Download - Acd 8 12 14
ACD 8/12/14
elderly womanCC: “I can’t keep anything down”
Adenocarcinoma, at least intramucosal, with prominent signet ring cell features
PATH
DYSPHAGIA
Intrinsic
Esophageal strictureEosinophilic
esophagitisEsophageal webs/ringsCarcinomaRadiation InjuryLymphocytic
esophagitisInfectious esophagitis
Extrinsic
CV abnormalities
Motility D/o• Achalasia• Spastic d/o• Scleroderma• Sjogren’s
Pseudoachalasia – described in pts with adenocarcinoma of the cardia due to microscopic infiltration of the myenteric plexus or vagus nerve More likely to be due to malignancy if short duration of symptoms
(< 6 months), presentation after age 60, excessive weight loss, and difficult passage of endoscope through GE junction
Weight loss and persistent abdominal pain are the most common symptoms
Dysphagia is common with proximal stomach or GE junction cancers
Palpable abdominal mass is the most common physical exam finding
Most common met sites: liver, peritoneal surfaces, nonregional or distant lymph nodes
Virchow’s Node: L supraclavicular adenopathySister Mary Joesph’s Node: periumbilical nodule Irish Node: L axillary NodeKrukenburg Tumor – mets to ovary
GASTRIC CANCER
GastrectomyEndoscopic resectionH. pylori treatmentAdjuvant or neoadjuvant chemo based on stagingCombination of chemo and radiationPalliative measures: chemo, palliative resection, stent for
obstructive symptoms, external beam radiation therapy, endoscopic laser ablation
TREATMENT OPTIONS
Harrison’s Internal MedicineUptodate.comTrate DM, Parkman HP, Fisher RS. Dysphagia. Evaluation,
diagnosis, and treatment. Prim Care 1996; 23:417.Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the
stomach. A patient care study by the American College of Surgeons. Ann Surg 1993; 218:583
REFERENCES