Stomach cancer differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(12 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Stomach cancer}}
{{CMG}}{{AE}}{{PSD}}
{{CMG}}{{AE}}{{PSD}}
{{Stomach cancer}}
==Overview==
==Overview==
Stomach cancer must be differentiated from [[gastric lymphoma]], [[gastric]] [[metastasis]], [[gastritis]], benign gastric [[ulcer]], menetrier disease.
[[Stomach cancer]] must be differentiated from other [[diseases]] presenting with episodic [[abdominal pain]], [[weight loss]] and [[loss of appetite]] such as [[gastric lymphoma]], [[gastric]] [[metastasis]], [[gastritis]], [[Peptic ulcer|benign gastric ulcer]], [[Ménétrier's disease|Menetrier's disease]].
==Differential diagnosis==
The differential can be broad and includes:
 
*[[Gastric lymphoma]]
 
*Gastric metastasis
 
*Gastric stromal [[tumour]] (GIST)
*[[Gastritis]]
*Benign gastric (peptic) [[ulcer]]
*Menetrier disease
*Secondary changes from [[pancreatitis]] (from extrinsic inflammatory change)
 
==Differential Diagnosis==
==Differential Diagnosis==
Stomach cancer must be differentiated from:<ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074  }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896  }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502  }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799  }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090  }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988  }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139  }} </ref>
[[Stomach cancer]] must be differentiated from other [[diseases]] presenting with episodic [[abdominal pain]], [[weight loss]] and [[loss of appetite]]. The differentials include the following:<ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074  }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896  }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502  }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799  }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090  }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988  }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139  }} </ref>
<div style="width: 85%;">
<div style="width: 85%;">
 
<small>
{| class="wikitable"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! rowspan="3" |Disease
| colspan="13" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
! rowspan="3" |Cause  
|+
! colspan="9" |Symptoms
| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Disease'''}}
!Diagnosis
| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Cause'''}}
! rowspan="3" |Other findings
| colspan="9" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Symptoms'''}}
| style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Diagnosis'''}}
| rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Other findings'''}}
|-
|-
! colspan="3" |Pain
| colspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Pain'''}}
! rowspan="2" |Nausea
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Nausea & Vomiting'''}}
&
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Heartburn'''}}
 
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Belching or Bloating'''}}
Vomiting
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Weight loss'''}}
! rowspan="2" |Heartburn
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Loss of Appetite'''}}
! rowspan="2" |Belching or  
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Stools'''}}
Bloating
| rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Endoscopy findings'''}}
! rowspan="2" |Weight loss
! rowspan="2" |Loss of  
Appetite
! rowspan="2" |Stools
! rowspan="2" |Endoscopy findings
|-
|-
!Location
| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Location'''}}
!Aggravating Factors
| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Aggravating Factors'''}}
!Alleviating Factors
| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Alleviating Factors'''}}
|-
|-
![[Acute gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Acute gastritis]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
* [[NSAIDS]]
* [[NSAIDS]]
* [[Corticosteroids]]
* [[Corticosteroids]]
* [[Alcohol]]
* [[Alcohol]]
* Spicy food
* Spicy [[food]]
* Viral infections
* [[Viral infections]]
* [[Crohn's disease]]
* [[Crohn's disease]]
* [[Autoimmune diseases]]
* [[Autoimmune diseases]]
* Bile reflux
* [[Bile]] reflux
* [[Cocaine]] use
* [[Cocaine]] use
* Breathing machine or ventilator
* Breathing machine or [[ventilator]]
* Ingestion of [[corrosive|corrosives]]
* Ingestion of [[corrosive|corrosives]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Epigastric pain]]
* [[Epigastric pain]]
|Food
| style="padding: 5px 5px; background: #F5F5F5;" | [[Food]]
|[[Antacids]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Antacids]]
|?
| style="padding: 5px 5px; background: #F5F5F5;" |  ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|[[Melena|Black stools]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Melena|Black stools]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Pangastritis or antral [[gastritis]]
* [[Pangastritis]] or antral [[gastritis]]
* [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
* [[Gastric erosion|Erosive]] (Superficial, deep, [[hemorrhagic]])
* Nonerosive (''[[H. pylori]]'')
* Nonerosive (''[[H. pylori]]'')
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|-
|-
![[Gastritis|Chronic gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|Chronic gastritis]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
* [[Alcohol]]
* [[Alcohol]]
* Medications
* Medications
* [[Autoimmune diseases]]  
* [[Autoimmune diseases]]  
* Chronic stress
* Chronic [[stress]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Epigastric pain]]
* [[Epigastric pain]]
|Food
| style="padding: 5px 5px; background: #F5F5F5;" | [[Food]]
|[[Antacids]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Antacids]]
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|''[[H. pylori]] [[gastritis]]''
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[H. pylori]] [[gastritis]]''
* [[Atrophy]]
* [[Atrophy]]
* Intestinal [[metaplasia]]
* [[Intestinal]] [[metaplasia]]
Lymphocytic gastritis
Lymphocytic [[gastritis]]
* Enlarged folds
* Enlarged folds
* Aphthoid erosions
* Aphthoid erosions
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|-
|-
![[Atrophic gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
* [[Autoimmune disease]]
* [[Autoimmune disease]]
|[[Epigastric pain]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|<nowiki>-</nowiki>
*[[Epigastric pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" |  
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|''[[H. pylori]]''
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
* Mucosal [[atrophy]]
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[H. pylori]]''
* [[Mucosal]] [[atrophy]]
[[Autoimmune]]
[[Autoimmune]]
* Mucosal [[atrophy]]
* [[Mucosal]] [[atrophy]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Iron deficiency anemia]]
* [[Iron deficiency anemia]]
Autoimmune gastritis diagnosis include:
*Autoimmune gastritis diagnosis includes:
* Antiparietal and anti-IF antibodies
**Antiparietal and anti-IF antibodies
* [[Achlorhydria]] and hypergastrinemia
**[[Achlorhydria]] and hypergastrinemia
* Low serum [[vitamin B12|cobalamine]]
**Low serum [[vitamin B12|cobalamine]]
|-
|-
![[Crohn's disease]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Crohn's disease]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Autoimmune disease]]
* [[Autoimmune disease]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
* Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
* [[Rectal bleeding]]
* [[Rectal bleeding]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Mucosal nodularity with cobblestoning
* [[Mucosal]] nodularity with cobblestoning
* Multiple [[aphthous ulcers]]
* Multiple [[aphthous ulcers]]
* Linier or serpiginous ulcerations
* Linier or serpiginous [[ulcerations]]
* Thickened antral folds
* Thickened antral folds
* Antral narrowing
* Antral narrowing
* Hypoperistalsis
* Hypoperistalsis
* Duodenal strictures
* [[Duodenal]] strictures
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Fever]]
* [[Fever]]
* [[Fatigue]]
* [[Fatigue]]
* [[Anemia]] ([[pernicious anemia]])
* [[Anemia]] ([[pernicious anemia]])
|-
|-
![[GERD]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[GERD]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* Lower esophageal sphincter abnormalities
* [[Lower esophageal sphincter]] abnormalities
 
* [[Hiatal hernia]]
* [[Hiatal hernia]]
* Abnormal esophageal contractions
* Abnormal [[esophageal]] contractions
* Prolonged emptying of [[stomach]]
* Prolonged emptying of [[stomach]]
* [[Gastrinomas]]
* [[Gastrinomas|Gastrinoma]]<nowiki/>s
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Epigastric pain]]
* [[Epigastric pain]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Spicy food
* Spicy food
* Tight fitting clothing
* Tight fitting clothing
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Antacids]]
* [[Antacids]]
* Head elevation during sleep
* Head elevation during sleep
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔


(Suspect delayed gastric emptying)
(Suspect delayed gastric emptying)
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Esophagitis]]
* [[Esophagitis]]
* Barrette esophagus
* [[Barrette's esophagus]]
* [[Strictures]]
* [[Strictures]]
|Other symptoms:
| style="padding: 5px 5px; background: #F5F5F5;" | Other symptoms:
* [[Dysphagia]]
* [[Dysphagia]]
* [[Regurgitation]]
* [[Regurgitation]]
Line 191: Line 175:
* Barrette esophagus
* Barrette esophagus
|-
|-
![[Peptic ulcer disease]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Peptic ulcer disease]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
* [[Smoking]]
* [[Smoking]]
Line 199: Line 183:
* Medications
* Medications
* Zollinger-ellison syndrome
* Zollinger-ellison syndrome
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Epigastric pain]] sometimes extending to back
* [[Epigastric pain]] sometimes extending to back
* [[Right upper quadrant pain]]
* [[Right upper quadrant pain]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
'''[[Duodenal ulcer]]'''
'''[[Duodenal ulcer]]'''
*Pain aggravates with empty stomach
*Pain aggravates with empty stomach
'''[[Gastric ulcer]]'''
'''[[Gastric ulcer]]'''
*Pain aggravates with food
*Pain aggravates with food
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Antacids]]
* [[Antacids]]


* [[Duodenal ulcer]]
* [[Duodenal ulcer]]
:*Pain alleviates with food
:*Pain alleviates with food
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Melena|Black stools]]
* [[Melena|Black stools]]
|'''Gastric ulcers'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Gastric ulcers'''
* Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
* Discrete [[mucosal]] [[lesions]] with a punched-out smooth [[ulcer]] base with whitish fibrinoid base
* Most [[ulcers]] are at the junction of [[fundus]] and antrum  
* Most [[ulcers]] are at the junction of [[fundus]] and [[antrum]]
* 0.5-2.5cm
* 0.5-2.5cm
'''Duodenal ulcers'''
'''Duodenal ulcers'''
Line 227: Line 211:
* Found in the first part of [[duodenum]]
* Found in the first part of [[duodenum]]
* <1cm
* <1cm
|'''Other diagnostic tests'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Other diagnostic tests'''
* Serum [[gastrin]] levels
* Serum [[gastrin]] levels
* [[Secretin]] stimulation test
* [[Secretin]] stimulation test
* [[Biopsy]]
* [[Biopsy]]
|-
|-
![[Gastrinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastrinoma]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* Associated with [[MEN type 1]]
* Associated with [[MEN type 1]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔


(suspect [[gastric outlet obstruction]])
(suspect [[gastric outlet obstruction]])
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Melena|Black stools]]
* [[Melena|Black stools]]
|Useful in collecting the tissue for [[biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" | Useful in collecting the tissue for [[biopsy]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
* May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
* Associated with [[MEN type 1]]
* Associated with [[MEN type 1]]
Line 257: Line 241:
* [[CT]] and [[MRI]]
* [[CT]] and [[MRI]]
|-
|-
![[Gastric Cancer|Gastric Adenocarcinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric Cancer|Gastric Adenocarcinoma]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]'' infection
* ''[[H. pylori]]'' infection
* Smoked and salted food
* Smoked and salted food
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Melena|Black stools]], or blood in stools
* [[Melena|Black stools]], or blood in stools
|'''Esophagogastroduodenoscopy'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Esophagogastroduodenoscopy'''
* Multiple biopsies are taken to establish the diagnosis
* Multiple biopsies are taken to establish the diagnosis
|'''Other symptoms'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Other symptoms'''
* [[Dysphagia]]
* [[Dysphagia]]
* Early [[satiety]]
* Early [[satiety]]
* Frequent [[burping]]
* Frequent [[burping]]
|-
|-
![[Gastric lymphoma|Primary gastric lymphoma]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric lymphoma|Primary gastric lymphoma]]
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]'' infection
* ''[[H. pylori]]'' infection
|
| style="padding: 5px 5px; background: #F5F5F5;" |  
* [[Abdominal pain]]
* [[Abdominal pain]]
* [[Chest pain]]
* [[Chest pain]]
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|?
| style="padding: 5px 5px; background: #F5F5F5;" | ✔
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
|Useful in collecting the tissue for [[biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" | Useful in collecting the [[tissue]] for [[biopsy]]
|'''Other symptoms'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Other symptoms'''
* Painless swollen [[lymph nodes]] in neck and armpit
* Painless swollen [[lymph nodes]] in neck and armpit
* Night sweats
* Night sweats
Line 301: Line 285:
* [[Cough]] or trouble breathing
* [[Cough]] or trouble breathing
|}
|}
 
</small>
</div>
</div>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
 
[[Category:Oncology]]
{{WH}}
[[Category:Medicine]]
{{WS}}
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 00:18, 30 July 2020

Stomach cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Stomach Cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

Staging

History and Symptoms

Physical Examination

Laboratory Findings

Endoscopy and Biopsy

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Stomach cancer differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Stomach cancer differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Stomach cancer differential diagnosis

CDC on Stomach cancer differential diagnosis

Stomach cancer differential diagnosis in the news

Blogs on Stomach cancer differential diagnosis

Directions to Hospitals Treating Stomach cancer

Risk calculators and risk factors for Stomach cancer differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Stomach cancer must be differentiated from other diseases presenting with episodic abdominal pain, weight loss and loss of appetite such as gastric lymphoma, gastric metastasis, gastritis, benign gastric ulcer, Menetrier's disease.

Differential Diagnosis

Stomach cancer must be differentiated from other diseases presenting with episodic abdominal pain, weight loss and loss of appetite. The differentials include the following:[1][2][3][4][5][6][7][8][9]

Differential Diagnosis
Disease Cause Symptoms Diagnosis Other findings
Pain Nausea & Vomiting Heartburn Belching or Bloating Weight loss Loss of Appetite Stools Endoscopy findings
Location Aggravating Factors Alleviating Factors
Acute gastritis Food Antacids ✔ ✔ ✔ - ✔ Black stools -
Chronic gastritis Food Antacids ✔ ✔ ✔ ✔ ✔ - H. pylori gastritis

Lymphocytic gastritis

  • Enlarged folds
  • Aphthoid erosions
 -
Atrophic gastritis - - ✔ - ✔ ✔ - H. pylori

Autoimmune

Crohn's disease - - - - - ✔ ✔
GERD
  • Spicy food
  • Tight fitting clothing
 ✔

(Suspect delayed gastric emptying)

✔ - - - - Other symptoms:

Complications

Peptic ulcer disease

Duodenal ulcer

  • Pain aggravates with empty stomach

Gastric ulcer

  • Pain aggravates with food
  • Pain alleviates with food
 ✔ ✔ - - - Gastric ulcers

Duodenal ulcers

Other diagnostic tests
Gastrinoma - - ✔

(suspect gastric outlet obstruction)

✔ - - - Useful in collecting the tissue for biopsy

Diagnostic tests

Gastric Adenocarcinoma - - ✔ ✔ ✔ ✔ ✔ Esophagogastroduodenoscopy
  • Multiple biopsies are taken to establish the diagnosis
 Other symptoms
Primary gastric lymphoma - - - - - ✔ - - Useful in collecting the tissue for biopsy Other symptoms

References

  1. ↑ Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.
  2. ↑ Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.
  3. ↑ Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.
  4. ↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
  5. ↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
  6. ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
  7. ↑ Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.
  8. ↑ Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.
  9. ↑ Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Stomach_cancer_differential_diagnosis&oldid=1643556"