Understanding Stomach Cancer -- Diagnosis and Treatment

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), and/or bumps (nodules) in or under the skin of the abdomen or rectum during a physical exam. But these generally indicate advanced cancer.

If you complain of vague symptoms such as indigestion, weight loss, nausea, vomiting, and loss of appetite, your doctor may order screening 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 diagnosis in order to stage the cancer.  To evaluate if the tumor has spread to the lymph nodes or other organs such as the liver, lungs or bone, the chest, abdomen, and pelvis are scanned. This test can also detect fluid in the abdomen (ascites) as well as abdominal and pelvic nodules.

Additional staging tests. In order to determine the severity of stomach cancer, other tests like a bone scan, PET scan, or endoscopic ultrasonography (EUS) 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, to remove 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. Stomach lymphomas, more often than adenocarcinomas, are treated by gastrectomy. Only about one-third of stomach cancer cases can be treated and cured surgically.
• Chemotherapy, which is the use of anticancer medications. This may be used before and/or after surgery and 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 operable (known as neo-adjuvant therapy).
• Radiation therapy, which is the use of ionizing X-rays to kill cancer cells and shrink tumors. This may be used with or without chemotherapy before and/or after surgery. It can also be used to relieve symptoms in those with localized cancer (cancer that hasn't spread to other parts of the body).
• A rare form of stomach cancer, called gastrointestinal stromal tumor (GIST), can often be treated with drugs that are molecules which inhibit enzymes the tumor cells need to grow.

If treated at an early stage before it spreads, stomach cancer is curable. 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, making it difficult to treat. Fewer than one in five patients diagnosed with stomach cancer that has spread to other organs or lymph nodes survives five years.