A 55-year-old man with carcinoma of the stomach is found to have a firm, non-tender enlarged node in the left supraclavicular fossa. Through which structure has the tumour reached this node?
- A Retrograde spread along the thoracic duct ✓
- B Transcoelomic seeding across the peritoneal cavity
- C Direct invasion through the diaphragmatic crura
- D Haematogenous spread via the portal vein to the lungs and then systemic circulation
Correct answer: A. Retrograde spread along the thoracic duct
Explanation
The left supraclavicular node (Virchow's node, Troisier's sign) is involved by retrograde extension of tumour along the thoracic duct, which drains abdominal lymph into the left subclavian vein region. Transcoelomic spread produces Krukenberg ovarian deposits and a Sister Mary Joseph umbilical nodule instead. Haematogenous spread goes to liver, lung, bone and brain, while direct invasion spreads to adjacent organs such as pancreas and transverse colon.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.