Clinical history and examination: The doctor will ask for symptoms such as abdominal pain, heartburn, acidity, burping, nausea, vomiting, blood in vomit, swelling in the abdomen, poor appetite and unexplained weight loss. The abdomen will also be examined for swelling and pain. Endoscopic examination: The doctor uses a thin, flexible, light-emitting tube called an endoscope to examine the esophagus (food pipe) and stomach by passing it down the patient’s throat. If any abnormality is seen a sample of the tissue is taken using tools attached to the endoscope and are sent to the lab.
Radiological examination: CT-scan is useful to stage the cancer and detect spread of the cancer to other parts of the body. It may also be used to guide the doctor while collecting a biopsy sample. In some cases, contrast may be injected in to the vein to improve the visualisation of the tumour on CT. Chest X- and a PET scan are used to detect the spread of cancer (also called metastasis). A special X-ray called a barium meal can allow radiologists to gather more details on the tumour wherein the patient swallows a liquid containing barium, which acts as a contrast agent. An endoscopic ultrasound uses an ultrasound probe introduced down the throat and into the stomach to provides images of the layers of the stomach wall and nearby lymph nodes. It is useful to determine how far the cancer has spread in the stomach wall and in the nearby tissue.
Source: Covenant Health
How Does a PET Scan Work?
Source: NIBIB gov
Histopathological examination / Biopsy: A sample collected by endoscopy or surgical removal is examined by the pathologist under the microscope. The pathologist will confirm the diagnosis of cancer and provide information about the characteristics of the tumour cells that can help in deciding the best route of treatment. The doctor may also conduct other tests such as genetic tests and immunohistochemistry. These tests may include HER-2 (a growth promoting protein in tumour cells that can be specifically targeted), PDL-1 (an immune checkpoint protein that can be targeted by immunotherapy).
Additional Videos about Testing
Barium Swallow Exam
Source: Bastian Medical Media
Diagnosis and Detection of Stomach Cancer
Source: Johns Hopkins Medicine
Treatment Of Gastric Cancer
The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.
Endoscopic Mucosal Resection (EMR): EMR can be done for those patients in whom the cancer does not extend beyond the inner layer of the stomach (also known as mucosa). A small tube is passed down the throat and into the stomach and the tumour is removed.
Endoscopic Mucosal Resection Surgery
Source: Mount Sinai Health System
Surgery: The onco surgeon aims to remove all cancerous tissue from the body and may remove a part of the stomach, or the entire stomach. There are various types of : Distal subtotal gastrectomy: It is used for tumours that are found in the lower distal part of the stomach. The lower part of the stomach, first part of the small intestine and the lymph nodes are removed. Reconstruction is done by connecting a part of the small intestine to the remaining upper part of the stomach.
Proximal gastrectomy: It is used for tumours in the upper part of the stomach. This surgery removes the upper part of the stomach, some part of the esophagus and lymph nodes in the area. Reconstruction is done by pulling the remaining part of the stomach up to the remaining upper part of the esophagus.
Total gastrectomy: If the tumour has spread throughout the stomach, and the complete removal of the stomach is performed. The oesophagus is attached to the small intestine). If the lymph nodes or organs around the stomach are affected, those will be removed as well along with the tumour. In some cases an adjuvant therapy is a therapy given in addition to surgery. This may be chemotherapy either alone or combined with radiotherapy.
Side effects: Bleeding, blood clots, injury, to nearby organs, heartburn, abdominal pain vitamin deficiencies, leakage of abdominal contents, diarrhoea.
Chemotherapy: Chemotherapy uses chemical agents to destroy cancer cells. A chemotherapy regimen consists of a number of cycles given over a period of time and may include a single drug or a combination of drugs. It maybe sometimes be combined with radiotherapy. Side effects: Side effects depend on the agent used, but common side effects include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhoea.
What is Chemotherapy?
Source: Covenant Health
Radiation therapy: This form of therapy uses high-energy particles to destroy cancer cells. Patients may receive radiation from an external machine (external-beam radiation therapy). It is sometimes used before surgery to shrink the size of the tumor or after surgery to destroy any cancer cells that were left behind. Side effects: fatigue, mild skin reactions, upset stomach, and loose bowel movements.
What is cancer radiotherapy?
Source: Cancer Research UK
Radiation Therapy: What to Expect
Source: Accelerated Education Program
Targeted therapy: Some cancers have specific genes or proteins that can be targeted to block the growth and spread of the cancer cells and prevent damage to healthy cells. Targeted therapies can include HER2-targeted therapy and Anti-angiogenesis therapy among others. Side effects depend on the agent used.
Immunotherapy (biologic therapy): This form of therapy boosts the body’s immune system to fight cancer cells. There are a number of different agents that can be used. Side effects: Different side effects are caused by different agents but common side effects include skin reactions, allergies, flu-like symptoms, diarrhea, and weight loss.
Palliative Care: Palliative care deals with the physical symptoms and side effects of cancer and related therapies. It focuses on improving the quality of life of the patient.
Source: Get Palliative Care
Sources: American Cancer Society; European Society for Medical Oncology (ESMO); eMedicine; Mayo Clinic; Cancer.Net