Early Detection – Introduction

Being a rare type of cancer that do not have any form of symptoms until it’s in an advanced stage, that is why detecting stomach cancer is quite difficult. Although once cancer is detected early, there are high chance of surviving, but for stomach cancer, even if detected at later stages, it is still treatable.

Unlike Africa, North America especially USA, in some countries in East Asia and South America, where stomach cancer is much more common, mass screening of the population has helped find many stomach cancers at an early, possibly more curable stage. There is no mass screening in Nigeria. However, it’s not clear if this has led to a lower number of stomach cancer deaths.

The benefits of screening might outweigh the risks in some people who are at an increased risk for stomach cancer because of certain risk factors e.g., those who have certain potentially pre-cancerous stomach conditions or inherited conditions such as familial adenomatous polyposis.

Staging Stomach Cancer

One of the best ways of describing or knowing the right place where cancer is located; if or the places it might have spread to; or the probability of affecting other organs of the body is referred to STAGING. After a person is diagnosed with stomach cancer (gastric cancer), medical doctors use different examination tools with tests to help determine the stage of the cancer, that is why staging the stomach cancer will not be complete if all the tests and examination haven’t been carried out.

Stomach cancer starts from stage 0 which is also referred to as carcinoma in situ. Stomach cancer stage grouping starts from 1 (I) through 4 (IV), but there is a probability of having a re-current stomach cancer. And these stages are further divided into alphabets such as A, B, C etc., so as to show some extra details. The lower the number, the lesser the cancer has spread, and the higher the number, the farther the cancer has spread to other part of the body.

Stomach Cancer Stage Grouping

Stage 0

This stage is also referred to as the “carcinoma in situ”. At this stage, abnormal cells are found on the surface of the epithelium; inside the lining of the mucosa of the stomach wall. These cancerous cells have not spread to any other layer of the stomach, but can become cancer and spread to nearby lymph nodes.

Stage I

At this stage, stomach cancer is present in the lining of the mucosa. Stage I is further divided into Stage IA and IB.

• Stage IA: The cancer has formed inside the mucosa of the stomach wall, and probably spread to the submucosa.
• Stage IB: In this stage, stomach cancer has formed inside the mucosa, spread to the submucosa, and have spread to 1 or 2 lymph nodes but not anywhere else; spreading to the outer muscle layer of the stomach wall.

Stage II

At this stage, stomach cancer has spread to one or few nearby lymph nodes but not lymph nodes of other parts of the body or distant organs.

• Stage IIA: At this stage, stomach cancer has spread to 1 to 2 lymph nodes but it is not found at other organs, growing at the outer muscular layers of the wall of the stomach. The cancer has spread to the subserosa of the stomach wall; or may have spread to the submucosa of the stomach wall and is found in 3 to 6 lymph nodes near the cancerous cells.
• Stage IIB: At this stage, there are certain conditions that makes stomach cancer classified at this stage: Stomach cancer has spread to the serosa or/and; spread to the subserosa and found in 1 or 2 lymph nodes near the tumor, or/and; the cancer has grown through all the layers of the muscle into the connective tissue outside the stomach, growing into the peritoneal lining, but not spread to any lymph nodes or nearby organs, or/and; the cancer has grown into the inner layers of the wall of the stomach, spreading to 7 to 15 lymph nodes but not elsewhere.

Stage III

At this stage, depending on places where the cancer might have spread, stomach cancer stage III is divided into IIIA, IIIB, and IIIC.

• Stage IIIA: At this stage, cancer has spread to the subserosa, spreading to 3 to 6 lymph nodes; or to the muscle layer of the stomach, spreading to 7 to 15 nearby lymph nodes; or to the serosa of the stomach wall, spreading to 1 to 6 nearby lymph nodes; or to nearby organs such as the liver, pancreas, abdomen wall, spleen, colon, kidney, or small intestine, and probably the back of the abdomen.
• Stage IIIB: In this stage, cancer may have spread to the submucosa or to the muscle layer of the stomach wall, spreading to the 16 or more nearby lymph nodes; or spread to the subserosa or the serosa (outermost layer) of the stomach wall, spreading to 7 to 15 nearby lymph nodes; or cancer has spread from the stomach to some nearby organs like colon, liver, pancreas, adrenal gland, kidney, spleen, or small intestine, spreading to 1 to 6 nearby lymph nodes.
• Stage IIIC: Here, cancer has spread to the serosa or to the subserosa of the stomach wall, spreading to 16 or more nearby lymph nodes; or cancer has spread from the stomach to nearby organs like colon, liver, pancreas, adrenal gland, kidney, spleen, or small intestine, spreading to 7 or more nearby lymph nodes.

Stage IV

In stage IV, cancer has spread to other parts of the body, such as the lungs, liver, distant lymph nodes, and the tissue that lines the abdomen wall.

Recurrent Stomach Cancer

Recurring stomach cancer is a cancer that occurs after treatment has been completed. This recurrence can be localized meaning stomach cancer re-occur at the first place where it started. Also, recurrent stomach cancer can be a distant metastasis, meaning the cancer has started at another organ or part of the body.

Diagnosis of Stomach Cancer

Stomach cancer can be diagnosed using various form of tests, and these test help to determine where the cancer might have spread from one organ to another. These diagnostic tests also help to determine the type of treatment plan that suits the person’s overall health conditions.

When individuals develop persistent symptoms of stomach cancer, it is advisable to seek medical attention immediately. These symptoms, personal and family history, medical history and lifestyle choices help medical doctors during diagnosis. Also, they perform physical examination to check for tenderness or lump around the stomach.

Blood tests can also be used to identify if there are excessive substances which could indicate cancer, and also check the count of red and white blood cells, as well as platelets and hemoglobin.

Diagnostic tests for stomach cancer may include the following:

Upper Endoscopy

Upper endoscopy, also known as esophagogastroduodenoscopy or EGD is a test done whenever there is suspicion of stomach cancer. Here, the doctor uses an endoscope to look inside the stomach, examining the esophagus, stomach, and the duodenum so as to see any abnormality. Once an abnormality is seen, samples are collected using biopsy and sent for test in a laboratory.

Biopsy

During endoscopy, once any form of abnormal cells is diagnosed, then samples of these abnormal are removed and sent to a laboratory for analysis. The process of removal is referred to as biopsy. Sometimes, some stomach cancer may start within the deep part of the stomach wall, making biopsy a bit difficult to detect. And once this is suspected, endoscopic ultrasound is used to get a biopsy sample. Biopsies can also be taken from areas apart from the stomach if there is suspicion that stomach cancer might have spread to nearby lymph nodes.

Imaging Tests

Imaging tests are used to show a detailed of the stomach, using x-rays, radioactive or sound waves, magnetic fields to create pictures of the inside of the body. Imaging tests such as x-rays, CT scans, PET scans are usually used during imaging tests.

• Upper Gastrointestinal (GI) Series (Barium Swallow): This is an x-ray test used to look at the inner lining of the esophagus, stomach, and first part of the small intestine. This test is used less often than upper endoscopy to look for stomach cancer or other stomach problems, while the individual drinks or swallow a liquid called barium. Although, less invasive than endoscopy, upper gastrointestinal (barium swallow) might be useful in some situations.
• Computed Tomography (CT) Scan: This is the usage of x-rays to have a detailed pictures of inside of the body. CT scan shows the exact location of the stomach cancer; also, other parts of the body where the stomach cancer might have spread, such as the nearby lymph nodes.
• Endoscopic Ultrasound: This is often used to show how far a cancer might have spread into the wall of the stomach, or nearby lymph nodes.
• Chest X-ray: Although not necessarily important once CT scan has been done, this type of imaging test help to show if cancer might have spread to the lungs, determining if a person has any form of lung or heart diseases.
• Positron Emission Tomography (PET) Scan: This helps to determine the extent of stomach cancer in the body. Although not as effective in giving detailed picture of the body, yet PET can look for possible areas where cancer might have spread in the body once.
• Magnetic Resonance Imaging (MRI): Unlike x-rays, MRI use radio waves and strong magnets to create a detailed image of soft tissues in the body. In the case of stomach cancer, MRI isn’t used just like CT scans but can help to locate tumors in the liver.

Imaging test may be done for certain reasons, and these includes:

• To learn if the suspected area is cancerous
• To learn how far stomach cancer has spread
• To learn about the best treatment plan and how effective such treatment has been

Exploratory Surgery (Laparoscope)

Once stomach cancer has spread beyond the stomach, within the abdomen or chest, medical doctors may recommend surgery to detect cancer, especially if imaging tests have not shown it spread. This diagnostic method is known as laparoscope.

[Next Article: Treatment of Stomach Cancer]

References: American Cancer Society; WHO; WebMD, Cancer.net

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