Answer 'a' i.e. Weightloss is commonest feature Symptoms of gastric cancer Earliest symptom is usually vague postprandial abdominal heaviness Most common symptom is weight loss Other symptoms are: - anorexia - abdominal pain (usually not severe) vomiting may be present and becomes a major feature if pyloric obstruction occurs. It may have coffee-ground colour due to bleeding by the tumor. - dysphagia may be the presenting symptom if the lesion is at the cardia. Paraneoplastic symptoms such as - Trousseau's syndrome (thrombophlebitis) - Acanthosis nigricans (hyperpigmentation of the axilla and groin) - Peripheral neuropathy Option b & c Spread of gastric carcinoma - intramural spread within the submucosa - direct spread through the gastric walls - lymphatic spread hematogenous - transperitoneal through peritoneal seedlings about option 'b' - I am not very sure, but it appears to be uncorrect. Most common secondaries are noted in intrabdominal and supraclavicular lymphnodes. Liver is the most common site for hematogenous spread of tumor (Harrison 16/e, p 525) Option 'd' - Barium meal is -75% sensitive for gastric cancer and is the simplest study to perform but it is not confirmatory. Endoscopy with biopsy is always needed if gastric Ca is suspected, to confirm the diagnosis. Harrison 16/e, p 526 writes - "Gastric adenocarcinoma is a relatively radioresistant tumor and adequate control of the primary tumor requires doses of external beam irradiation that exceeds the tolerance of surrounding structures, such as the bowel mucosa and the spinal cord. As a result, the major role of radiation therapy in patients has been palliation of pain."