Clinical features

Initial presentation is insidious. Patients are most commonly over 50 years of age and develop dyspepsia that may be mistaken for a symptom of an ulcer.

Later features of gastric carcinoma include:

• anorexia and weight loss in more than 95%
• pyloric obstruction
• haematemesis in 5%
• dysphagia with proximal lesions
• epigastric pain - late feature
• palpable mass - 33%
• hepatomegaly
• peritoneal seedlings which may lead to:
  • ascites
  • ovarian mass (Krukenburgs tumour)
  • pelvic mass
• enlarged left supraclavicular node - Virchow's node, Troisier's sign
• may present with perforation
• association with acanthosis nigricans and dermatomyositis
• pleural effusions if the cancer has spread to the lungs
• Sister Joseph nodule