MBBS OSCE · General Surgery / Gastroenterology
OSCE — suspected gastric cancer with Virchow node
OSCE station on advanced gastric cancer presentation, metastatic eponyms, staging pathway including laparoscopy, and resectable vs palliative pathways with FLOT and D2 principles.
8 min stationVerification in progress
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Exam tags
NEET-PGINICETUSMLEPLAB
Brief (to candidate)
A 58-year-old man with early satiety, epigastric pain, and weight loss has a hard epigastric mass and a left supraclavicular node. Hb 8.8 g/dL. Assess and plan management in 8 minutes.
Candidate instructions
- Focused history (dyspepsia alarms, H. pylori, smoking, family/CDH1 clues).
- Examine for Virchow, SMJ nodule, ascites, DRE/Blumer if relevant.
- State stage implication of Virchow node.
- Outline investigation ladder including staging laparoscopy for potentially resectable cases.
- Contrast palliative systemic pathway vs D2 gastrectomy + perioperative FLOT for localised disease.
Examiner checklist
| Domain | Expected |
|---|---|
| Exam eponyms | Virchow/Troisier = stage IV; SMJ, Krukenberg, Blumer |
| Pathogenesis | Correa cascade; H. pylori Class I; Lauren types |
| Staging | OGD multi-biopsy; CT CAP; staging laparoscopy; HER2 |
| Curative path | Subtotal/total + D2; perioperative FLOT (not FOLFIRINOX) |
| Supportive | Nutrition; B12 lifelong after total gastrectomy |
| Communication | Honest prognosis; MDT; palliative care if metastatic |
Common errors
- Offering curative gastrectomy without staging out peritoneal disease.
- Naming mFOLFIRINOX as gastric adjuvant.
- Missing H. pylori eradication opportunity in earlier disease.
Model key actions
- Virchow node = stage IV until full staging; do not offer futile radical surgery without excluding peritoneal disease.
- OGD with multiple biopsies; CT CAP; staging laparoscopy for cT2+/equivocal M0.
- Resectable: perioperative FLOT + gastrectomy with spleen-preserving D2.
- Metastatic HER2+ may receive trastuzumab-containing systemic therapy; early nutrition and palliative care.
Communication points
- Explain need for endoscopy and staging before any operation.
- Discuss H. pylori as Class I carcinogen and eradication when residual stomach remains.
- Lifelong B12 after total gastrectomy; dumping diet education.
References3ShowHide
- [1]Sundar R, Nakayama I, Markar SR, et al. Gastric cancer. Lancet, 2025.PMID 40319897
- [3]Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol, 2010.PMID 20409751
- [2]Duan Y, Xu Y, Dou Y, et al. Helicobacter pylori and gastric cancer: mechanisms and new perspectives. Review, 2025.PMID 39849657