Stomach cancer differential diagnosis: Difference between revisions

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* Breathing machine or [[ventilator]]
* Breathing machine or [[ventilator]]
* Ingestion of [[corrosive|corrosives]]
* Ingestion of [[corrosive|corrosives]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Epigastric pain]]
* [[Epigastric pain]]
|[[Food]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Food]]
|[[Antacids]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Antacids]]
|✔
| style="padding: 5px 5px; background: #F5F5F5;" |  ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|[[Melena|Black stools]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Melena|Black stools]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Pangastritis]] or antral [[gastritis]]
* [[Pangastritis]] or antral [[gastritis]]
* [[Gastric erosion|Erosive]] (Superficial, deep, [[hemorrhagic]])
* [[Gastric erosion|Erosive]] (Superficial, deep, [[hemorrhagic]])
* Nonerosive (''[[H. pylori]]'')
* Nonerosive (''[[H. pylori]]'')
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|Chronic gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|Chronic gastritis]]
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* [[Autoimmune diseases]]  
* [[Autoimmune diseases]]  
* Chronic [[stress]]
* Chronic [[stress]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Epigastric pain]]
* [[Epigastric pain]]
|[[Food]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Food]]
|[[Antacids]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Antacids]]
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|''[[H. pylori]] [[gastritis]]''
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[H. pylori]] [[gastritis]]''
* [[Atrophy]]
* [[Atrophy]]
* [[Intestinal]] [[metaplasia]]
* [[Intestinal]] [[metaplasia]]
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* Enlarged folds
* Enlarged folds
* Aphthoid erosions
* Aphthoid erosions
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis]]
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* ''[[H. pylori]]''
* ''[[H. pylori]]''
* [[Autoimmune disease]]
* [[Autoimmune disease]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
*[[Epigastric pain]]
*[[Epigastric pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|''[[H. pylori]]''
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[H. pylori]]''
* [[Mucosal]] [[atrophy]]
* [[Mucosal]] [[atrophy]]
[[Autoimmune]]
[[Autoimmune]]
* [[Mucosal]] [[atrophy]]
* [[Mucosal]] [[atrophy]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Iron deficiency anemia]]
* [[Iron deficiency anemia]]
*Autoimmune gastritis diagnosis includes:
*Autoimmune gastritis diagnosis includes:
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| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Autoimmune disease]]
* [[Autoimmune disease]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 121: Line 121:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
* Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
* [[Rectal bleeding]]
* [[Rectal bleeding]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Mucosal]] nodularity with cobblestoning
* [[Mucosal]] nodularity with cobblestoning
* Multiple [[aphthous ulcers]]
* Multiple [[aphthous ulcers]]
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* Hypoperistalsis
* Hypoperistalsis
* [[Duodenal]] strictures
* [[Duodenal]] strictures
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Fever]]
* [[Fever]]
* [[Fatigue]]
* [[Fatigue]]
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* Prolonged emptying of [[stomach]]
* Prolonged emptying of [[stomach]]
* [[Gastrinomas|Gastrinoma]]<nowiki/>s
* [[Gastrinomas|Gastrinoma]]<nowiki/>s
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Epigastric pain]]
* [[Epigastric pain]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Spicy food
* Spicy food
* Tight fitting clothing
* Tight fitting clothing
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Antacids]]
* [[Antacids]]
* Head elevation during sleep
* Head elevation during sleep
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔


(Suspect delayed gastric emptying)
(Suspect delayed gastric emptying)
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Esophagitis]]
* [[Esophagitis]]
* [[Barrette's esophagus]]
* [[Barrette's esophagus]]
* [[Strictures]]
* [[Strictures]]
|Other symptoms:
| style="padding: 5px 5px; background: #F5F5F5;" | Other symptoms:
* [[Dysphagia]]
* [[Dysphagia]]
* [[Regurgitation]]
* [[Regurgitation]]
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* Medications
* Medications
* Zollinger-ellison syndrome
* Zollinger-ellison syndrome
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Epigastric pain]] sometimes extending to back
* [[Epigastric pain]] sometimes extending to back
* [[Right upper quadrant pain]]
* [[Right upper quadrant pain]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
'''[[Duodenal ulcer]]'''
'''[[Duodenal ulcer]]'''
*Pain aggravates with empty stomach
*Pain aggravates with empty stomach
'''[[Gastric ulcer]]'''
'''[[Gastric ulcer]]'''
*Pain aggravates with food
*Pain aggravates with food
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Antacids]]
* [[Antacids]]


* [[Duodenal ulcer]]
* [[Duodenal ulcer]]
:*Pain alleviates with food
:*Pain alleviates with food
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Melena|Black stools]]
* [[Melena|Black stools]]
|'''Gastric ulcers'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Gastric ulcers'''
* Discrete [[mucosal]] [[lesions]] with a punched-out smooth [[ulcer]] base with whitish fibrinoid base
* Discrete [[mucosal]] [[lesions]] with a punched-out smooth [[ulcer]] base with whitish fibrinoid base
* Most [[ulcers]] are at the junction of [[fundus]] and [[antrum]]  
* Most [[ulcers]] are at the junction of [[fundus]] and [[antrum]]  
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* Found in the first part of [[duodenum]]
* Found in the first part of [[duodenum]]
* <1cm
* <1cm
|'''Other diagnostic tests'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Other diagnostic tests'''
* Serum [[gastrin]] levels
* Serum [[gastrin]] levels
* [[Secretin]] stimulation test
* [[Secretin]] stimulation test
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| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Associated with [[MEN type 1]]
* Associated with [[MEN type 1]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔


(suspect [[gastric outlet obstruction]])
(suspect [[gastric outlet obstruction]])
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Melena|Black stools]]
* [[Melena|Black stools]]
|Useful in collecting the tissue for [[biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" | Useful in collecting the tissue for [[biopsy]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
* May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
* Associated with [[MEN type 1]]
* Associated with [[MEN type 1]]
Line 246: Line 246:
* ''[[H. pylori]]'' infection
* ''[[H. pylori]]'' infection
* Smoked and salted food
* Smoked and salted food
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Melena|Black stools]], or blood in stools
* [[Melena|Black stools]], or blood in stools
|'''Esophagogastroduodenoscopy'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Esophagogastroduodenoscopy'''
* Multiple biopsies are taken to establish the diagnosis
* Multiple biopsies are taken to establish the diagnosis
|'''Other symptoms'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Other symptoms'''
* [[Dysphagia]]
* [[Dysphagia]]
* Early [[satiety]]
* Early [[satiety]]
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| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]'' infection
* ''[[H. pylori]]'' infection
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
* [[Chest pain]]
* [[Chest pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|✔
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|Useful in collecting the [[tissue]] for [[biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" | Useful in collecting the [[tissue]] for [[biopsy]]
|'''Other symptoms'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Other symptoms'''
* Painless swollen [[lymph nodes]] in neck and armpit
* Painless swollen [[lymph nodes]] in neck and armpit
* Night sweats
* Night sweats
Line 288: Line 288:


</div>
</div>


==References==
==References==

Revision as of 11:45, 5 April 2019

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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
Acute gastritis Food Antacids ✔ ✔ ✔ - ✔ Black stools -
Chronic gastritis Food Antacids ✔ ✔ ✔ ✔ ✔ - H. pylori gastritis

Lymphocytic gastritis

  • Enlarged folds
  • Aphthoid erosions
 -
Atrophic gastritis - - ✔ - ✔ ✔ - H. pylori

Autoimmune

Crohn's disease - - - - - ✔ ✔
GERD
  • Spicy food
  • Tight fitting clothing
 ✔

(Suspect delayed gastric emptying)

✔ - - - - Other symptoms:

Complications

Peptic ulcer disease

Duodenal ulcer

  • Pain aggravates with empty stomach

Gastric ulcer

  • Pain aggravates with food
  • Pain alleviates with food
 ✔ ✔ - - - Gastric ulcers

Duodenal ulcers

Other diagnostic tests
Gastrinoma - - ✔

(suspect gastric outlet obstruction)

✔ - - - Useful in collecting the tissue for biopsy

Diagnostic tests

Gastric Adenocarcinoma - - ✔ ✔ ✔ ✔ ✔ Esophagogastroduodenoscopy
  • Multiple biopsies are taken to establish the diagnosis
 Other symptoms
Primary gastric lymphoma - - - - - ✔ - - Useful in collecting the tissue for biopsy Other symptoms

References

  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.
  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.
  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.
  4. ↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
  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.
  6. ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
  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.
  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.
  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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