |<nowiki>-</nowiki>
 |-
-![[Gastritis|Chronic gastritis]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|Chronic gastritis]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * ''[[H. pylori]]''
 * [[Alcohol]]
@@ Line 75: / Line 72: @@
 |Food
 |[[Antacids]]
-|?
+|✔
-|?
+|✔
-|?
+|✔
-|?
+|✔
-|?
+|✔
 |<nowiki>-</nowiki>
 |''[[H. pylori]] [[gastritis]]''
@@ Line 89: / Line 86: @@
 |<nowiki>-</nowiki>
 |-
-![[Atrophic gastritis]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * ''[[H. pylori]]''
 * [[Autoimmune disease]]
-|[[Epigastric pain]]
+|
+*[[Epigastric pain]]
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|?
+|✔
 |<nowiki>-</nowiki>
 |
-|?
+|✔
-|?
+|✔
 |<nowiki>-</nowiki>
 |''[[H. pylori]]''
@@ Line 108: / Line 106: @@
 |
 * [[Iron deficiency anemia]]
-Autoimmune gastritis diagnosis include:
+*Autoimmune gastritis diagnosis includes:
-* Antiparietal and anti-IF antibodies
+**Antiparietal and anti-IF antibodies
-* [[Achlorhydria]] and hypergastrinemia
+**[[Achlorhydria]] and hypergastrinemia
-* Low serum [[vitamin B12|cobalamine]]
+**Low serum [[vitamin B12|cobalamine]]
 |-
-![[Crohn's disease]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Crohn's disease]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * [[Autoimmune disease]]
 |
@@ Line 123: / Line 121: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|?
+|✔
-|?
+|✔
 |
 * Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
@@ Line 141: / Line 139: @@
 * [[Anemia]] ([[pernicious anemia]])
 |-
-![[GERD]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[GERD]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * Lower esophageal sphincter abnormalities
 * [[Hiatal hernia]]
 * Abnormal esophageal contractions
@@ Line 157: / Line 154: @@
 * [[Antacids]]
 * Head elevation during sleep
-|?
+|✔
 (Suspect delayed gastric emptying)
-|?
+|✔
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 167: / Line 164: @@
 |
 * [[Esophagitis]]
-* Barrette esophagus
+* [[Barrette's esophagus]]
 * [[Strictures]]
 |Other symptoms:
@@ Line 179: / Line 176: @@
 * Barrette esophagus
 |-
-![[Peptic ulcer disease]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Peptic ulcer disease]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * ''[[H. pylori]]''
 * [[Smoking]]
@@ Line 191: / Line 188: @@
 * [[Right upper quadrant pain]]
 |
- '''[[Duodenal ulcer]]'''
+'''[[Duodenal ulcer]]'''
 *Pain aggravates with empty stomach
 '''[[Gastric ulcer]]'''
@@ Line 200: / Line 197: @@
 * [[Duodenal ulcer]]
 :*Pain alleviates with food
-|?
+|✔
-|?
+|✔
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 220: / Line 217: @@
 * [[Biopsy]]
 |-
-![[Gastrinoma]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastrinoma]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * Associated with [[MEN type 1]]
 |
@@ Line 227: / Line 224: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|?
+|✔
 (suspect [[gastric outlet obstruction]])
-|?
+|✔
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 245: / Line 242: @@
 * [[CT]] and [[MRI]]
 |-
-![[Gastric Cancer|Gastric Adenocarcinoma]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric Cancer|Gastric Adenocarcinoma]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * ''[[H. pylori]]'' infection
 * Smoked and salted food
@@ Line 253: / Line 250: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|?
+|✔
-|?
+|✔
-|?
+|✔
-|?
+|✔
-|?
+|✔
 |
 * [[Melena|Black stools]], or blood in stools
@@ Line 267: / Line 264: @@
 * Frequent [[burping]]
 |-
-![[Gastric lymphoma|Primary gastric lymphoma]]
+| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric lymphoma|Primary gastric lymphoma]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * ''[[H. pylori]]'' infection
 |
@@ Line 278: / Line 275: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|?
+|✔
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 289: / Line 286: @@
 * [[Cough]] or trouble breathing
 |}
 </div>

Stomach cancer differential diagnosis: Difference between revisions

Revision as of 18:42, 19 December 2017

Overview

Differential Diagnosis

References

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