Virchow's Node — RACP Adult Medicine MCQ

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EasyGeneral Internal MedicineVirchow's NodeRACP Adult Medicine

A 60-year-old woman presents with a 3-month history of fatigue, weight loss, and a palpable left supraclavicular lymph node (Virchow's node). CT shows a gastric mass with peritoneal deposits. What does Virchow's node signify?

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Correct answer: E — Metastatic spread from an intra-abdominal malignancy via the thoracic duct

Virchow's node (left supraclavicular lymphadenopathy) classically represents metastatic spread from an intra-abdominal malignancy (most commonly gastric cancer, but also pancreatic, renal, and ovarian) via the thoracic duct. When associated with gastric cancer specifically, it is called Troisier's sign. Right supraclavicular lymphadenopathy is more commonly associated with intrathoracic malignancy (lung, oesophageal). Any unexplained supraclavicular lymphadenopathy in an adult warrants urgent investigation for malignancy.

Reference: Cancer Council Australia – 2021 – Gastric Cancer OCP