Stomach Cancer Diagnosis
Stomach cancer often does not have symptoms until it has spread to other parts of the body, or the symptoms are mistaken for other conditions. This means it can be challenging to diagnose, especially early on.
However, it is important to catch and diagnose stomach cancer as soon and as accurately as possible. This helps increase your odds for successful treatment and lowers the chance of side effects.
If you have symptoms that may signal stomach cancer, your doctor will examine you and ask questions about your health and lifestyle, including smoking and drinking habits, and your family medical history. One or more of the following tests may be used to find out if you have stomach cancer, if it has spread or if treatment is working.
Blood tests: No one blood test can definitely diagnose you with stomach cancer. However, your doctor can run blood tests that give important indicators about your health and may indicate whether other organ systems are being affected by cancer. Additional tests, like a complete blood count (CBC) test, can be used to check for anemia. This could be a sign that the cancer is bleeding into the stomach.
Your doctor can also test your blood for cancer antigen 125 (CA-125) and carcinoembryonic antigen (CEA). These proteins, or tumor markers, are sometimes produced by cancerous tumors, and they can be detected in the blood. These tests can be done to determine if your cancer is growing or responding to treatment. However, not all cancers produce CEA, and high CEA levels do not necessarily mean you have stomach cancer.
Fecal occult blood test: Stool is examined for traces of blood that are not visible to the naked eye. This may indicate that cancer is bleeding into the stomach.
Upper endoscopy: A small flexible tube with a camera at the end called an endoscope is inserted through the mouth into the esophagus and stomach. This allows your doctor to look for signs of cancer. The endoscope may also be equipped with a tool to remove samples of suspicious tissue (biopsy).
Biopsy: A biopsy is the removal of tissue to examine under a microscope to determine if cancer cells are present. For stomach cancer, biopsies are usually performed during an endoscopy.
Endoscopic ultrasound: Doctors insert an endoscope equipped with a small ultrasound device into the stomach. The ultrasound uses sound waves to produce an image on a video screen, allowing your doctor to see how deeply the cancer has invaded the stomach walls, or check for pre-cancerous changes.
Imaging tests allow your doctor to see the inside of your abdomen and stomach. They may be used to confirm the location of a cancerous stomach tumor, and they can also show whether the cancer has spread to nearby organs. Common imaging tests include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- X-rays (Also called an upper GI (gastrointestinal) series)
Staging laparoscopy: A staging laparoscopy is a minimally invasive procedure used to determine how far the disease has progressed. While the patient is under general anesthesia, doctors will insert a thin tube equipped with a camera into the abdominal cavity. They can then carefully examine the surfaces of the abdominal organs for signs that cancer has spread from the stomach. They may also 'wash' the abdominal cavity with a saline solution. This is called 'peritoneum washing.' The solution is removed and can be checked for the presence of cancer cells. This allows your doctor to catch cancer that is not yet visible on other imaging tests.
Behavioral and lifestyle changes can help prevent stomach cancer. Visit our prevention and screening section to learn how to manage your risk.
In rare cases, stomach cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Is stomach cancer hereditary?
Hereditary diffuse gastric cancer (HDGC) is a rare, serious genetic condition that increases the risk of developing stomach cancer. Despite its name, HDGC is a condition rather than a type of cancer itself. It¡¯s caused by an inherited gene mutation and greatly increases the chances of developing diffuse gastric cancer.
Unlike other forms of stomach cancer, diffuse gastric cancer spreads in a way that makes it difficult to detect. It often goes unnoticed until it reaches an advanced stage since the disease often doesn¡¯t have symptoms in its earliest stages. Unlike intestinal-type gastric cancers, HDGC doesn¡¯t usually form a distinct mass, but instead infiltrates the stomach lining diffusely.
To better understand how HDGC develops, how it¡¯s diagnosed, how it¡¯s treated and how you can manage your risk, we spoke with surgical oncologist Here¡¯s what he wants families to know.
How is HDGC-linked diffuse gastric cancer different from other forms of stomach cancer?
HDGC is caused by a mutation in genes that can be passed down in families. It¡¯s characterized by microscopic cancerous cells that grow in the stomach lining.
Non-hereditary stomach cancer is usually linked to environmental factors such as diet or a history of infections like H. pylori.
HDGC spreads differently, too. In people with HDGC, cancer cells spread diffusely. This means they scatter in an unorganized way rather than forming a solid tumor. That¡¯s why this type of cancer can be difficult to detect with imaging or tests.
What are some genetic mutations associated with hereditary stomach cancer?
The CDH1 gene mutation is the most common cause of HDGC. This gene makes E-cadherin, a protein that helps cells stick together. When CDH1 is mutated, cells lose their ability to stick together properly, allowing cancerous cells to spread more easily.
People with a CDH1 mutation also have a higher risk of lobular breast cancer and sometimes cleft lip or cleft palate. It may also be linked to cases of osteopenia in some patients.
Another gene mutation called CTNNA1 can also cause HDGC, but it¡¯s much rarer.
How can I manage my risk of HDGC and hereditary stomach cancer?
Because HDGC is passed down through families and less than 3% of all gastric cancers are hereditary, the best way to understand your risk is by knowing your family history. Genetic testing is recommended if you:
- have a family history of HDGC,
- were diagnosed with stomach cancer before age 50,
- have multiple family members who were diagnosed with stomach cancer before age 50,
- have a family history of lobular breast cancer, and/or
- have a family history of cleft lip or cleft palate and stomach cancer, which can both be linked to the CDH1 mutation.
After you complete genetic testing, you¡¯ll meet with a genetic counselor to discuss your and your family members¡¯ risks and screening options.
What are the most common HDGC symptoms?
Hereditary diffuse gastric cancer doesn¡¯t usually have symptoms in its earliest stages. That¡¯s why genetic testing is so important.
When the disease is caught later, symptoms might include abdominal pain, weight loss, or nausea and vomiting.
How is HDGC treated?
Doctors used to think that people with CDH1 gene mutations had over a 70% chance of getting stomach cancer. More recent studies show the risk is lower for most families, but it¡¯s still much higher than normal and depends a lot on family history.
?So, preventive surgery to remove the stomach is the most effective treatment option for those with the mutation. This surgery is called a prophylactic total gastrectomy.
Some people with the CDH1 mutation opt for regular monitoring instead of immediate surgery. Regular monitoring might include an endoscopy, where doctors use a long camera to see the esophagus and gastrointestinal tract, or biopsies of the stomach and surrounding organs.
Chemotherapy and radiation therapy are typically not effective options for early-stage HDGC-linked diffuse gastric cancer.
What is a patient¡¯s risk of cancer after HDGC treatment?
Removing the stomach practically eliminates the risk of diffuse gastric cancer returning. However, people with a CDH1 mutation may still have an elevated risk of lobular breast cancer. Even after preventive stomach removal, you will need to see your doctor regularly to monitor your overall health.
HGDC is a serious condition, but with genetic testing, preventive surgery and regular medical care, you can take charge of your health. While surgery can be a big change, most patients go on to live full and happy lives after a stomach removal.
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