Stomach cancer: symptoms, diagnosis, stages, treatment and prevention

Stomach cancer, also known as gastric cancer, is a malignant condition that occurs when the cells in the inner lining of the stomach mutated. It is a very common cancer that predominantly affects those aged >40 years old.

Symptoms

Symptoms of stomach cancer vary. In some patients, there are no apparent clinical symptoms and the stomach cancer is incidentally detected in a gastroscopy examination. In those with symptoms, the common symptoms of stomach cancer include:

  • Epigastric pain, the pain in the upper abdomen is usually without an identifiable pattern;
  • Nausea and/or vomiting;
  • Bloating;
  • Loss of appetite;
  • Early satiety, meaning you feel full even after taking only small amounts of food;
  • Unintentional weight loss;
  • Lumps above the left collarbone.

Patients with metastatic stomach cancer may also show symptoms related to the metastasis site. For example, patients with stomach cancer metastasized to the brain develop symptoms as headache, blurry vision, or limb paralysis.

Diagnosis

Upper endoscopy is the most important diagnostic procedure that patients need to undertake in order to diagnose stomach cancer. The upper endoscopy is a medical procedure, in which your doctor will insert a thin tube that has a camera on its top into your stomach through your mouth to directly visualize the inside of your stomach. Additionally, this tube also enables your doctors to take a sample of the suspicious area and send it to the pathology lab for pathologic examination, which is deemed to be the “gold standard” for diagnosing stomach cancer.

Other tests may sometimes also be performed in patients who can not tolerate upper endoscopy, such as upper abdominal CT scans to see if your stomach lining is thickened or barium swallow, in which you need to drink a cup of barium to image your stomach. Both CT and barium swallow could only suggest stomach cancer, yet they are not definitive diagnoses.

Stages

Staging stomach cancer is critically important, because the treatment and life expectancy are heavily dependant upon stomach cancer stages. For example, life expectancy is longer in local stomach cancer than in distant and metastatic stomach cancer. To staging the stomach cancer, the following factors matter: Tumor (T), lymph node metastasis (N) and distant metastasis (M).

T0: cancer in situ.

T1: stomach cancer has grown into the inner layer of the wall of the stomach.

T2: stomach cancer has grown into the outer muscular layers of the wall of the stomach.

T3: stomach cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the serosa.

T4a: stomach cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has also grown into the serosa.

T4b: stomach cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into nearby organs or structures.

N0: No lymph node metastasis.

N1: stomach cancer has spread to only 1 to 2 lymph nodes.

N2: stomach cancer has spread to only 3 to 6 lymph nodes.

N3a: stomach cancer has spread to only 7 to 15 lymph nodes.

N3b:stomach cancer has spread to more than 7 lymph nodes.

M0: no distant metastasis.

M1: have distant metastasis.

Stage TNM
0 T0N0M0
IA T1N0M0
IB T1N1M0 or T2N0M0
IIA T1N2M0 or T2N1M0 or T3N0M0
IIB T1N3aM0 or T2N2M0 or T3N1M0 or T4aN0M0
IIIA T2N3aM0 or T3N2M0 or T4aN1M0 or T4aN2M0 or T4bN0M0
IIIB T1N3bM0 or T2N3bM0 or T3N3aM0 or T4aN3aM0 or
T4bN1M0 or T4bN2M0
IIIC T3N3bM0 or T4aN3bMo or T4bN3aM0 or T4bN3bM0
IV any T any N M1

The smaller the stage, the longer patents are able to survive. For example, stomach cancer patients with stage IA lives longer than those with IV. As you can see, as long as distant metastasis occurs, such as stomach cancer spreading to the brain, the patient will be classified as M1 and the stage would be IV.

Treatment

The most effective treatment for stomach cancer is surgery that removes a proportion of or the entire stomach, depending on the size and location of the tumor. Surgery is frequently impossible for patients with IIIB or IV stomach cancer. In this situation, doctors often recommend chemotherapy or radiation therapy. Some post-surgery patients also receive chemotherapy as an adjunct treatment for eradicating residual cancer cells. Docetaxel and Cisplatin are the most common chemotherapy drugs.

Doctors may also use supportive measures to relieve the pain and vomiting.

Targeted drugs may work in some cases when standard chemo drugs don’t.

  • Trastuzumab (Herceptin) is effective in tumors with increased levels of HER2.
  • Ramucirumab (Cyramza®) is used to slow or stop the growth and spread of the cancer, most often after another drug stops working.
  • Imatinib (Gleevec), Sunitinib (Sutent) and Regorafenib (Stivarga) are approved for a rare form of stomach cancer called gastrointestinal stromal tumor.


Prevention

  1. Treat H. pylori infection. The H. pylori infection can lead to stomach cancer.
  2. Have a heathy diet, eat less salty and processed foods, eat more fresh vegetables and fruits.
  3. Quit smoking if you can.
  4. Exercise regularly to boost your immunity.
  5. Take screening since age 40.
* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.