There are several clinical findings in stomach cancer that I look for when I see a patient for the first time in clinic with worrying symptoms such as weight loss, early satiety and vomiting.
Often they have been referred urgently to the clinic by their family doctor for my opinion.
They often arrive nervous and with preconceived ideas of what I might have to say to them.
The initial consultation is always a difficult one, but more of an introduction and to explain the investigations they need.
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One other important aspect of the consultation is the chance for the person to ask questions and for me to provide as honest an answer as possible.
Also, it is an important part of the appointment to perform a full medical examination as it is possible to pick up abnormalities associated with an underlying tumor
For the client though, not picking up any abnormalities gives some reassurance. Finding abnormality, in a yet to confirm gastric tumor, usually indicates stage 4 disease which is potentially a life threatening stage of the disease.
So what am I looking for in this scenario?
When you examine someone with malignant disease one of the common clinical findings in stomach cancer patients is cachexia.
Cachexia is visible weight with reduced fat and muscle wasting evident.
This isn't confined to gastric malignancy nor does it indicate stage 4 disease, but none the less it is a worrying feature.
Learning to examine a person quickly and effectively takes many years of practice.
I won’t go in to the full examination, but will highlight some findings that may be related.
The first part of any examination is to watch the person walk in to the room.
Do they look unwell? Are they pale which could indicate anemia? Do their clothes look baggy on them? A tell tale sign of weight loss.
Clubbing in medical speak is not going to a nightclub, rather a change in the way your nails form which become bulbous and like drum sticks. The angle at the base of the nail is lost.
Clubbing can occur in a wide variety of conditions, including tumors. It is not common to although can occur.
Other gastrointestinal conditions including Crohn’s disease and liver cirrhosis can cause this abnormality
If your cancer has spread, one common route is the lymphatic system. This system can be thought of as the waste disposal system of your body.
There is a node that can enlarge in the area called the left supraclavicular fossa. By this, it means just above the left clavicle in the dip behind it towards your breast bone.
If found it is known as Troisiers sign and is strongly associated with stomach malignancy.
If the tumor spreads to the chest, sometimes fluid builds up around the lung which is known as a pleural effusion.
This can occur in other cancerous and non-cancerous conditions such as heart failure , TB and kidney failure.
When examining someone with a pleural effusion they may or may not be breathless.
If you tap on the chest over the fluid it sounds stony dull like a thud rather than the normal hollow sound that you should here. You can try this for yourself!
When a doctor listens to a chest they should hear good breath sounds, but these are reduced or absent in a pleural effusion.
Sometimes feeling your abdomen or tummy reveals a mass arising from the stomach in or near the top of your abdomen in the centre.
Sometimes a mass or enlargement of the liver can be felt. Normally you shouldn't feel your liver, but if enlarged you may feel it in the right, upper side of the abdomen that moves with taking a deep breath in and then out.
Apart from the Virchow’s node, other lymph glands may be enlarged in the neck, arm pits and groin region. These would be consistent with stage 4 disease.
I hope this has given you a better understanding of the clinical findings in stomach cancer and what your doctor is looking for when you are examined.
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