Stomach cancer: symptoms, modern methods of diagnosis and therapy

Stomach cancer – a common oncological disease in which a malignant tumor grows from the epithelial cells of the gastric mucosa. It can form in any part of the organ, and in the process of its development it affects neighboring tissues and organs, such as the liver, lungs, etc. The highest incidence and mortality rates from stomach cancer have been recorded in Japan, Russia, Chile, Korea, and China. Often the disease is diagnosed in late stages (III-IV). The reason for this lies in late detection: there is no specialized national screening program for stomach cancer in our country, and often a visit to a doctor occurs when significant symptoms appear.

The risk of developing this type of cancer increases with age, the peak incidence is at 65 years of age, men get sick more often. In people under the age of 30, pathology is rarely detected.

There are risk factors that contribute to the development of stomach cancer. These include:

1. Heredity. About 10% of patients with stomach cancer report a family history, but a hereditary form of the disease can be established in 1–3% of cases.
2. Helicobacter pylori (H. Pylori). This bacterium causes peptic ulcers, chronic gastritis and increases the likelihood of developing a malignant tumor in the stomach.
3. Lifestyle, including smoking and nutritional factors (drinking alcohol, large amounts of salt, fried, pickled foods, etc.)
4. Background diseases: chronic atrophic hyperplastic gastritis, adenomatous polyps, pernicious anemia, conditions after gastrectomy, Ménétrier's disease, peptic ulcer.

Stomach cancer symptoms

In the early stages, stomach cancer may have no symptoms or symptoms may coincide with other diseases, for example, chronic stomach diseases. At this stage, diagnosis in most cases is incidental, when gastroscopy is performed in connection with other indications.

What symptoms suggest it is cancer:

• discomfort in the stomach, a feeling of heaviness and fullness in the upper part, excessively rapid saturation during meals - all these symptoms resemble gastritis, but may also indicate the presence of a tumor;
• severe abdominal pain, loss of appetite, weight loss, vomiting, development of anemia - all this indicates later stages of cancer;
• stomach bleeding may also indicate the development of a tumor.

The first symptoms and clinical picture of a tumor in different parts of the stomach may differ. Clinical manifestations depend on the stage and extent of the disease. As it worsens, the symptoms of stomach cancer become more pronounced: persistent pain in the stomach area that can radiate to the back, frequent heartburn, vomiting immediately after eating, an enlarged abdomen, a bulging formation in the pit of the stomach noticeable to the touch - this is a sign that the tumor has grown into the anterior wall of the abdominal cavity. Further, the symptoms worsen, black stools or black or bloody vomit appears due to gastric bleeding. From blood loss, the patient becomes pale and dizzy.

The problem with diagnosis is that the first signs of the disease are often ignored. Hidden course, disguise as other diseases of the gastrointestinal tract and rapid development lead to late diagnosis of the disease.

Benign epithelial tumors and pre-invasive processes of the stomach

Only a specialist knows well what cancer looks like and can distinguish malignant from benign with the help of examinations.

Benign formations include:

• Polyps. Most often found in elderly people and account for 90% of the total number of benign formations in the stomach. Determined by endoscopic examination. The shape of polyps can be varied, as well as their number and morphological structure. Despite the low risk of transformation into a malignant tumor, polyps are most often biopsied and removed.
• Adenomas. A separate type of polyp that develops in the epithelial tissue of the stomach. Most often, their appearance is accompanied by mucosal dysplasia, which leads to the development of symptoms such as heartburn, pain and nausea after eating. This condition is assessed as precancerous and requires surgical intervention.
• Dysplasia. This is a violation of the structure of tissue, deformation of cells and their structures. The degrees of dysplasia are distinguished. Mild can turn into medium, and that into severe. Severe dysplasia is considered a precancerous disease and is subject to serious monitoring and treatment.

Carcinomas are classified as malignant formations. There are many variants of the morphological structure of the tumor, which differ in the course of the disease and the necessary treatment.

Classification of stomach cancer

Without a correct classification of stomach cancer, it is impossible to choose the correct treatment tactics, type of operation, or life prognosis for the patient. Today, stomach cancer is classified according to many parameters:

• The site of origin of stomach cancer. Tumors are divided into groups according to localization in certain parts of the stomach: fundus, body, cardiac, pyloric and antral sections.
• Histological structure of the tumor. Treatment tactics for stomach cancer also largely depend on the histological structure of the tumor. Histological examination evaluates the type of tumor, the degree of malignancy, the degree of growth into the lining of the stomach, growth into adjacent tissues, etc. There are many histological types, the most common of which is adenocarcinoma, which develops from glandular cells of the mucous membrane.
• Tumor stage. This factor is also one of the key ones when choosing treatment tactics for stomach cancer and predicting the patient’s future fate. Stomach cancer can be early, when the malignant tumor covers only the mucous membrane, and advanced, when it grows into other layers. But a more accurate classification of stomach cancer by stage takes into account not only the depth of tumor germination, but the number of affected lymph nodes and the presence of distant metastases.

Diagnostic and treatment methods

The main method for diagnosing stomach cancer is fibrogastroscopy with tumor biopsy and histological (morphological) examination of the biopsy material. This is the only reliable and trustworthy method for the primary detection of malignant tumors in the stomach. During the study, the specialist evaluates the condition of the mucous membrane and also distinguishes tumors well.

Modern equipment makes it possible to conduct a study such as EDGS + endosonography (endo-ultrasound). For this, a miniature sensor is used that works through the side wall of the stomach. This method allows you to obtain more information about the already discovered formation: the depth of germination, the degree of spread.

To determine the stage of development and draw up a treatment plan for stomach cancer, a number of additional studies are needed:

• testing for Helicobacter pylori and eradication if detected
• radiography with contrast determines the level of damage to various organs of the gastrointestinal tract;
• computed tomography is used to search for metastases in both the chest and abdomen, and contrast is additionally used;
• Chest X-ray, ultrasound of the abdominal organs can diagnose metastases of the lungs, liver or lymph nodes, as well as determine whether the formation spreads to other organs, however, preference is given to CT with contrast as a more accurate diagnostic method;
• Ultrasound of the neck can exclude the occurrence of metastases in this area;
• positron emission tomography allows you to detect even the most distant metastases and identify all metastatic foci, incl. in the bones
• Bone scintigraphy is performed if bone damage is suspected;
• colonoscopy is performed to exclude intestinal tumors in patients over 50 years of age;
• Diagnostic laparoscopy is performed to determine the level of spread of the formation and the possibility of its removal.
• Determination of tumor markers CA-72-4, CEA, CA19-9 for dynamic control during treatment
• Molecular genetic testing to determine the tactics of drug therapy and identify hereditary syndromes.

What methods of therapy are used in modern clinics:

• Surgical removal of stomach cancer.
  • Endoscopic treatment of “early” gastric cancer.
  • Resection: removal of part of the stomach tissue. This method of intervention is not possible in every case; it is important to first conduct a full examination of the tumor and make sure that removal of the affected tissue will be sufficient.
  • Gastrectomy: complete removal of the stomach.
• Chemotherapy. Performed in combination with surgery (perioperative or adjuvant (postoperative)) to reduce the risk of disease progression. In case of an inoperable process, it is the main method of treatment.
• Targeted therapy is one of the most modern types of treatment. Blocks a protein that promotes the growth and reproduction of tumor cells.
• Immunotherapy. It is a series of drugs that allow you to direct your own immune system to destroy the tumor.
• Radiation therapy is prescribed in combination with other types of treatment. As a rule, in conjunction with chemotherapy and surgery. Its purpose is to reduce the severity of pain.
• Intraperitoneal hyperthermic chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPEC) are currently being conducted in clinical trials. These methods involve the introduction of chemotherapy drugs directly into the abdominal cavity to affect tumor cells in a widespread process.

Palliative care is not a treatment method, but a way to create more comfortable living conditions. Painkillers and cancer-inhibiting drugs are used. Only your doctor can give detailed recommendations for stomach cancer.

Why is it important to undergo timely diagnosis

Stomach cancer is dangerous due to its latent course and rapid development. Symptoms, which many mistakenly mistake for ordinary discomfort or a minor disorder, quickly give way to more threatening ones. At the same time, therapy for late stages of cancer is quite difficult, but at the initial stage, cancer is quite treatable.

In order to timely detect and effectively eliminate oncological pathology, it is recommended to undergo regular examinations and be observed by specialists if there is discomfort in the gastrointestinal tract.

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