Early detection of Stomach/Gastric Cancer

Stomach Cancer or Gastric Cancer is cancer involving the part of gut where digestion commences. The stomach stores food for a while when acid and enzymes start the digestion process. Most of the patients with stomach cancer present late in diagnosis since the symptoms are not compelling enough early in the disease for patient to seek doctors advise.

These symptoms are often addressed as non-specific and patients continue to take Anta-acids or PPIs like Pantocid for long duration after consultation with their family/general physician. Other symptoms which include vomiting, loss of appetite/loss of weight which compels patients for evaluation.

The symptoms which call for urgent attention in these patients are usually:

• Progressive Weakness – This occurs if the patient continues to bleed from the ulcer/tumour in stomach and eventually his/her haemoglobin falls appreciably enough to produce symptoms of lethargy, weakness, low energy.
• Passage of black stools- Patients can miss noticing passage of blackish stools. However, the passage of black stools points towards bleeding from the foregut and is one of the common symptoms of gastric cancer.
• Anaemia- Patients of stomach cancer eventually develop anaemia due to progressive loss of blood over a period of time.
• Pain in upper abdomen – This occurs late in gastric cancer and is usually a manifestation of advanced stomach cancer infiltrating into other organs
• Persistent vomiting – Persistent vomiting occurs late in the disease when the tumour has blocked the food passage and not allowing food to pass distally. Food gets collected in stomach and is partially digested giving rise to symptoms of regurgitation and then vomiting, along with bad breath.
• Abdominal distension due to accumulation of fluid in abdomen, also called as ascites – this suggests that either the disease has spread to
• Significant weight loss –

Diagnosis of Gastric Cancer requires:

• Upper Gastrointestinal Scopy / Endoscopy – This procedure is done either under sedation or in awake state by a gastroenterologist. A tube with camera at its end is inserted through the mouth which is then negotiated through the food pipe to the stomach and into the first part of small intestine. A thorough inspection of the alimentary tract is done and biopsy is taken from any suspicious area examined.
• Biopsy – The tissue obtained during Endoscopy is sent for This biopsy is then tested in lab where a confirmatory diagnosis of cancer can be made.
• PET CECT – A PET scan combined with CECT helps to find out if the cancer has spread to different parts of the body or not. It also helps tells about the extent of stomach that will be needed to be removed to get rid of the tumour. The extent of nodes involved can also be estimated with any distant organ involvement. The clinical staging can be done on the basis of PET CECT findings.

The delay in diagnosis of Gastric cancer occurs due to several reasons:

• Non-specific symptoms like bloating, abdominal fullness can occur in other conditions like gastritis or gall stone disease and are not sever enough to compel the patient to seek attention in early stage.
• Unawareness regarding the symptoms which point towards gastric cancer/stomach cancer
• Not reaching the right Doctor – Most patients go through a number of other speciality doctors before finally reaching an Oncologist/Cancer specialist. All these delay can lead to progression of disease and hence upstaging the disease in the course. Occasionally such patient may be in a stage of disease when cure is not an option anymore.
• Denial in acceptance of a Diagnosis of Cancer – Cancer is grave disease, but with the newer modalities of management it is possible to get cured if diagnosed in time and treated timely at the right place.
• Looking for alternative treatment modalities which don’t have a scientific evidence for treatment. These kind of treatment prescribed by alternative medicine practitioner further lengthen the agony of the patient by causing the disease to progress and hence the patient ends up in terminal stage of the disease.

If the patient is diagnosed at an early stage the treatment includes removal of part or whole of stomach (Sub-total/partial gastrectomy or Total gastrectomy) depending on the part of stomach involved along with removal of draining lymph nodes and joining of food pipe to the rest of small intestine. The surgery takes place under general anaesthesia and takes around 3-5 hours depending on type of surgery. Post-surgery patient is not allowed orally for 3-7 days depending the type of surgery. If only a part of stomach is removal (Distal/Subtotal Radical Gastrectomy) then oral feeding resumes by post-operative day 3 and usually by day 7 in case of Total Gastrectomy. IN case of total gastrectomy feeding procedure either Naso-Jejunal tube placement or a Feeding jejunostomy is done to take care of nutritional need in the immediate post-operative period. We have routinely been performing these surgeries and have good long term results. Post recovery based on the final biopsy a stage is assigned and then need for adjuvant chemotherapy/ Chemo-radiation is assessed.