Medical Monday: Signs Of Stomach Cancer

DEAR MAYO CLINIC: A 62-year-old man I worked with was diagnosed with stomach cancer earlier this year. He reportedly was feeling full even after eating small meals and experienced stomach pain above his belly button. I am starting to worry because I have recently started to experience similar symptoms. I'm only 38. Is it possible I could have stomach cancer? How do I get screened? What are the treatment options?

ANSWER: Most people diagnosed with stomach cancer, which is also called gastric cancer, are over the age of 60. However, in the U.S., stomach cancers in people under 40 have been steadily rising. Overall, this form of cancer is not very common, but factors that increase your risk include:

• Eating smoked, salted, processed or charcoaled meats, and pickled vegetables.
• Eating few or no fruits and vegetables.
• Alcohol use.
• Previous stomach surgery.
• Helicobacter pylori (H. pylori) infection.
• Inherited cancer syndromes such as: hereditary diffuse gastric cancer, Lynch syndrome (hereditary nonpolyposis colorectal cancer), familial adenomatous polyposis, gastric adenoma and proximal polyposis of the stomach, Li-Fraumeni syndrome, and Peutz-Jeghers syndrome.

Unfortunately, stomach cancer doesn't always cause symptoms in its early stages, and many symptoms may not happen until the cancer is advanced. Signs and symptoms of stomach cancer may include:

• Difficulty swallowing.
• Belly pain.
• Feeling bloated after eating.
• Feeling full after eating small amounts of food.
• Not feeling hungry when you would expect to be hungry.
• Losing weight without trying.
• Feeling very tired.
• Stools that look black.

If you have signs and symptoms that worry you, you should make an appointment with your healthcare team. Many other conditions can cause symptoms that are similar to stomach cancer. Your healthcare team may recommend testing such as an upper endoscopy, also called an upper gastrointestinal endoscopy, which is a procedure that is used to visually examine your upper digestive system. This can be used to screen for stomach cancer as the cause of your symptoms. An EGD allows the doctor to look at the inside of your stomach. Stomach cancer can appear as an ulcer, a mass or a thickening of the stomach wall. Your physician then can obtain biopsies of the area to determine if you have stomach cancer.

The treatment of stomach cancer depends on the stage. Endoscopic ultrasound, a minimally invasive procedure to assess diseases of the digestive (gastrointestinal) tract and other nearby organs and tissues, CT or PET scan imaging, and a staging laparoscopy are used to determine the clinical stage.

While it is uncommon to find early stomach cancer, treatment for early-stage disease often only requires local treatment. For example, in early stomach cancers that involve only the mucosa, or inner lining of the stomach, and measure less than 2-3 centimeters in size, the stomach cancer can be removed using endoscopic submucosal dissection without the need for surgery or additional treatment. For other early stomach cancers that do not meet these criteria, surgery to remove the stomach cancer and regional lymph nodes is recommended.

However, if the cancer is found to have spread to the lymph nodes at the time of surgery, then the patient is at a higher risk of stomach cancer returning after surgery alone. Therefore, chemotherapy after surgery is often recommended to decrease the risk of cancer recurrence.

Typically, patients are diagnosed with more advanced stomach cancer, which means a deeper involvement of the stomach or spread to regional lymph nodes. In this more common situation, combining chemotherapy and surgery is necessary for the best outcomes. Chemotherapy usually is given before and after surgery in this case.

Finally, if the stomach cancer has been found to have spread outside the stomach and regional lymph nodes, then this is stage 4 cancer. The primary treatment is systemic therapy. Additional testing can be done on the tumor to determine if the stomach cancer might respond to targeted therapy or immunotherapy. In some cases where there is a small amount of tumor spread to the lining of the abdomen, also called the peritoneum, surgery called cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be used to prolong a patient's survival.

Treatment options to treat stomach cancer are complex and should be individualized to your particular situation. It is essential to seek out an experienced team to help with the accurate staging of cancer, help with management decisions and for high-quality endoscopic or surgical resection. -- Dr. Travis Grotz, Surgical Oncology, Mayo Clinic, Rochester, Minnesota