What Are The Signs And Symptoms Of Stomach Cancer?

  • Passant TarekMasters of International Public Health Liverpool John Moores University (LJMU) - UK
  • Shajrat MirMaster's Degree, Biotechnology Engineering, International Islamic University Malaysia
  • Kunashe Blessing GonyeBSc in Neuroscience, University College London, UK

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Overview

Stomach cancer, also known as gastric cancer, is one of the most widely spread types of cancer and is considered the third most common cause for death around the world. There are many types of stomach cancers including adenocarcinomas, which account for about 95% of cases and arises in the cells of the stomach lining and rarer forms including lymphoma of the stomach (arises in the lymphatic tissue), and gastrointestinal stromal tumours (developing in the connective tissue of the stomach).

There are many risk factors that contribute to the spread and pathogenesis of gastric cancer including:

  • Genetic factors and syndromes: DNA aneuploidy, oncogene mutation, allelic loss of tumour suppressor genes, familial adenomatous polyposis, Menetrier’s Disease, Peutz-Jeghers syndrome, Li–Fraumeni syndrome
  • Dietary factors: high intake of salted, pickled, or smoked foods, low intake of fruits and vegetables
  • Excessive consumption of alcohol and tobacco
  • Helicobacter pylori infection

Importance of knowing the signs and symptoms of stomach cancer

Early diagnosis of cancer cases usually provides better prognosis, meaning that the forecast of how the disease will progress will be more accurate. However, with stomach cancer cases, this can be difficult as its symptoms can be mistaken with those of other medical conditions. For instance, the symptoms of early stage cancer are identical to those of benign dyspepsia, (include examples of symptoms). 

The alarming symptoms of stomach cancer tend to appear at the end stages which are related to gastro-intestinal bleeding or blood in stools. On the other hand, symptoms like bloating, pain or discomfort are not a direct indication of malignancy because they are related to many other diseases. 

The guidelines recommend performing proper laboratory investigations even for patients who are suffering simple acidic suppression. The British Society of Gastroenterology recommended patients over 45 years suffering from dyspepsia to perform endoscopy for investigations, while those who are under 45 perform endoscopy just in cases where symptoms or signs suggest the presence of malignancy.

Signs and symptoms of stomach cancer

There are several laboratory tests that can help in achieving proper diagnosis of gastric cancer including: Complete blood count (CBC), Esophagogastroduodenoscopy (EGD) with biopsy, stool test to check for blood in the stools. Flexible spectral imaging color enhancement (FICE) is an endoscopic technique that was developed to enhance the capillary and the pit patterns of the gastric mucosa. FICE technology is based on the selection of spectral transmittance with a dedicated wavelength. 

Chromo-endoscopy is another diagnostic way that is beneficial in determining the extent of lateral tumour.

Multiple changes may take place in the morphology and color of the mucosa, especially in the case of early gastric cancer, including mild elevation and shallow depression of the mucosa with an uneven surface. When the mucosa appears to have a pale red or fading colour, it indicates an advanced stage of the disease.

Early symptoms and treatment

As discussed earlier, it’s rare to diagnose stomach cancer in the early stages. Only 5% of the gastric carcinoma cases in Western countries can be diagnosed earlier, prior to cancer penetration of the full thickness of the stomach wall or even before metastasis. 

Early gastric cancer is a term that usually points out the extent of the invasion of the gastric cells, but it doesn’t necessarily mean that it started a short time ago. The tumour at this stage is usually limited to the mucosa or submucosa and will not include the muscles or the muscularis propria. These cases show a 5 year survival rate of 90%, irrespective of whether or not nodal disease is present. 

In Japan, endoscopists were able to diagnose more than 50% of early gastric cancer cases, which led to better prognosis and increased the percentage of survival. However, in other countries, such as… health professionals were able to diagnose only 10% of the cases suffering from gastric cancer. Diagnosing gastric cancer at an early stage is rare in western countries. This may be due to a lack of experience or diligence of the endoscopists in the West compared to those in Japan. 

A great approach is the prescription of proton pump inhibitors that heal malignant ulcers and decrease the symptoms, thus leading to impossible identification of the disease clinically and endoscopically. Most of the early gastric cancer cases in the Western region can be identified only after performing a surgical resection.

Abdominal or epigastric pain occurs in approximately 80% of the cases, and it is identical to the pain from a benign gastric ulcer. If this pain is a result of obstruction of the gastric lumen, it may get better by vomiting. Most of the patients with early gastric cancer are found to be either asymptomatic or complain of non-specific upper abdominal pain, which is mostly diagnosed as ‘dyspepsia’. Dyspeptic symptoms account for approximately 40% of the population suffering from abdominal pain and thus cannot be reliable in gastric cancer diagnosis. Early symptoms usually include:

  • Indigestion and heartburn
  • Abdominal pain or discomfort
  • Nausea and vomiting
  • Bloating
  • Loss of appetite

In the early stages, ‘Upper Endoscopy’ is the treatment of choice because the cancer is limited to the stomach's superficial layers, so removal through this technique is possible. Either endoscopic submucosal dissection or endoscopic mucosal dissection can be performed.

Advanced symptoms and treatments

Symptoms may include the following:

  • Blood in stool
  • Difficulty swallowing
  • Fatigue and weakness
  • Jaundice
  • Ascites

Symptoms of patients suffering from gastric cancer usually appear after developing advanced stages with either local or distant metastases. Common presenting findings include epigastric pain, bloating, or a palpable epigastric mass. Sometimes, patients may suffer from upper gastrointestinal bleeding, which occurs as a result of increased ulceration related to the treatment. More advanced cases can include symptoms such as anorexia, weight loss, jaundice, ascites, and hepatic enlargement.

At the advanced stages, where the tumour invades beyond the stomach's superficial layers, patients may need surgery to remove all or part of their stomach, which is called gastrectomy. There are two types of gastrectomy. ‘Subtotal gastrectomy’, in which part of your stomach is affected by the cancer and is removed, while the other is called ‘Total gastrectomy’ which removes your entire stomach. In the operation, the health professionals usually connect the esophagus to your small intestine so that you can still eat.

Summary

Cure is always better than prevention. Despite the fact that people cannot prevent cancer, they can decrease the risk towards developing the cases or even reaching an uncurable stage. This can be done through following simple precautions, such as: 

Treatment of H. pylori infection in case the pastiest test was positive. 

Treat ulcers, gastritis, and other stomach conditions promptly. Untreated stomach conditions, especially those caused by H. pylori bacteria, increase your risk of stomach cancer.

Eating a healthy diet which is rich in fruits and vegetables, with reduced amounts of salt and red meat may decrease the risk of stomach cancer and maintain a healthy weight. Also, you should eat foods high in vitamin C, beta-carotene, and carotenoids, such as citrus fruits, leafy green vegetables, and carrots, which are good sources of key nutrients. 

References

  1. Maconi G, Manes G, Porro GB. Role of symptoms in diagnosis and outcome of gastric cancer. World J Gastroenterol. 2008 Feb 28;14(8):1149-55.
  2. Axon, A. Symptoms and diagnosis of gastric cancer at an early curable stage. Best Practice & Research Clinical Gastroenterology. 2003; 20(4), 697–708.
  3. Tan YK, Fielding JW. Early diagnosis of early gastric cancer. Eur J Gastroenterol Hepatol. 2006 Aug;18(8):821-9.-Zali H, Rezaei-Tavirani M, Azodi M. Gastric cancer: prevention, risk factors and treatment. Gastroenterol Hepatol Bed Bench. 2011 Fall;4(4):175-85.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Passant Tarek

Masters of International Public Health Liverpool John Moores University (LJMU) - UK

Masters of Dental sciences - SCU- Egypt

Passant is a Dentist and Healthcare professional with strong focus on public health and improvement of health outcomes through research and evidence-based practice. She has more than 10 years of diverse healthcare experience in different sectors. Currently, she is a blogger at the Swedish Organization of Global Health, in addition to being a united nations volunteer at the UNDP at the Department of Health and Development working towards improving different health investment cases.

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