Stomach Cancer?

How Do I Know If I Have Stomach Cancer?

Your doctor may identify signs of stomach cancer, such as enlarged lymph nodes or liver, increased fluid in the abdomen (ascites), or bumps (nodules) in or under the skin of the abdomen or rectum during a physical exam. These signs typically indicate an advanced cancer.

If you complain of vague symptoms such as persistent indigestion, pain, difficulty swallowing, weight loss, nausea, vomiting, and loss of appetite, your doctor should order tests. These include:

Upper GI series. These are X-rays of the esophagus (food tube) and stomach, which is called the upper gastrointestinal (GI) tract. You drink a barium solution, which outlines the stomach on the X-ray, helping the doctor find tumors or other abnormalities.

Endoscopy and biopsy. This test examines the esophagus and stomach using a thin, lighted tube called an endoscope, which is passed through the mouth to the stomach. Through the endoscope, the doctor can look directly at the inside of your stomach. If an abnormal area is found, the doctor will remove some tissue to be examined under a microscope (called a biopsy). A biopsy is the only sure way to diagnose cancer. Endoscopy and biopsy are the best methods of identifying stomach cancer.

CT scan. A computed tomography (CT) scan can give your doctor detailed pictures of structures inside of the body using X-rays. This test is used after a stomach cancer is diagnosed in order to determine the stage of the cancer. To evaluate whether the tumor has spread to the lymph nodes or other organs, the chest, abdomen, and pelvis are scanned. The CT scan can also detect fluid in the abdomen (ascites) as well as abdominal and pelvic nodules.

Endoscopic ultrasound. This test can determine the depth of invasion of the tumor and evaluate lymph nodes around the cancer.

Additional staging tests. In order to determine the severity of stomach cancer, other tests such as a bone scan, PET scan, or laparoscopy may be performed.

What Are the Treatments for Stomach Cancer?

Treatments for stomach cancer may include one or more of the following:

  • Surgery, called gastrectomy, removes all or part of the stomach, as well as some of the tissue surrounding the stomach. Lymph nodes near the stomach are also removed and biopsied to check for cancer cells. Only about one-third of stomach cancer cases can be treated surgically.
  • Chemotherapy is the use of anticancer drugs. This may be used before and after surgery or for cancers that have spread to other organs. Prior to surgery, chemotherapy —  with or without radiation — is sometimes used to shrink the tumor or to make an inoperable tumor suitable for surgery (known as neo-adjuvant therapy).
  • Radiation therapy is the use of ionizing X-rays to kill cancer cells and shrink tumors. This is used with chemotherapy before or after surgery and sometimes both. It can also be used to relieve symptoms in those with localized cancer (cancer that hasn’t spread to other parts of the body) or to relieve localized symptoms in persons whose cancer has metastasized (spread to another part of the body).

If treated at an early stage before it spreads, stomach cancer may be associated with a long survival. A patient whose tumor is removed completely has a good chance of surviving at least five years. Unfortunately, by the time most cases of stomach cancer are diagnosed, the cancer has spread to local lymph nodes or other organs. Fewer than one in five patients diagnosed with stomach cancer that has spread to other organs or lymph nodes will survive five years.

General Information About Gastric Cancer

Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach.

The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. Food moves from the throat to the stomach through a hollow, muscular tube called the esophagus. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.

The stomach and esophagus are part of the upper digestive system.

The wall of the stomach is made up of 3 layers of tissue: the mucosal (innermost) layer, the muscularis (middle) layer, and the serosal (outermost) layer. Gastric cancer begins in the cells lining the mucosal layer and spreads through the outer layers as it grows.

Stromal tumors of the stomach begin in supporting connective tissue and are treated differently from gastric cancer. See the PDQ summary on Gastrointestinal Stromal Tumors Treatment for more information.

For more information about cancers of the stomach, see the following PDQ summaries:

  • Unusual Cancers of Childhood
  • Stomach (Gastric) Cancer Prevention
  • Stomach (Gastric) Cancer Screening

Age, diet, and stomach disease can affect the risk of developing gastric cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for gastric cancer include the following:

  • Having any of the following medical conditions:
    • Helicobacter pylori (H. pylori) infection of the stomach.
    • Chronicgastritis (inflammation of the stomach).
    • Pernicious anemia.
    • Intestinalmetaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
    • Familial adenomatous polyposis (FAP) or gastricpolyps.
  • Eating a diet high in salted, smoked foods and low in fruits and vegetables.
  • Eating foods that have not been prepared or stored properly.
  • Being older or male.
  • Smoking cigarettes.
  • Having a mother, father, sister, or brother who has had stomach cancer.

Possible signs of gastric cancer include indigestion and stomach discomfort or pain.

These and other symptoms may be caused by gastric cancer. Other conditions may cause the same symptoms.

In the early stages of gastric cancer, the following symptoms may occur:

  • Indigestion and stomach discomfort.
  • A bloated feeling after eating.
  • Mild nausea.
  • Loss of appetite.
  • Heartburn.

In more advanced stages of gastric cancer, the following symptoms may occur:

  • Blood in the stool.
  • Vomiting.
  • Weight loss for no known reason.
  • Stomach pain.
  • Jaundice (yellowing of eyes and skin).
  • Ascites (build-up of fluid in the abdomen).
  • Trouble swallowing.

A doctor should be consulted if any of these problems occur.

Tests that examine the stomach and esophagus are used to detect (find) and diagnose gastric cancer.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.
  • Upper endoscopy: A procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus.Upper endoscopy. A thin, lighted tube is inserted through the mouth to look for abnormal areas in the esophagus, stomach, and first part of the small intestine.
  • Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
  • Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.Barium swallow for stomach cancer. The patient swallows barium liquid and it flows through the esophagus and into the stomach. X-rays are taken to look for abnormal areas.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy of the stomach is usually done during the endoscopy.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body).
  • The patient’s general health.

When gastric cancer is found very early, there is a better chance of recovery. Gastric cancer is often in an advanced stage when it is diagnosed. At later stages, gastric cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the NCI Web site.

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