A Case of Adenocarcinoma of Stomach

Adenocarcinoma of stomach- A Short Description.

Synonyms- Gastric adenocarcinoma.

 Age- Peaks in the 60's.

 Sex - Slight male predominance.

Anatomic Location- Anywhere in stomach.

Clinical Information- If symptomatic, usually pain and weight loss.

Gross Appearance- Variable. May present as ulcer, exophytic mass or as diffuse infiltration of stomach wall (linitis plastica).

Histology

Cytologically malignant glands or papillary structures extending into submucosa with desmoplastic response. May have abundant mucin (colloid type) or signet ring cells (see related lesion entry for Adenocarcinoma of stomach signet-ring cell type). Grading based on degree of gland formation. May grow in nodules with pushing border (expanding type) or infiltrate in small glands and single cells (diffuse type). Adenocarcinomas arising in Barrett's esophagus are similar.

Behaviour

Prognosis is related to clinical stage. Majority of cancers present in late stage, hence there is an overall poor prognosis.

CASE STUDY 

[Scanned images of the pre and post treatment reports of the patient sent by the author are with the Editor, but could not be displayed due to unavailability of space. Anyone who is interested in the details can contact the author or the editor at info@homeorizon.com]

Name: Mr. Virender Singh Yadav Sex/Age: M 47 yrs     

Religion: Hindu                             

Marital status: Married

Occupation: Police Inspector

History of Presenting Illness

The gentleman presented with six months' standing severe episodes of colicky pain in epigastrium, which extends to the back and accompanied by vomiting of sour taste. Vomiting does not ameliorate. Severe heart burn and sour eructations.  No thirst. Sleep normal. Condition worse only in day time. Anorexia. Weak, emaciated.

Past History

Alcohol and tobacco.

Family History

Mother died of carcinoma breast two years ago.

Patient as a Person

Appearance:                              Emaciated

Skin:                                                    Normal

Appetite:                                            Anorexia

Cravings:                                           Alcohol, Tobacco, Salt

Aversion:                                           Sweets

Thirst:                                                 Thirst less

Thermally                                          Hot

Emotional State                               Irritable, depressed, sad.

Temperature                                     Normal

Pulse                                                  72 /Min.

Respiratory rate                               16 /Min.

Blood pressure                                 140/92 mm Hg

Weight                                               56 kg

Systemic examination

Respiratory system                         NAD

Cardiovascular system                  S 1- S2 Normally Heard, no murmurs

Local examination                           Tenderness at epigastrium

Investigations

Biopsy at Malhotra Lab Services, chandigarh (on 14-11-2003) reported as "Biopsy stomach- the biopsy is highly suspicious of malignancy" - Adenocarcinoma?

Biopsy at AIIMS New Delhi on 09-12-2003 reported as "Biopsy from growth in the stomach shows features of an Adenocarcinoma"

Spiral NCCT & CECT, Whole abdomen at ADS Diagnostic Centre, New Delhi on 06-12-2003 shows "Diffuse infiltrating thickening of gastric wall in fundus body - the possibility of gastric adenocarcinoma needs to be ruled out."                                               

Provisional Diagnosis

Gastric Adenocarcinoma

Constitutional Totality

Mentals                                           Irritability , sad, depressed.

Desires                                     Salt, Alcohol, tobacco

Aversion                                   Sweets

Food Aggravation                      None

Physical Generals                      Emaciation, cachexia

                                                Hot Patient

                                                Day time aggravation.

Acute Totality

Burning, colicky pain at epigastrium, < day time, Better night, Accompanied with vomiting which does not ameliorate, Pain extending to back.

Miasmatic Totality

Fundamental miasm                       Syphilis

Dominant miasm                             Psora++

(Irritability, colicky pain, desire alcohol, tobacco etc.)

                                                            Syphilis+++

(Emaciation, Tissue Destruction, Ulcerations, irritability)

Sycosis+++ (Day time aggravation, Aversion sweets, Irritability, severe pains, adenoid growth etc.)

General Management

High protein diet.

Specific Management

Strict control on diet. No alcohol or tobacco.

Case Analysis

Virender Singh Yadav M 47   Adenocarcinoma Stomach

Prominence  -  Prominence  -  Intensity is considered

First Prescription

Date 11-12-2003      Nux vom 200 HS,    Sac Lac TDS

Criteria:

• General symptoms matched.

• Mental and Physicals similar.

• Desires and aversions matched.

Second Prescription

Comment: Mentally cheerful. Little improvement.

Date: 20-12-2003  Causticum 30 TDS

Criteria: Most of the symptoms gone except Heart burn.

Third Prescription

Comment: Much improvement

Date: 03-01-2004 Causticum 30 TDS                                   

Criteria: Case improving rapidly. Weight gain of three Kgs.

Fourth Prescription

Comment: Much better. No pains.

Date: 11-01-2004 Causticum 30 TDS

Criteria: Better in all respects.

Adv. Biopsy

Fifth Prescription

Comment: Biopsy done at AIIMS on 17-01-2004. Report- Specimen sent as omental deposit and mesenteric deposit both show fibroadipose with focal dermic inflammation. No tumor deposit is identified in either of the specimens.

Date: 20-01-2004 Sac Lac TDS

Criteria: Asymptomatic. Improved.

Sixth Prescription

Comment: Symptom less. Cheerful.

Date: 19-02-2004 Sac Lac TDS                              

Criteria : No pain or more symptoms.

Seventh Prescription

Comment: Much better. No pains. But had tension if he may have some more disease remaining in stomach.

Date : 20-03-2004  Causticum 30 TDS

Criteria : Suspicious. Anxious about healh.

Adv. Biopsy

Eighth Prescription

Comment : Biopsy done at SRL Ranbaxy Lab, Mumbai on 24-03-2004. Report- Gastric biopsy from antrum. No specific diagnostic pathology, inflammatory or neoplastic.

Date: 30-03-2004  Sac Lac TDS                                        

Criteria : Margins are free of tumor.                                    

Result - Marked Improvement