How does gastric carcinoma present, and what is the classical triad?

It often presents late. The classical triad is anorexia, asthenia (weakness), and anaemia. Other features: epigastric pain/dyspepsia, weight loss, occult GI bleeding, vomiting, early satiety, and dysphagia with proximal tumours.

Clinical relevance. Recognising the often-vague presentation prompts the early endoscopy that improves the chance of cure.

More Detail

Presentation of gastric carcinoma

Gastric cancer frequently presents late because early symptoms are vague and overlap with benign dyspepsia.

Classical triad

• Anorexia
• Asthenia (weakness/fatigue)
• Anaemia (from occult blood loss)

Common symptoms

• Epigastric pain or persistent dyspepsia, weight loss, early satiety, nausea/vomiting.
• Occult GI bleeding is very common; overt bleeding in under 20%.
• Dysphagia with proximal (cardia) tumours.

Less common

• Pseudoachalasia (if the myenteric plexus is involved), colonic obstruction or gastro-colic fistula from direct spread.

Why it matters

About half present with disease beyond locoregional confines, and of locoregional cases only about half are resectable for cure - so new dyspepsia with alarm features in an older patient warrants prompt endoscopy.