Signs Of Stomach Cancer, Stages Of Gastric Cancer, Diagnosis and Treatment

Stomach or gastric cancer usually affects age group of 55-65 years. It is seen more in males. There is a hereditary tendency and an increased incidence of stomach cancer in those with blood group A.

Factors associated with increased risk for stomach cancer are-

  • High salt intake.
  • Exposure to alpha-toxins, nickel refining and rubber processing.
  • Living in areas with high nitrate content in the soil.
  • Chronic gastritis usually type-A.

Stages of Gastric Cancer

Nearly 95% of stomach cancers are adenocarcinomas.

The remaining includes lymphoma, leiomyosarcoma, carcinoid tumor, metastatic cancer and others.

Morphological type’s are

  1. Polypoid.
  2. Ulcerating.
  3. Ulcerating and infiltrating.
  4. Infiltrating.

Three most important prognostic variables are the depth of the tumor invasion and presence of metastasis.

By the TNM (tumor, node, and metastasis) classification 5 year survival rates vary from 70% fro stage I, 30% for stage II, 9% for stage III and 0.5% and 2% for stage IV.

Clinical Features of Stomach Cancer

Patient may present with the following symptoms

  • Epigastric discomfort, fullness or burning after heavy meal or belching.
  • Disturbance of appetite and nausea.
  • Decrease in appetite.
  • Recurrent bouts of nausea and vomiting.
  • Post-prandial distress simulating peptic ulcer.
  • Haematemesis (vomiting of blood) or malena (blood in stools) may be the first presenting symptom in some cases.
  • Slight dysphagia (difficulty in eating) after solid foods, cough induced by swallowing and regurgitation may occur if lesion is in lower esophagus.
  • Colonic symptoms include diarrhea due to rapid stomach emptying or even constipation and lower abdominal discomfort.
  • Patient may approach medical help with compliant of lump in abdomen.
  • Loss of weight and strength.
  • Anemia and pallor.
  • Symptoms due to metastasis- like ascites, jaundice, and pathological fractures.
  • Acute abdomen- rarely perforation of gastric carcinoma may be the first manifestation.

Signs of Stomach Cancer

Epigastric mass, jaundice, a left supra-clavicular node or ascites may be seen.

Physical signs almost invariably signify an incurable disease, with the exception of pyloric stenosis which may be caused by a relatively early cancer.

Diagnosis of Gastric Cancer

  1. Radiology: Double contrast studies are done to detect mucosal abnormalities due to neoplastic invasion/infiltration.
  2. Endoscopy: If barium meal results are equivocal, then brush cytology combined with biopsy with help of endoscopy helps confirming the diagnosis.
  3. CT-scan is often useful in staging of stomach cancer particularly for detecting hepatic and lymph node metastasis.

Treatment for Stomach Cancer

  • Radiotherapy is not frequently used as gastric adenocarcinoma is a relatively radio-resistant tumor. Therefore, radiation can help only in palliation of pain.
  • Chemotherapy has been used, however results are not encouraging. It has been used to down-stage locally advanced cancer prior to surgery.
  • Surgery remains the main treatment modality for cure and palliation.
  • In early cases, local gastric resection and in more advanced cases sub-total or total gastrectomy is the treatment of choice.