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Stomach cancer

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From MayoClinic.com


When to seek medical advice

Stomach cancer is treatable if caught early. Unfortunately, it rarely causes symptoms in the beginning stages. When symptoms do occur, they're often vague and can easily be mistaken for other, less serious problems such as a stomach virus or acid reflux.

See your doctor if you have a persistent feeling of discomfort in the upper or middle region of your abdomen, especially if it occurs in conjunction with fatigue and weight loss.

And see your doctor right away if you develop black, tarry stools or if you vomit after meals. Although not always indicative of stomach cancer, these signs may result from other conditions that require medical care.

Screening and diagnosis

Stomach cancer produces symptoms that can be similar to those of ulcers, pancreatic cancer and mesenteric ischemia — a condition that occurs when you have diminished blood flow to your intestine. To help diagnose stomach cancer and rule out other possibilities, your doctor may recommend one or more of the following diagnostic tests:

  • Fecal occult blood test. This noninvasive test checks for hidden (occult) blood in your stool. Although microscopic bleeding is often one of the first signs of stomach cancer, it can also indicate a number of other problems.

  • Upper endoscopy. This procedure allows your doctor to see abnormalities in your upper gastrointestinal (GI) tract that may not be visible on X-rays. For the test, your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus, stomach and the first part of your small intestine. Your throat is usually numbed before you're asked to swallow the endoscope, and you'll receive additional medication to ensure that you're comfortable during the procedure. If any tissue in your upper intestinal tract looks suspicious, your doctor can remove a small sample (biopsy) using instruments inserted through the endoscope. The sample is then sent to a lab for examination by a pathologist. Upper endoscopy takes about 20 to 30 minutes, although you won't be sent home until the medication wears off — usually one to two hours later. Risks of the procedure are rare and include bleeding and perforation of the stomach lining. The most common complication is a slight sore throat from swallowing the endoscope.

  • Stomach X-ray (barium upper GI series). This test uses a series of X-rays to examine your esophagus, your stomach and the first part of your small intestine. Before the test, you'll drink a thick liquid (barium) that temporarily coats the lining of your stomach so that it shows up clearly on the X-rays. You may also be asked to swallow a gas-producing liquid or pill, such as sodium bicarbonate, which stretches the stomach and separates its folds, thereby providing a better view of the inner lining. After the test you can eat normally and resume your usual activities, although you'll need to drink extra water to help flush the barium from your system. The most common complication of the procedure is temporary constipation.

If you receive a diagnosis of stomach cancer, your doctor is likely to recommend additional tests to help determine the extent of the disease (staging tests) and the best course of treatment. These may include:

  • Endoscopic ultrasound. This test, which isn't universally available, helps determine whether cancer has spread into the walls of your stomach or to nearby tissues and lymph nodes. Endoscopic ultrasound is similar to upper endoscopy, but in this case, the endoscope carries a small ultrasound probe that uses high-frequency sound waves to create images of your stomach and surrounding tissues, including lymph nodes.

  • Computerized tomography (CT) scan. Used to help check for the spread of cancer outside the stomach — especially to organs such as the liver and lungs — this test uses split-second computer processing and X-ray beams to produce detailed cross-sectional images of your internal organs. A CT scan exposes you to more radiation than conventional X-rays do, but in most cases, the benefits outweigh the risks.

  • Magnetic resonance imaging (MRI). This test also looks for the spread of cancer beyond your stomach. But unlike a CT scan, MRI uses a powerful magnetic field and radio waves — not X-rays — to produce cross-sectional images of your body.

  • Chest X-ray. This test checks whether cancer has spread to your lungs.


Stomach cancer can lead to severe weight loss and to the accumulation of fluid in your abdomen (ascites). But the most serious complication of the disease is the spread of cancer cells to the lymph nodes and to organs such as the liver, pancreas and colon.


The kind of treatment you receive for stomach cancer depends on a number of factors, including the location of the cancer, how advanced it is, your overall health and your own preferences. Especially when cancer is advanced, choosing a treatment plan is a major decision, and it's important to take time to evaluate your choices.

You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you're considering.

The goal of any treatment is always to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.

Treatment options include the following:

  • Surgery. This is the most common treatment for stomach cancer. Depending on the extent of the cancer, your doctor may remove part (subtotal, or partial, gastrectomy) or all (total gastrectomy) of your stomach as well as some of the surrounding tissue. Lymph nodes near the tumor are also often removed during surgery. After a subtotal gastrectomy, the remaining part of your stomach is connected to your esophagus and your small intestine. If your entire stomach is removed, your surgeon attaches your esophagus directly to your small intestine. When stomach cancer is caught at an early stage and your surgeon is able to remove the entire tumor, a complete recovery is possible. Unfortunately, diagnosis usually doesn't occur until stomach cancer has spread through the stomach wall to nearby lymph nodes or other organs. At this point, it's not possible to remove all the cancer surgically, but your doctor may still recommend an operation to alleviate pain, intractable bleeding or obstruction. In some cases of advanced stomach cancer, a laser beam directed through an endoscope can vaporize most of the tumor and relieve obstruction without surgery. After gastrectomy, some people experience leakage or obstruction where the intestinal tract has been reconstructed. More common problems associated with partial or total gastrectomy include diarrhea, vomiting and dumping syndrome, which occurs when the small intestine fills too quickly with undigested food. Symptoms of dumping may occur immediately after eating (early dumping) or two to three hours after a meal (late dumping) and include nausea, vomiting, diarrhea, shortness of breath, weakness, sweating and dizziness.

  • Chemotherapy. This treatment uses drugs to help kill cancer cells. Injected into a vein or taken orally, chemotherapy medications travel through your bloodstream and are often used to eliminate cancer cells that may remain after surgery or to treat cancers that have spread to other parts of the body. Chemotherapy may also be used to control cancer growth, prolong life or relieve symptoms of advanced disease. Although it sometimes may be the only treatment needed, doctors most often use chemotherapy in conjunction with other therapies. For example, in locally advanced stomach cancer, which occurs when the tumor affects only the stomach and nearby tissues, chemotherapy and radiation (radiotherapy) are usually offered after surgery to help increase survival and improve quality of life. Because anticancer drugs affect healthy cells as well as malignant ones — especially fast-growing cells in your digestive tract and bone marrow — side effects such as nausea and vomiting, fatigue, and an increased risk of infection due to a shortage of white blood cells are common. Although not everyone experiences these side effects, chemotherapy can sometimes feel like another illness and is often the part of treatment about which people are most apprehensive. But a new class of antinausea medication can reduce the most severe intestinal symptoms. Sometimes acupuncture or relaxation techniques, such as guided imagery, meditation and deep breathing, may also help control nausea and vomiting. In addition, you normally receive chemotherapy in cycles, with periods of treatment alternating with periods of recovery during which your body can rest and produce new, healthy cells. Ask your treatment team about the side effects of any treatment you're considering and the best ways to minimize those effects.

  • Radiation therapy (radiotherapy). This therapy uses high-energy X-rays to kill cancer cells. Unlike chemotherapy, which affects your entire body, radiation affects only those parts of your body through which the radiation beam passes. Because any tissue touched by radiation can be damaged, doctors are careful to aim the beam in a way that's least likely to harm healthy tissue. Radiation that comes from a machine outside your body (external beam radiation) is generally used to treat stomach cancer, especially in conjunction with chemotherapy. It may also help relieve pain and blockages. You normally receive treatments five days a week for five to six weeks. Side effects may include a burn similar to sunburn on your skin where the radiation enters your body, nausea, vomiting, and fatigue that may increase over the course of treatment.

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