Review Question - QID 101066

This patient's presentation of epigastric pain, unintentional weight loss, and a diet heavy in smoked meat/fish is most consistent with gastric (stomach) cancer. Stomach cancer may be treated with a total gastrectomy, which would result in intrinsic factor deficiency and malabsorption of vitamin B12 (cobalamin).

Stomach cancer (almost always adenocarcinoma) can present with varied symptoms, including weight loss, epigastric pain, heartburn, anorexia, or nausea/vomiting. A diet heavy in salted/smoked meat/fish and Helicobacter pylori infection are two important risk factors for the development of this malignancy. Treatment with total gastrectomy results in loss of intrinsic factor and subsequent malabsorption of B12. This can lead to megaloblastic anemia known as pernicious anemia. Acanthosis nigricans may also be present.

Figure A is an example of acanthosis nigricans, a brown/black poorly defined hyperpigmentation of the skin, which may be present with gastric cancer.

Incorrect Answers:
Answer 2: Increased prothrombin time results from loss of clotting factors as seen in cirrhosis of the liver.

Answer 3: Acute cellular rejection may result following organ transplant. Organ transplant is not the most appropriate treatment for this patient.

Answer 4: Diabetes can result from the destruction of the insulin-producing beta cells in pancreatic islets. It can also present with acanthosis nigricans, but is otherwise inconsistent with this patient's presentation.

Answer 5: Esophageal squamous cell carcinoma is most commonly associated with smoking. It would not result from surgical treatment of gastric cancer.