Diagnosis of gastric cancer: basic methods

Every year, more than 12 million people worldwide are diagnosed with the terrifying disease of cancer, and oncology takes the lives of about 7 million people. Ukraine is in the top ten countries in terms of cancer incidence: more than 160 thousand new cases per year.

Among all oncological diseases, stomach cancer is the fourth most common, after lung, breast and colon cancer.

Diagnosis of stomach cancer cannot be based on the etiology of this disease, because reliable scientifically proven reasons for the appearance of stomach cancer in humans have not yet been determined by medicine. But there are a great many factors that can give impetus to the transformation of cells of the gastric mucosa into a springboard for malignant neoplasm.

These include the specifics of a person's diet, in which fatty, fried and spicy foods predominate. And alcohol abuse coupled with smoking. And such chronic pathologies of the stomach as ulcers, gastritis (erosive or atrophic), polyps, as well as previous surgical intervention. Often the cause of an oncological disease, including stomach cancer, is associated with heredity, serious metabolic disorders or problems with the immune system.

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Early diagnosis of stomach cancer

The earlier gastric cancer is detected, the greater the chances of successfully coping with the disease. After all, when gastric cancer is detected at its very beginning, eight out of ten patients survive. But, unfortunately, the early form of cancer can be diagnosed in no more than ten cases out of a hundred. And in more than 70% of cases of visits to medical institutions, late stages of gastric cancer are diagnosed.

According to the unanimous opinion of doctors, early diagnosis of stomach cancer (adenocarcinoma, saucer cancer, stromal tumors, infiltrative-ulcerative, diffuse cancer) is a complex process, since in most cases this insidious disease does not manifest itself in any way at first: there is no pain or any functional disorders.

Oncologists define the initial stage of cancer as a primary tumor of the mucous and submucous layers of the stomach no larger than 2 cm. And it is usually detected during an X-ray or endoscopic examination of patients for other diseases: chronic atrophic gastritis, chronic hypertrophic polyadenomatous gastritis (Menetrier's disease), chronic gastric ulcer, adenomatous polyps or pernicious anemia (Addison-Biermer disease).

Thus, in a significant number of patients with pernicious anemia (caused by a deficiency of vitamin B12 and leading to atrophy of the gastric mucosa), doctors eventually diagnose stomach cancer. And the degeneration of polyps and chronic stomach ulcers into cancer reaches 20%.

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Reasons for Diagnosing Stomach Cancer

Among the very first symptoms that make specialists suspect stomach cancer are weakness, unexplained elevated body temperature, loss of appetite and weight loss, pale or sallow skin. Patients suffer from heartburn, constipation and diarrhea. However, such symptoms are characteristic of a fairly wide range of gastrointestinal diseases.

But there are also more pronounced symptoms of malignant tumors of the stomach, when patients complain of prolonged aching or pulling pains on the left side of the hypochondrium, which begin after eating. If the tumor has affected the area where the stomach passes into the duodenum (the so-called pyloric part of the stomach), then dyspepsia (a feeling of heaviness and fullness in the stomach), nausea and vomiting (of what was eaten the day before) are inevitable. All this is so serious that you need to see a doctor immediately.

Methods of diagnosis of stomach cancer

Based on the data of laboratory blood tests - general and biochemical analyses, it is possible to detect anemia (low hemoglobin levels) or protein metabolism disorder (as they say, "low protein") in a patient. In addition, the erythrocyte sedimentation rate (ESR) is determined, which will be elevated in oncology. But it is impossible to diagnose stomach cancer based on blood test data alone, and the patient is referred to take a blood test for a cancer antigen, that is, for the presence of proteins (oncomarkers) in the blood, secreted only by cancer cells.

When analyzing the composition of gastric juice, it is possible to determine the content of hydrochloric acid in it: its production in the stomach during cancerous lesions of the organ is reduced to almost zero - due to atrophy of the gastric mucosa.

Therefore, without other methods of diagnosing stomach cancer, it is impossible to make a correct diagnosis. The main diagnostic technologies include:

• X-ray of the stomach,
• endogastroscopy (EGDS) with gastric tissue biopsy,
• ultrasound examination (ultrasound),
• computed tomography (CT),
• magnetic resonance imaging (MRI).

Conventional traditional X-ray examination of the stomach is effective in ulcerative-infiltrative cancer (since in this case biopsy results are often negative). X-rays can also be used to detect recurrences of a cancerous tumor after its surgical treatment.

Diagnosis of stomach cancer by endogastroscopy (EGDS) allows to examine the gastric mucosa, determine its condition and, most importantly, perform a biopsy of those areas of the mucosa that raise suspicion of cancer. Biopsy is the most reliable method of studying the cellular composition of tissue, and biopsy is mandatory to confirm an oncological diagnosis.

After a comprehensive X-ray endoscopic examination, ultrasound diagnostics (US) and radiation diagnostics of stomach cancer (CT) are performed. These methods of diagnosing stomach cancer allow detecting malignant tumors, determining their location, size and even structure.

The most common method of examining abdominal organs is ultrasound (US). With its help, specialists identify indirect signs of stomach cancer (by changes in the shape of the organ's outline), the tumor's involvement in nearby organs, and the presence or absence of metastases (to the liver, lymph nodes, or peritoneum). Ultrasound examination is effective in the early diagnosis of stomach cancer affecting the walls of the organ.

Modern radiation diagnostics of stomach cancer - computed tomography (CT) - is aimed mainly at refining ultrasound data regarding the presence of metastases in internal organs located in the abdominal cavity. Thanks to the image of the stomach and its tissues from various angles, CT helps oncologists more accurately determine the stage of stomach cancer.

Magnetic resonance imaging (MRI) uses a safe magnetic field rather than X-rays to obtain images. MRI diagnostics provides a clear "picture" of almost all tissues and organs. Diagnosticians consider MRI to be the most effective method for diagnosing stomach cancer and other neoplasms in the human body.

Diagnosis of stomach cancer is also carried out using endosonography. Specialists "examine" the walls of the stomach layer by layer and determine the stage of the oncological disease. This method helps to identify metastases of stomach cancer in nearby lymph nodes. In particularly problematic cases of diagnosis, laparoscopy is performed: a laparoscope (a type of endoscope) is inserted into the abdominal cavity through a small puncture, and the doctor uses it to examine the organs. The peculiarity of this method of diagnosing stomach cancer is that a biopsy can be performed at the same time.

Differential diagnosis of gastric cancer

Differential diagnostics is widely used in medical practice, especially in cases where the "bouquet" of symptoms of a disease is so extensive that it seems that the patient has several diseases at once. The principle on which differential diagnostics of stomach cancer (as well as any other pathology) is based is to establish the only possible disease in each specific case by excluding symptoms that do not correspond to the disease.

Oncologists do not hide the fact that the most difficult thing is to distinguish ulcerated forms of stomach cancer from a regular ulcer. The whole point is that the clinical manifestations of both pathologies have an incredible number of similar symptoms, and the only difference is the frequency and intensity of their manifestations. At the same time, there is simply no “list” that would clearly indicate the criteria for classifying a disease as oncology.

For example, both infiltrative-ulcerative cancer and gastric ulcer patients often complain of pain after eating, which is localized in the epigastric region (i.e. in the area of the stomach projection on the anterior abdominal wall). A simple analysis of gastric juice for acidity level is of little help, and only the detection of a persistent form of histamine-resistant achlorhydria in a patient - a decrease in the secretory function of the stomach - provides grounds for determining malignant ulceration of the gastric mucosa.

The results of X-ray and endoscopic examination of patients with suspected stomach cancer and patients with stomach ulcers are very similar. And in this case, doctors make a conclusion only on the basis of histological examination of gastric tissue cells taken during a biopsy. Moreover, to exclude errors, the biopsy is done 2-3 times.

Differential diagnostics of stomach cancer helps doctors to understand the case of a benign gastric polyp and a cancerous tumor that has arisen in the place of this polyp. Here, endogastroscopy (EGDS) with a biopsy of the stomach tissue also comes to the rescue, since X-ray examination, as practice shows, in a good half of cases does not detect even ordinary gastric polyps.

As you can see, modern medicine has quite a few methods for diagnosing stomach cancer. And doctors can detect oncology and prescribe adequate treatment. The main thing is to pay close attention to your health, seek help in time for any suspicion of cancer and not perceive this diagnosis as a death sentence.

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