Stomach cancer usually presents with the symptoms of indigestion, abdominal fullness, burping, loss of appetite and heart burn. Late symptoms include, hemoptysis, melena, weight loss, weakness or fatigue, and pain after eating. Obstruction of gastric outlet, gastro-esophageal junction and pleural effusion are also late symptoms. Usually it is difficult to catch the gastric cancer in its early stages because patients of gastric cancer usually present with the similar symptoms as those of Peptic Ulcer Disease. So patients keep on getting treatment of peptic ulcer disease while cancer continue to grow. At the time of diagnosis, usually cancer has already been reached to advance stages.

 

In Capital Hospital Islamabad, a 61 year old male patient presented in emergency department complaining of difficulty in swallowing, unable to eat any thing, food regurgitation, vomiting, nausea, lack of appetite, epigastric pain, easy fatigability and significant weight loss. Sometime he also noticed blood in the vomitus. His laboratory investigations show anemia with Hemoglobin level of 9.9 g/dl.

Vomiting followed soon after eating. At first, it was though that he might have got some kind of esophageal problem. So Barium swallow was ordered, which came out normal. Now Dr. Siddique Akbar Satti, decided to go for an upper GI endoscopy. Endoscopy was done by Dr. Siddique Akbar Satti (Head Department of Medicine Capital Hospital Islamabad), which showed following picture.

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The above pictures show gastro-esophageal end of stomach. You can see that there is a large annular growth in the stomach that has made the gastric cavity very narrow. This is a large annular tumor and this suggests why barium swallow came out normal. In this patient, this large tumor at the cardiac end of stomach is responsible for dysphagia, food regurgitation, and vomiting soon after eating. Tissue samples were taken and sent for histopathology which showed features of gastric carcinoma.

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Author:

Dr. Adil R. MBBS

Special Thanks:

Dr. Siddique Akbar Satti, Head Department of Medicine, Capital Hospital Islamabad.

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