CASE STUDY #3

Gastric Cancer

A. Background and Diagnosis of Disease

HP is 70-year-old African-American male who was having loss of appetite for several
weeks and a 10-pound loss of weight. In the past week he reported having one incident
of vomiting, and the vomitus was tinged with blood. His father died of stomach cancer,
and he became concerned when he saw the blood. He decides to come to a doctor (you).

 You are eliciting a “history of the present illness” that further defines his problem.
What questions would you like to ask HP and why? What does it mean to have
bloody vomitus - what kinds of problems would you be considering for a patient
with this kind of presentation?
In order to understand his present problem better, you need to understand his past

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medical history, his family history and his personal habits. What are the most
relevant questions that you would like to ask HP?

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 What features of the patient’s physical examination might be relevant?
 What are the risk factors for stomach cancer?

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What additional studies would you, the physician, like to order/? Why?
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On upper GI endoscopy, his esophagus appeared normal, but the gastric antrum appeared
red, flat, and irregularly granular in surface texture. There was an ulcer in the antrum that
had an irregular shape and a raised, bumpy border. The edges and center of the ulcer, the
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surrounding gastric antrum, the gastric body, the gastric cardia and the lower esophagus
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were biopsied.
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 What is a gastric ulcer?? What is the most common cause of a gastric ulcer?
 Is the endoscopic appearance of the ulcer significant? What most likely diagnosis
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of HP’s ulcer and why?

What is the red, granular mucosa adjacent to the tumor?
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 What do you expect each of the biopsies to show?
 What is the underlying cause of HP’s ulcer?
 How did the ulcer develop (what steps were involved and what causative factors
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contributed)?
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 What are your next steps in managing this patient?

You admit HP to the hospital for further workup. At the time of admission, his laboratory
results revealed anemia.
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 Why is the patient anemic?

 Are there any blood tests that could serve as confirmatory biomarkers for MK’s
cancer?
 What is a biomarker?

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  What other tests did you order? Why?
 Depending on the possible results of those tests, how would you proceed?

The work-up fails to reveal any evidence of distant metastatic spread.

 What treatment option is appropriate for HP?

HP undergoes a distal gastrectomy and lymphadenectomy. The proximal surgical

resection margin was sent for frozen section and showed intestinal metaplasia but no
cancer. The gastric stump was attached to the side of a loop of jejunum.

 What information do you need from the pathology report on the resection
specimen to understand his prognosis and plan the next step of HP’s
management?
 What are the possible consequences of HP’s surgery?
 What are his chances of surviving his cancer?

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Famous people who have died from stomach cancer: John Wayne, Napoleon, Sydney

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Pollack, Oscar Hammerstein, Patrick Henry, Enrico Fermi, James Balwin

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This study source was downloaded by 100000837401635 from CourseHero.com on 11-20-2021 23:55:28 GMT -06:00

https://www.coursehero.com/file/10960127/Case-Study-Stomach-cancer/
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