Home // About Us // Privacy Statement // Advertising Policy // Contact Us

Case 42: Weight gain

A 64 year old man returns for follow up 6 months after resection of a gastric cancer. He has been putting on weight but hasn't been eating well and is still having abdominal pain. A CT has been performed.

1. What does the CT show?

Multiple hypodense lesions within the liver consistent with metastases. There is also a significant volume of ascites.

2. What would you look for on examination?

General inspection looking for cachexia, anaemia, or jaundice. Examination of the left supraclavicular fossa for lymphadenopthay (Trossier's sign). Abdominal examination for ascites and hepatomegaly. Also examine for a Sister Joseph's nodule at the umbilicus.

3. What staging investigations would you arrange prior to resection of a gastric cancer?

Confirm the diagnosis with endoscopy and biopsy. Also assess size and site. Further T staging with endoscopic ultrasound (EUS) is of limited value in altering management. Nodal staging with EUS is not sensitive or specific enough to be universally utilised. A CT scan of the chest and abdomen is mandatory to look for distant metastases. Laparoscopy with cytology is used to exclude serosal involvement, sextensive nodal metastases or malignant ascites.

Further Links-- National Cancer Institute - Gastric cancer treatment

Reference : The Cochrane Database of Systematic Reviews 2006 Chemotherapy for advanced gastric cancer

Powerpoint Presentations
Assessment & Investigation of Gastric Cancer

Role of Adjuvant & Neoadjuvant Therapy in Oesophagogastric Malignancy