Signs and Symptoms of Stomach Cancer

Unfortunately, early-stage stomach cancer rarely causes symptoms. This is one of the reasons why stomach cancer is so hard to detect early. The signs and symptoms of stomach cancer can include:

• unintended weight loss and lack of appetite
• abdominal pain
• vague discomfort in the abdomen, usually above the navel
• a sense of fullness in the upper abdomen after eating a small meal
• heartburn, indigestion, or ulcer-type symptoms
• nausea
• vomiting, with or without blood
• swelling or fluid build-up in the abdomen.

Most of these symptoms are more likely to occur with non-cancerous conditions, such as a stomach virus. They may also occur with other types of cancer. But people who have any of these problems, especially if they persist, should check with their doctor so the cause can be determined and treated if needed.

Since symptoms of stomach cancer often do not appear until the disease is advanced, only about 20% of stomach cancers in the United States are found in the early stages, before they have spread to other areas of the body.

Medical History and Physical Examination

A complete medical history is an interview in which the doctor asks you questions about risk factors and symptoms to see if they might suggest stomach cancer or another cause. The doctor may also want to know about your general health in case you need surgery.

A physical exam provides information about your general health, possible signs of stomach cancer, and other health problems. In particular, the doctor will feel your abdomen for any abnormal changes.

Upper Endoscopy

Endoscopy is the main test used to diagnose stomach cancer when people have certain risk factors for stomach cancer or when signs and symptoms suggest this disease may be present.

During this test, you are sedated (made sleepy). The doctor passes a thin, flexible, lighted tube called an endoscope down your throat. This instrument allows the doctor to view the lining of your esophagus, stomach, and first part of the small intestine. If abnormal areas are noted, biopsies (tissue samples) can be taken using instruments passed through the endoscope. The tissue samples are looked at under a microscope to see if cancer is present.

When viewed through an endoscope, stomach cancer can appear as an ulcer, a mushroom-shaped or protruding mass, or a flat, thickened area of mucosa known as linitis plastica. Linitis plastica can be hard to recognize in its earliest stages, and a biopsy is needed to get an accurate diagnosis.

Endoscopy can also be used as part of a special imaging test known as endoscopic ultrasound, which is described below.

Imaging Tests

Imaging tests may help guide a doctor toward a diagnosis if there is some question about whether a person has cancer, but they are often used to help determine the stage (extent) of the cancer once it has already been found.

Upper gastrointestinal (GI) series: This is an x-ray test to look at the esophagus, stomach and first part of the small intestine. For this test, the patient drinks a barium-containing solution that coats the lining of these organs. Because x-rays can't pass through the coating of barium, this will outline any abnormalities of the lining of these organs. Several x-ray pictures are then taken. To identify early stomach cancer, a "double contrast" technique is commonly used. After the barium solution is swallowed, a thin tube is passed into the stomach and air is pumped in. This makes the barium coating very thin, so even small abnormalities will show up.

Endoscopic ultrasound (EUS): Ultrasound uses sound waves to produce images of organs such as the stomach. During a standard ultrasound, a transducer, which is a wand-shaped probe, is placed on the skin. It emits sound waves and detects the echoes as they bounce off internal organs. The pattern of echoes is processed by a computer to produce a black and white image on a screen. While this type of ultrasound is useful in some instances, the picture quality is limited because of the distance the sound waves and echoes have to travel and the layers of body tissue they have to go through.

Endoscopic ultrasound involves using a small transducer that is placed on the tip of an endoscope (see above), which is passed down the throat and into the stomach. It allows the doctor to look at the layers of the stomach wall, as well as the nearby lymph nodes and other structures. The picture quality is better than a standard ultrasound because of the smaller distance the sound waves have to travel.

EUS is most useful in helping to determine the local extent of the cancer -- that is, how far cancer may have spread into the wall of the stomach, to nearby tissues, and to nearby lymph nodes. It can also be used to help guide a needle into a suspicious area in order to get a tissue sample (an EUS-guided needle biopsy).

Computed tomography (CT) scan: The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into images of slices of the part of your body being studied.

Often after the first set of pictures is taken you may be asked to drink 1 or 2 pints of a radiocontrast agent, or dye, and/or you may receive an intravenous (IV) line through which the contrast dye is injected. This dye helps better outline structures in your body. A second set of pictures is then taken. The solution you drink and the injection can also cause some flushing (redness and warm feeling). Some people are allergic and get hives, or rarely more serious reactions like trouble breathing and low blood pressure can occur. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

CT scans take longer than regular x-rays. You need to lie still on a table while they are being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lay in when the pictures are being taken.

CT scans show the stomach fairly clearly and often can confirm the location of the cancer. CT scans can also show the organs near the stomach, such as the liver, as well as lymph nodes and distant organs where cancer might have spread. The CT scan can help determine the extent (stage) of the cancer and whether surgery may be a good treatment option.

CT scans can also be used to guide a biopsy needle into a suspected area of cancer spread (a CT-guided needle biopsy). The patient remains on the CT scanning table while a doctor moves a biopsy needle through the skin toward the mass. CT scans are repeated until the needle is within the mass. A fine-needle biopsy sample (tiny fragment of tissue) or a core-needle biopsy sample (a thin cylinder of tissue about ½-inch long and less than 1/8-inch in diameter) is then removed and looked at under a microscope.

Magnetic resonance imaging (MRI) scan: MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by the body and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. Not only does this produce images of cross-sectional slices of the body like a CT scanner, it can also produce images of slices that are parallel with the length of your body. A contrast material might be injected just as with CT scans, but this is used less often.

Most doctors prefer CT scans to look at the stomach. But an MRI may sometimes provide more information.

MRI scans take longer than CT scans -- often up to an hour. You may have to lie inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Newer, "open" MRI machines can help with this if needed. The MRI machine makes loud buzzing noises that you may find disturbing. Some places provide headphones to block this out.

Positron emission tomography (PET) scan: In this test, radioactive glucose (a type of sugar) is injected into the patient's vein. Because cancer cells are growing faster than normal cells, they use sugar much faster, so they take up the radioactive material. A special camera can then create a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information. This test, which is still being studied, is useful for spotting cancer that has spread beyond the stomach and can't be removed by surgery. It may be a very useful test for staging the cancer.

A PET/CT scan combines a CT scan and a PET scan to pinpoint the tumor even better. This test may be especially useful for spotting cancer that has spread beyond the stomach and wouldn't be treatable by surgery. It may be a useful test for staging the cancer. Because this test is so new, it is still being studied.

Chest x-ray: This test can help find out whether the cancer has spread to the lungs. It may also be useful to determine whether there are any serious lung or heart diseases present.

Other Tests

Laparoscopy: This test is usually done only after stomach cancer has already been found. While CT or MRI scans can create detailed pictures of the inside of the body, they may miss some tumors, especially if they are very small. To help confirm a stomach cancer is still localized enough to be treated with surgery, doctors often do a laparoscopy first. This involves inserting a laparoscope (a thin, flexible tube) through a small surgical opening in the patient's side. The laparoscope has a small camera on its end, which transmits pictures of the inside of the abdomen to a TV screen. Doctors can look at the surfaces of the organs and nearby lymph nodes closely to make sure the cancer hasn't spread and that all the cancer can be removed. Sometimes laparoscopy is combined with ultrasound to give a better picture of the cancer.

Lab tests: When looking for signs of stomach cancer, a doctor may order a blood test called a complete blood count (CBC) to look for anemia (which could be caused by internal bleeding). A fecal occult blood test may be done to look for blood in stool (feces).

The doctor may recommend other tests if cancer is found, especially if you are going to have surgery. For instance, blood tests can be done to make sure your liver and kidney function are normal. You may also have an electrocardiogram (EKG) to make sure your heart is functioning well.