Stomach cancer physical examination

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

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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

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### General Appearance

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* Patients with gastric cancer are generally weak due to weight loss.

### Skin

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* 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

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* Virchow's node: Left supraclavicular adenopathy.[4]

### Abdomen

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* 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

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* Blood on rectal exam.
* Blumer's shelf: Rectal mass/shelf palpable on rectal exam.[6]

### Genitourinary

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* Ovarian mass may be suggestive of Krukenberg syndome.[7]

### Extremities

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* Muscle weakness.

### Paraneoplastic syndrome manifestations

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* Microangiopathic hemolytic anemia.[8]
* Membranous nephropathy.[9]
* Trousseau's syndrome: Hypercoagulable states.[10]
* Polyarteritis nodosa.[11]

## References

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1. ↑ Fuchs CS, Mayer RJ (1995). "Gastric carcinoma". N Engl J Med. 333 (1): 32–41. doi:10.1056/NEJM199507063330107. PMID 7776992.
2. ↑ 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.CS1 maint: Multiple names: authors list (link)
3. ↑ Dantzig PI (1973). "Sign of Leser-Trélat". Arch Dermatol. 108 (5): 700–1. PMID 4270762.
4. ↑ Morgenstern L (1979). "The Virchow-Troisier node: a historical note". Am J Surg. 138 (5): 703. PMID 386813.
5. ↑ 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.CS1 maint: Multiple names: authors list (link)
6. ↑ 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.
7. ↑ Gilliland R, Gill PJ (1992). "Incidence and prognosis of Krukenberg tumour in Northern Ireland". Br J Surg. 79 (12): 1364–6. PMID 1336701.
8. ↑ 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.CS1 maint: Multiple names: authors list (link)
9. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
10. ↑ 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.CS1 maint: Multiple names: authors list (link)
11. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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