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Neck: no adenopathy. Abdomen: a 4 x 4 cm firm nodular slightly tender and movable mass in the epigastric region. Rest of abdomen non-tender. No mention of lymph nodes.
UGI: suggestive of carcinoma of the stomach. No size mentioned.
Chest: no active disease.
Alkaline phosphatase: within normal limits.
Palliative subtotal gastrectomy: large mass of carcinoma in distal stomach which seems to stop sharply at the pylorus. Tumor occupying approximately lower 1/3 of stomach. Umbilicated relatively good-sized metastasis in dome of liver, probably 4-5 cm in diameter. Regional nodal metastases and direct extension to the gastric antrum's adjacent omentum.
Stomach: irregularly shaped fungating lesion measuring 5.0 cm in greatest dimension. At one point erodes through serosa. Tumor has infiltrated laterally through the pylorus to involve the subserosa and muscularis of duodenum. Tumor present in lymphatics. Adenocarcinoma, poorly to moderately differentiated with penetration of serosa, metastases to lymph nodes of greater and lesser omentum.
Surgery: Subtotal gastrectomy
Chemotherapy: 5-FU with leucovorin and cisplatin