Stomach cancer physical examination: Difference between revisions
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===Skin=== | ===Skin=== | ||
*[[Pallor]] | *[[Pallor]]. | ||
*[[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> | *[[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]]: | *[[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]]: | *[[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=== | ||
*[[Virchow's node]]: Left [[supraclavicular]] [[adenopathy]]<ref name="pmid386813">{{cite journal| author=Morgenstern L| title=The Virchow-Troisier node: a historical note. | journal=Am J Surg | year= 1979 | volume= 138 | issue= 5 | pages= 703 | pmid=386813 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=386813 }}</ref> | *[[Virchow's node]]: Left [[supraclavicular]] [[adenopathy]].<ref name="pmid386813">{{cite journal| author=Morgenstern L| title=The Virchow-Troisier node: a historical note. | journal=Am J Surg | year= 1979 | volume= 138 | issue= 5 | pages= 703 | pmid=386813 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=386813 }}</ref> | ||
===Abdomen=== | ===Abdomen=== | ||
* The presence of a palpable [[abdominal mass]] is the most common physical finding<ref name="pmid8239772">{{cite journal| author=Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R| title=Cancer of the stomach. A patient care study by the American College of Surgeons. | journal=Ann Surg | year= 1993 | volume= 218 | issue= 5 | pages= 583-92 | pmid=8239772 | doi= | pmc=1243028 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8239772 }}</ref> | * The presence of a palpable [[abdominal mass]] is the most common physical finding.<ref name="pmid8239772">{{cite journal| author=Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R| title=Cancer of the stomach. A patient care study by the American College of Surgeons. | journal=Ann Surg | year= 1993 | volume= 218 | issue= 5 | pages= 583-92 | pmid=8239772 | doi= | pmc=1243028 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8239772 }}</ref> | ||
*[[Abdominal distention]] | *[[Abdominal distention]]. | ||
*[[Sister Mary Joseph nodule]]: | *[[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]]: | *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 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> | *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 === | === Extremities === | ||
*[[Muscle weakness]] | *[[Muscle weakness]]. | ||
=== '''Paraneoplastic syndrome manifestations''' === | === '''Paraneoplastic syndrome manifestations''' === | ||
* [[Microangiopathic hemolytic anemia]]<ref name="pmid481196">{{cite journal| author=Antman KH, Skarin AT, Mayer RJ, Hargreaves HK, Canellos GP| title=Microangiopathic hemolytic anemia and cancer: a review. | journal=Medicine (Baltimore) | year= 1979 | volume= 58 | issue= 5 | pages= 377-84 | pmid=481196 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=481196 }}</ref> | * [[Microangiopathic hemolytic anemia|Microangiopathic hemolytic anemia.]]<ref name="pmid481196">{{cite journal| author=Antman KH, Skarin AT, Mayer RJ, Hargreaves HK, Canellos GP| title=Microangiopathic hemolytic anemia and cancer: a review. | journal=Medicine (Baltimore) | year= 1979 | volume= 58 | issue= 5 | pages= 377-84 | pmid=481196 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=481196 }}</ref> | ||
* [[Membranous nephropathy]]<ref name="pmid6986318">{{cite journal| author=Wakashin M, Wakashin Y, Iesato K, Ueda S, Mori Y, Tsuchida H et al.| title=Association of gastric cancer and nephrotic syndrome. An immunologic study in three patients. | journal=Gastroenterology | year= 1980 | volume= 78 | issue= 4 | pages= 749-56 | pmid=6986318 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986318 }}</ref> | * [[Membranous nephropathy|Membranous nephropathy.]]<ref name="pmid6986318">{{cite journal| author=Wakashin M, Wakashin Y, Iesato K, Ueda S, Mori Y, Tsuchida H et al.| title=Association of gastric cancer and nephrotic syndrome. An immunologic study in three patients. | journal=Gastroenterology | year= 1980 | volume= 78 | issue= 4 | pages= 749-56 | pmid=6986318 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986318 }}</ref> | ||
* [[Trousseau's syndrome]]: [[hypercoagulable states]]<ref name="pmid19421245">{{cite journal| author=Carmack SW, Genta RM, Graham DY, Lauwers GY| title=Management of gastric polyps: a pathology-based guide for gastroenterologists. | journal=Nat Rev Gastroenterol Hepatol | year= 2009 | volume= 6 | issue= 6 | pages= 331-41 | pmid=19421245 | doi=10.1038/nrgastro.2009.70 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19421245 }}</ref> | * [[Trousseau's syndrome]]: [[hypercoagulable states]].<ref name="pmid19421245">{{cite journal| author=Carmack SW, Genta RM, Graham DY, Lauwers GY| title=Management of gastric polyps: a pathology-based guide for gastroenterologists. | journal=Nat Rev Gastroenterol Hepatol | year= 2009 | volume= 6 | issue= 6 | pages= 331-41 | pmid=19421245 | doi=10.1038/nrgastro.2009.70 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19421245 }}</ref> | ||
* [[Polyarteritis nodosa]]<ref name="pmid17142647">{{cite journal| author=Rugge M, Meggio A, Pennelli G, Piscioli F, Giacomelli L, De Pretis G et al.| title=Gastritis staging in clinical practice: the OLGA staging system. | journal=Gut | year= 2007 | volume= 56 | issue= 5 | pages= 631-6 | pmid=17142647 | doi=10.1136/gut.2006.106666 | pmc=1942143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17142647 }}</ref> | * [[Polyarteritis nodosa]].<ref name="pmid17142647">{{cite journal| author=Rugge M, Meggio A, Pennelli G, Piscioli F, Giacomelli L, De Pretis G et al.| title=Gastritis staging in clinical practice: the OLGA staging system. | journal=Gut | year= 2007 | volume= 56 | issue= 5 | pages= 631-6 | pmid=17142647 | doi=10.1136/gut.2006.106666 | pmc=1942143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17142647 }}</ref> | ||
==References== | ==References== | ||
Revision as of 22:34, 8 April 2019
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.