Most Common Presentation of Gastric Cancer
The correct answer is (c) vague abdominal pain and weight loss, as gastric cancer most commonly presents with non-specific symptoms including weight loss, dyspepsia, vomiting, and early satiety rather than acute dramatic presentations. 1
Clinical Presentation Pattern
The ESMO clinical practice guidelines explicitly state that in symptomatic patients, the presenting features commonly include weight loss, dysphagia, dyspepsia, vomiting, early satiety and/or iron-deficiency anaemia. 1 These are insidious, non-specific symptoms that develop gradually rather than acute emergencies.
Why Other Options Are Less Common:
Hematemesis and melena (option a): While gastrointestinal bleeding can occur, it is not the most common presentation. Iron-deficiency anemia from chronic occult bleeding is more typical than overt bleeding. 1, 2
Acute perforation (option b): This represents a complication of advanced disease, not a typical presenting feature. Most patients present with chronic symptoms before such acute events occur. 1
Epigastric mass (option d): A palpable abdominal mass indicates advanced disease and is a physical examination finding rather than a presenting symptom. 1 While it may be present on examination, patients typically report symptoms like weight loss and abdominal discomfort first.
Clinical Context
The majority of patients present with advanced disease and alarm symptoms such as weight loss, vomiting, and anorexia. 1 This reflects the insidious nature of gastric cancer, where vague symptoms delay diagnosis until the disease has progressed significantly.
Key Alarm Symptoms to Recognize:
- Weight loss (unexplained) 1, 2
- Dyspepsia (persistent indigestion) 1, 2
- Vomiting 1, 2
- Early satiety 1, 2
- Dysphagia 1, 2
- Iron-deficiency anemia 1, 2
Important Clinical Pitfall
Do not dismiss persistent dyspepsia as benign, especially in patients over 55 years with new-onset symptoms or those with risk factors. 1, 2 The subtle nature of gastric cancer symptoms means that clinicians must maintain a high index of suspicion, particularly when alarm features are present or when symptoms persist despite standard therapy.