Medical History Physical Exam And Tests To Look For Bleeding
When taking your medical history, the doctor will ask about your symptoms and possible risk factors to see if they might suggest stomach cancer or another cause. The physical examcan give your doctor information about possible signs of stomach cancer or other health problems. In particular, the doctor will feel your belly for anything abnormal.
The doctor might order a blood test to look for anemia , which could be caused by the cancer bleeding into the stomach. A test might also be done to look for blood in your stool that can’t be seen by the naked eye, which could also be a sign of bleeding in the stomach.
If your doctor thinks you might have stomach cancer or another type of stomach problem, he or she will likely refer you to a gastroenterologist , who will examine you and might do further testing.
Gastric Cancer Is A Disease In Which Malignant 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 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 wall of the stomach is made up of 5 layers of tissue. From the innermost layer to the outermost layer, the layers of the stomach wall are: mucosa, submucosa, muscle, subserosa , and serosa. Gastric cancer begins in the mucosa 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:
How Is Stomach Cancer Diagnosed
Several different tests can be used to help diagnose stomach cancer.
- Radiologic tests like a CT scan, barium swallow and MRI can help identify a problem in the stomach if the tumor is large enough.
- An upper endoscopy is used to take a biopsy of the lesion to make the diagnosis or to detect early cancer before a mass is large enough to be seen on radiologic tests. An upper endoscopy is performed by inserting a thin tube with a tiny camera through the mouth and into the stomach, where biopsies are obtained from the tumor.
- To find out how much of the stomach wall a tumor involves and to help assess the stage of the cancer, a doctor will order an endoscopic ultrasound, which uses a special type of endoscope that has an ultrasound probe. The endoscope is placed in the stomach through the mouth. The ultrasound probe is able to look through the surface of the stomach lining to the stomach wall beyond and see how much of the stomach is involved by the tumor.
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Signs And Symptoms Of Stomach Cancer
Early-stage stomach cancer rarely causes symptoms. In countries where screening for stomach cancer is not routine, such as the United States, most stomach cancers arent found until theyve grown fairly large or have spread outside the stomach.
When stomach cancer does cause signs and symptoms, they can include:
- Poor appetite
- Vague discomfort in the abdomen, usually above the navel
- Feeling full after eating only a small meal
- Heartburn or indigestion
- Vomiting, with or without blood
- Swelling or fluid build-up in the abdomen
- Blood in the stool
- Feeling tired or weak, as a result of having too few red blood cells
- Yellowing of the skin and eyes , if the cancer spreads to the liver
Most of these symptoms are more likely to be caused by things other than stomach cancer, such as a viral infection or an ulcer. Some of these symptoms may also be caused by other types of cancer. But people who have any of these problems, especially if they dont go away or get worse, should see a doctor so the cause can be found and treated, if needed.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Ku GY, Ilson DH. Chapter 72: Cancer of the Stomach. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloffs Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier 2020.
Gastric Cancer: Diagnosis And Treatment Options
JOHN C. LAYKE, D.O. University of Illinois Metropolitan Group Hospitals, Chicago, Illinois
PETER P. LOPEZ, M.D. University of Miami School of Medicine, Miami, Florida
Am Fam Physician. 2004 Mar 1 69:1133-1141.
The overall incidence of gastric cancer in the United States has rapidly declined over the past 50 years. Gastric cancer is now 13th most common cause of cancer mortality in the United States, with an estimated 12,100 deaths in 2003.1 However, in developing countries, the incidence of gastric cancer is much higher and is second only to lung cancer in rates of mortality.
The typical patient with gastric cancer is male and between 40 and 70 years of age . Native Americans, Hispanic Americans, and blacks are twice as likely as whites to have gastric carcinoma.
Ninety-five percent of all malignant gastric tumors are adenocarcinomas the remaining 5 percent include lymphomas, stromal tumors, and other rare tumors.2 The overall declining incidence of gastric carcinoma is related to distal stomach tumors caused by Helicobacter pylori infection. Proximal stomach tumors of the cardiac region have actually increased in incidence in recent years.3 This trend has been attributed to the increased incidence of Barretts esophagus and its direct correlation with the development of esophageal adenocarci-noma.4 This review discusses diagnosis, treatment, and survival outcomes in patients with gastric adenocarcinoma.
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Why You Might Have A Gastroscopy
You might have a gastroscopy to find out the cause of symptoms such as:
- abnormal bleeding
- low levels of iron
- difficulty swallowing
If you have Barrett’s oesophagus you’ll have regular gastroscopies to check for any changes to cells in the lining of your food pipe.
During the test your endoscopist takes samples of any abnormal looking areas. They send the samples to the laboratory to be looked at under a microscope.
What Is The Prognosis For People Who Have Stomach Cancer
The outlook for stomach cancer depends on the stage of the cancer. People in the early stages of stomach cancer have a much greater rate of survival than those at a later stage:
- If stomach cancer is found in its earliest stage and can be removed with an endoscope, the five-year survival rate is higher than 90 percent.
- If the cancer is found after it has spread to areas surrounding the stomach, the five-year survival rate is 28 percent.
- If the cancer has spread to areas beyond those surrounding the stomach, the five-year survival rate is 4 percent.
Last reviewed by a Cleveland Clinic medical professional on 02/17/2019.
References
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Stomach Cancer Is On The Decline
The really good news is that this type of cancer is very rare in the United States, and its actually decreasing in incidence, says Dr. El-Hayek. Less than 2 percent of all new cancer diagnoses are from stomach cancer.
The main reason for the decrease in cases is probably that infections from Helicobacter pylori, a type of bacteria known more commonly as H. pylori, are being diagnosed earlier than they used to be, Dr. El-Hayek notes. H. pylori is believed to be one of the major causes of stomach cancer because it can cause chronic inflammation in your stomach lining, as well as ulcers.
Now that were making the diagnosis of H. pylori earlier when patients get symptoms, theyre treated with antibiotics, the infection is eradicated and the overall risk of stomach cancer is presumably decreased, Dr. El-Hayek says.
Although H. pylori infections are extremely common, many people dont ever have any symptoms. For those who do get symptoms, its normally this dull, achy pain after eating, says Dr. El-Hayek. You might also notice nausea, bloating, burping, weight loss and lack of appetite. If you experience any of these, Dr. El-Hayek recommends that you see your doctor for testing.
Common Body Scans For Detecting Cancer
Body scans fall into five categories: nuclear medicine, x-rays, magnetic resonance imaging , endoscopy and ultrasound.
Nuclear Medicine
Nuclear medicine uses radioactive isotopes to detect and diagnose cancers. Nuclear medicine lets a doctor observe the organs in action and helps them determine the location of the disease. Depending on the organ in question, you might ingest a radioactive substance , or have it injected into your veins for the scan. Cameras in the nuclear scanning machine will trace how much of the tracer is absorbed by certain areas of the body–more absorption can indicate the presence of cancer and the extent of it. Examples of common nuclear scans include the PET scan or the combined PET/CT scan.
X-rays
X-rays use electromagnetic energy to detect and diagnose problems in your body. Examples of x-ray technology include the standard x-ray, computed tomography , and mammograms. A standard x-ray works best on bone and other dense tissues, and is good for detecting bone cancers or tumors in the lungs. Advanced x-ray machines, like the CT scan or mammogram are good for detecting cancers in softer tissues, like the breasts.
Magnetic Resonance Imaging
The MRI uses magnets to detect and diagnose cancers. MRI scans can work on soft or dense tissue and are especially useful in viewing the spinal cord and brain.
Endoscopy
Ultrasound
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients 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 website.
How Can I Prevent Stomach Cancer
Treat stomach infections. If you have ulcers from an H. pylori infection, get treatment. Antibiotics can kill the bacteria, and other drugs will heal the sores in the lining of your stomach to cut your risk of cancer.
Eat healthy. Get more fresh fruits and vegetables on your plate every day. Theyâre high in fiber and in some vitamins that can lower your cancer risk. Avoid very salty, pickled, cured, or smoked foods like hot dogs, processed lunch meats, or smoked cheeses. Keep your weight at a healthy level, too. Being overweight or obese can also raise your risk of the disease.
Donât smoke. Your stomach cancer risk doubles if you use tobacco.
Watch aspirin or NSAID use. If you take daily aspirin to prevent heart problems or NSAID drugs for arthritis, talk to your doctor about how these drugs might affect your stomach.
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Upper Endoscopy With Biopsy
When doctors suspect stomach cancer, they may perform an upper endoscopy, which allows them to view the lining of the stomach. During this procedure, a doctor inserts an endoscopea thin, lighted tube with a tiny camera on the endinto the nose or mouth, through the esophagus, and into the stomach, as well as the first part of the small intestine. The procedure is performed using a sedative.
When the lining of the stomach looks suspicious, your doctor may perform a biopsy. This involves inserting small surgical tools through the endoscope to remove tissue samples to check for signs of cancer. A pathologist, a doctor who studies diseases in a laboratory, examines the biopsy samples to determine whether a person has adenocarcinoma and, if so, how aggressive it is.
Doctors may also test the stomach cells for excessive amounts of a protein called human epidermal growth factor receptor 2 on their surface. This protein helps a cancer grow. Sometimes, people with HER2-positive cancer may be candidates for targeted drug therapy.
Having The Test While Drowsy
You lie down on the couch.
Your nurse puts a small plastic tube into a vein in your arm. They then inject the sedative into the cannula. It takes a few minutes for you to get more relaxed, this makes you drowsy. You are still able to follow instructions from your endoscopist and nurse.
They give you oxygen through a small plastic tube with prongs that sit just inside your nostrils. They also put a clip on your finger to check your oxygen levels and heart rate.
Your endoscopist then passes the gastroscope down your throat.
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Patients May Want To Think About Taking Part In A Clinical Trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Stomach Cancer Screening In People At Increased Risk
The benefits of screening might outweigh the risks in some people who are at increased risk for stomach cancer because they have certain risk factors . For example, upper endoscopy might be recommended at regular intervals in these people.
If you have risk factors that might increase your risk of stomach cancer, talk to your doctor about the possible pros and cons of stomach cancer screening for you.
Screening isn’t usually recommended for people in families with hereditary diffuse gastric cancer . Instead, doctors often recommend that people who have changes in the CDH1 gene that causes this syndrome consider having their stomach removed , because their risk of stomach cancer is very high.
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Screening For Stomach Cancer
Unfortunately, theres no recommended screening test for spotting earlygastric cancer in the general population. However, Ngamruengphong saysdoctors use upper endoscopy to screen for and detect stomach cancer inpeople at high risk for developing the disease.
Theres no standard guideline on who to screen for stomach cancer, so webase screening recommendations on patients risk for developing thiscancer. Based on what we find, we determine how often patients shouldundergo follow-up screenings, she says.
Factors that Ngamruengphong considers when identifying at-risk patientsinclude:
- Ethnicity : First- and second-generation immigrants from East Asia, Russia and South America are considered higher risk. Those areas see more cases of stomach cancer than the United States.
- Family history : Having a family member with stomach cancer increases risk.
- Race : Non-Caucasians are at higher risk.
- Smoking history : Smoking increases the risk of stomach cancer.
- Physical health and genetics : Certain types of gastric infection and hereditary syndromes, such as Lynch syndrome and Peutz-Jeghers syndrome, also increase stomach cancer risk.
What Are The Different Types Of Stomach Cancer
Stomach cancer, also known as , is the name for a category of cancer. There are many different types of stomach cancer:
- Adenocarcinoma: Adenocarcinoma is the most common type of gastric cancer, comprising more than 90% of all stomach cancers. Carcinoma that occurs in the innermost lining of the stomach.
- : Cancer of the immune system that accounts for 4% of all stomach cancer, which is not from the mucosa of the stomach lining. It is broken up into primary and secondary lymphoma of the stomach.
- Primary lymphoma involves the stomach and can eventually affect the lymph nodes, bone marrow and other parts of the body.
- Secondary lymphoma initially involves other parts of the body, like circulating blood, lymph nodes, bone marrow and other organs. Secondarily, cancer spreads to the stomach.
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Tests That Examine The Stomach And Esophagus Are Used To Diagnose Gastric Cancer
The following tests and procedures may be used:
- Physical exam and health 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 patients 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 amount of a substance can be a sign of disease.
- Complete blood count : A procedure in which a sample of blood is drawn and checked for the following:
- The amount of hemoglobin in the red blood cells.
- The portion of the sample made up of red blood cells.