Early signs of stomach cancer

Like many cancer types, stomach cancer develops slowly over several years. But the early changes that occur first and that may lead to cancer rarely cause symptoms, so they often go undetected. As a result, most cases are not diagnosed until the cancer has already spread beyond the stomach to nearby lymph nodes and tissues as well as distant body areas, making treatment challenging.

“In the United States, and here at Roswell Park, a lot of patients have cancer that occurs at the junction of the stomach and esophagus, called the GE junction,” says Sarbajit Mukherjee, MD, gastrointestinal medical oncologist at Roswell Park Comprehensive Cancer Center. GE-junction cancer is often associated with a history of acid reflux, which can cause Barrett’s Esophagus, a precancerous condition. Those who have been on acid reflux medications for months or years should be monitored for this condition.

It’s important that people with acid reflux or those with a family history of stomach cancer be alert to any new stomach symptoms and address them as soon as possible.

Symptoms to alert your doctor

Cancers can start in different sections of the stomach, and each can cause different symptoms and have different treatments. “The list is very long, and every patient presents a little differently,” says Dr. Mukherjee. But some of the common symptoms include unexplained weight loss, difficulty swallowing and sometimes blood in the stool.

Unintentional weight should raise a red flag, especially if you have a family history of stomach cancer. Some minority populations, such as Asian/Pacific individuals, have a higher incidence of stomach cancer and should be extra cautious and see their doctor, Dr. Mukherjee advises. "The weight loss may come about as a result of other symptoms such as abdominal pain, fullness of the stomach, or loss of appetite and nausea,” he says. "The abdominal pain, typically in the upper abdomen, is usually kind of a vague pain, and it becomes more severe when the cancer is more advanced.”

Difficulty swallowing, called dysphagia, can be another common symptom. At first, it might not seem like a problem. "But, it can progress from problems with solids to having trouble with softer or even pureed foods and liquids."

A person might not notice blood in their stool because it  is usually hidden or occult bleeding. “Patients usually don’t notice it, but they can keep losing blood and can become anemic,” he says. “Sometimes you can see overt bleeding. The stool color has changed to mostly black, tarry color, though that is uncommon.”

If the cancer metastasizes, symptoms may appear related to those areas, such as enlarged liver or lymph nodes. The cancer also tends to spread to the peritoneum, a membrane inside the abdomen. Symptoms of this include distention of the abdomen, pain and a slowing down or obstruction of the bowels. Any stomach pain that lasts for more than a few weeks, or keeps coming back, should be checked out. Finally, if you experience blood in the stool or vomit, don’t delay. See a doctor immediately.

Getting a diagnosis

Although a fecal occult blood test is used to screen for colorectal cancer, it is not used for gastric cancer screening. “We do not have any standards for gastric cancer screening in the U.S. It is considered somewhat rare here,” says Dr. Mukherjee. But if blood is detected with a fecal occult blood test, it does not automatically mean colon cancer. Your physician will need to investigate further to determine the cause of the blood.

An upper GI endoscopy is the next step in diagnosis. “Nothing allows you to diagnose gastric cancer better than an upper GI,” says Dr. Mukherjee. “You can locate the tumor, take biopsies and, if it’s at an early stage, you can even remove it. When diagnosed early, it can be cured. You need interventional endoscopists with special skills and training, and we are fortunate to have them here at Roswell Park.”

Once a diagnosis is made, a standard CT scan is used to look for cancer spread. “Sometimes other testing is needed, for example diagnostic laparoscopy, to see if it has spread to the peritoneum,” he adds.

Seeking quality cancer care

There are at least four different reasons for patients to seek stomach cancer treatment at Roswell Park, explains Dr. Mukherjee. “We have screening expertise, especially when there is a family history, and you may benefit from our genetic screening. Second, when diagnosed very early, we have interventional endoscopists with special skills and training to remove it. Third, if you need surgery, you want a center that performs these surgeries frequently, and our surgeons have more experience than many other centers. Finally, Roswell Park is an academic research center. I always recommend patients being treated at a community hospital receive a second opinion here, because you may have an opportunity to participate in a trial which can allow you to access treatment options you can’t get elsewhere.”