Single Best Answer (SBA) · Gastric Cancer
A 68-year-old man presents with epigastric discomfort, early satiety, anorexia and weight loss. Examination reveals a hard, enlarged left supraclavicular lymph node. In suspected gastric carcinoma, what is this node called and what does it signify?
Show answer and explanation
Answer: C. Virchow's node, indicating lymphatic (often advanced) spread
Lymphatic spread of gastric carcinoma: Virchow's node
An enlarged, hard left supraclavicular lymph node (Virchow's node) in a patient with suspected gastric cancer is Troisier's sign and indicates lymphatic spread, usually of advanced disease.
Signs of spread in gastric cancer
| Sign | Route / meaning |
|---|---|
| Virchow's node (left supraclavicular) | Lymphatic spread (Troisier's sign) |
| Sister Mary Joseph nodule (periumbilical) | Lymphatic/transperitoneal spread to umbilicus |
| Left axillary node (Irish node) | Lymphatic spread |
| Krukenberg tumour (enlarged ovary) | Transcoelomic spread |
| Ascites, enlarged nodular liver | Transcoelomic / bloodstream spread |
Why it matters
- A palpable abdominal mass is the commonest physical finding, but signs like Virchow's node indicate the disease has spread beyond locoregional confines.
- About 50% present with disease already beyond locoregional limits, and of locoregional cases only about half are resectable for cure.
Classic presentation
The classical triad is anorexia, asthenia and anaemia ('three A's'), often with weight loss and epigastric symptoms.
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