Gastric cancer

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Gastric cancer

Gastrointestinal system

Peritoneum and peritoneal cavity disorders




Gastric cancer


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USMLE® Step 1 questions

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Gastric cancer

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USMLE® Step 1 style questions USMLE

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A 77-year-old man presents to the primary care physician with a painless mass in his left neck. The patient reports rapid enlargement of this mass over the past several weeks. In addition, he reports a 20-lb (9.1 kg) weight loss, fatigue, and decreased appetite. Past medical history is notable for recurrent peptic ulcer disease, hypertension, and hypercholesterolemia. He reports a 10-pack-year smoking history but quit 25 years ago. He reports drinking 1-2 beers per day.  Temperature is 37 °C (98.6 °F), pulse is 65/min, respirations are 12/min and blood pressure is 142/62 mmHg. Physical examination shows a hard 3 cm x  3 cm mass in the left supraclavicular fossa, temporal wasting, epigastric tenderness to palpation, and a small periumbilical subcutaneous nodule. Which of the following is the most likely diagnosis?  

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Acanthosis nigricans p. 221, 495

stomach cancer p. 388


stomach cancer p. 388

Diffuse stomach cancer p. 388

Gastric cancer p. 388

carcinogens causing p. 223

metastases of p. 224

oncogenes and p. 222

oncogenic microbes and p. 224

sign of Leser-Trélat and p. 221

trastuzumab for p. 450

types of p. 388

Gastritis p. 388

stomach cancer and p. 388

Leser-Trélat sign p. 221, 489

stomach cancer as cause p. 388

Metastases p. 401

gastric cancer p. 388


stomach cancer and p. 388


stomach cancer and p. 388

Weight loss

stomach cancer p. 388


Gastric cancer is when malignant or cancerous cells arise in the stomach.

This cancer can appear in any part of the stomach and it’s classified into adenocarcinoma, lymphoma, carcinoid tumor, and leiomyosarcoma; depending on the type of cells it originates from.

Adeno- means gland; so, adenocarcinoma arises from columnar glandular epithelium.

Lymphoma arises from lymphocytes.

Carcinoid tumor is originated in the G-cells of the stomach.

And leiomyosarcoma arises from smooth muscle cells from the gastric wall.

Gastric cancer is generally considered a poor prognosis cancer, because it doesn't cause specific symptoms until later stages.

The stomach has four regions: the cardia, the fundus, the body, and the pyloric antrum.

There’s also a pyloric sphincter or valve at the end of the stomach, which closes while eating, keeping food inside for the stomach to digest.

Now, the gastric wall is made up of four layers: from the outside in, there’s the adventitia, or serosa; the muscular layer; the submucosa; and the mucosa.

The mucosa comes into direct contact with food, and it also has three layers of its own.

The innermost layer is the epithelial layer and it absorbs and secretes mucus and digestive enzymes.

The middle layer is the lamina propria and it has blood, lymph vessels, and mucosa associated lymphoid tissue, or MALT for short, which are nodules of immune cells called lymphocytes, in charge of eliminating pathogens that could pass through the epithelial layer.

The outermost layer of the mucosa is the muscularis mucosa, and it’s a layer of smooth muscle that contracts and helps with the break down food.

The epithelial layer dips down below the surface of the stomach lining to form gastric pits.

And these pits are contiguous with gastric glands below which contain various epithelial cell types, each secreting a variety of substances.

So for example, foveolar cells, or surface mucus cells, secrete mucus, which is a mix of water and glycoproteins that coats the stomach epithelial cells.

With all of these digestive enzymes and hydrochloric acid floating around, the stomach and duodenal mucosa would get digested if not for this mucus which coats and protects the epithelial cells.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Modern Oncological Approaches to Gastric Adenocarcinoma" Gastroenterology Clinics of North America (2013)
  6. "Incidence and survival of stomach cancer in a high-risk population of Chile" World Journal of Gastroenterology (2009)

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