Snap Shot A 78-year-old Japanese man, who moved to New York last year to live with his daughter, presents to the emergency room with fatigue, loss of appetite, and signs of anemia. He is Guaic positive. Introduction Gastric tumors include Gastric adenocarcinoma accounts for 95% of malignant tumors of the stomach less common are lymphomas (4%) associated with H. pylori leiomyosarcomas 10% of gastric tumors are benign polyps of leiomyomas Risk factors include male >50 years old blood group A nitrosamines (pickled foods) low fiber high salt intake chronic gastritis H pylori achlorhydria ETOH Krukenberg tumor mucinous, signet-ring cells with metastasis to the ovaries Linitis plastica infiltrating, diffuse CA most lethal form of gastric CA Presentation Early-stage stomach cancer produces no specific symptoms Patients and physicians tend to dismiss symptoms Symptoms include heartburn or indigestion stomach pain anorexia nausea sensation of pressure in the stomach weight loss Physical Exam Virchow's nodule: rock hard supraclavicular node Feel for ovarian masses with Krukenberg tumor Sister Mary Joseph sign: hard nodes at umbilicus Blumer's shelf: palpable nodule superior on rectal exam Evaluation Endoscopy with biopsy Staging begins with CT abdomen/pelvis Treatment Treatment is mostly palliative Combination of surgery and chemotherapy in some cases 5-cm surgical margin indicated Result better for gastric lymphoma Prognosis, Prevention, and Complications Linitis plastica invariably fatal within months