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Early Detection, Screening, and Diagnosis for Stomach Cancer

Mass screening of the general population for stomach cancer is not done in America since the rates are quite low. According to the American Cancer Society, only 1.5% of all diagnosed cancers are stomach cancer.

Screening is the process of testing for cancers despite the absence of symptoms. These are common practices for cancers like breast cancer and prostate cancer, which are more prevalent in the population.

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Screening is not recommended for low-risk individuals in the US, but if you are at high risk for stomach cancer, your doctor should recommend regular testing. In cases of patients with potentially precancerous stomach conditions like atrophic gastritis and intestinal metaplasia or certain gene mutations and inherited conditions like Lynch syndrome or FAP, a regular upper endoscopy may be recommended.

For people with CDH1 gene changes that cause Hereditary Diffuse Gastric Cancer (HDGC), doctors even recommend removing the stomach entirely in what is called a total gastrectomy without screening, since the risk of stomach cancer is very high.

Tests for Stomach Cancer

Your doctor will first determine if you have any of the risk factors for stomach cancer, like genetic conditions, family history, and any lifestyle risk factors. It is important to be transparent with your doctor to help determine potential causes for the symptoms you have. Remember that abdominal pain does not immediately equate to stomach cancer, as there are multiple organs in the abdomen. The doctor will also administer a physical exam of your abdomen to check for swelling or any abnormalities. Blood tests will also reveal if you are infected with Heliobacter pylori.

Upper Endoscopy

An upper endoscopy, also known as esophagogastroduodenoscopy or EGD, is a common test performed if stomach cancer is suspected. During this procedure, a thin flexible tube with a small camera on the end is passed down the throat. This allows the doctor to view the lining of the esophagus, stomach, and beginning of the small intestine. If any abnormal areas are detected, small tissue samples (biopsies) can be taken through the endoscope for further examination under a microscope to check for cancer cells. While endoscopy can sometimes detect stomach cancers, certain types may still be difficult to visualize.

In addition to its diagnostic role, endoscopy can also serve therapeutic purposes for stomach cancer. In some cases, very early-stage cancers may be removed endoscopically. Endoscopy can help prevent or alleviate symptoms and complications from stomach cancer, potentially avoiding the need for major surgery. Moreover, it can be combined with ultrasound imaging (endoscopic ultrasound) to enhance visualization. Patients typically receive sedation medication before undergoing an upper endoscopy to ensure comfort during the procedure.

Biopsy

A biopsy involves taking small tissue samples from the areas of the stomach where cancer is suspected. Biopsies for suspected stomach cancer are typically performed during an upper endoscopy procedure, where tools can be passed through the endoscope to obtain samples from the stomach lining. However, some stomach cancers originate deep within the stomach wall, making them difficult to biopsy via standard endoscopy. In these cases, an endoscopic ultrasound can guide a hollow needle into the stomach wall to retrieve biopsy samples from deeper layers. Additionally, biopsies may be collected from potential sites of cancer spread, such as nearby lymph nodes or other suspicious areas in the body, to facilitate comprehensive evaluation and staging.

Biopsy samples are then observed under the microscope. Since cancer cells have shapes and forms distinct from normal stomach cells, the doctors will be able to ascertain whether or not you are positive for stomach cancer. Tests for the growth-promoting protein HER2 will also be done. HER2 proteins can increase the growth rate of cancer cells. Tests for other gene and protein changes will also be done, to see if immunotherapy or targeted drug therapy may be a treatment option. If PD-L1, MSI-H, dMMR, or TMBH proteins are found, immune checkpoint inhibitors may be viable for treatment. If NTRK gene changes are found, targeted drug therapy may be an option.

Imaging Tests

Imaging tests use either X-rays, sound waves, or magnetic fields to generate an image of the inside of the stomach or abdomen to help detect cancer cells, map out potential pathways of spread, and help plan treatment. The following imaging tests may be used for diagnosing stomach cancer:

Upper gastrointestinal (GI) Series

A barium swallow or upper gastrointestinal (GI) series is an X-ray imaging test that allows visualization of the inner lining of the esophagus, stomach, and initial portion of the small intestine. For this examination, the patient drinks a chalky barium solution that coats the digestive tract lining. X-rays are then taken, with the barium coating outlining any abnormalities present along the tract's surface. Although less invasive than upper endoscopy, barium swallow exams are used less frequently for stomach cancer evaluations because they may miss some abnormal areas and do not allow biopsy sample collection. However, this imaging test can still prove useful in certain clinical situations when endoscopy is not feasible or desired.

CT Scan

Computed tomography (CT) scans use X-rays to generate detailed cross-sectional images of the body's soft tissues. For stomach cancer, CT scans can visualize the stomach itself and confirm the location of tumors. Additionally, they can detect any spread of the cancer to other organs like the liver or nearby lymph nodes, helping determine the extent (stage) of the disease and evaluating if surgery may be an appropriate treatment option. CT guidance can also be used to obtain biopsy samples from suspected areas of cancer spread. During this procedure, CT imaging assists the doctor in precisely guiding a hollow biopsy needle through the skin and into the targeted mass or lesion to extract tissue samples for laboratory analysis.

Endoscopic Ultrasound

Endoscopic ultrasound (EUS) is a specialized technique that combines endoscopy with ultrasound imaging to evaluate the extent of stomach cancer invasion. During the procedure, which is performed under sedation, a small ultrasound probe is positioned on the tip of an endoscope that is passed down the throat and into the stomach. Once against the stomach wall near the cancerous area, the probe emits sound waves and collects the returning echoes to generate detailed images. EUS allows assessment of the different layers of the stomach wall as well as visualization of nearby lymph nodes and structures outside the stomach that may be involved. Furthermore, EUS guidance can be used to precisely direct a needle into suspicious areas to acquire biopsy samples (EUS-guided needle biopsy) for further analysis.

PET Scan

Positron emission tomography (PET) scans can assist in determining the extent of stomach cancer spread throughout the body. The procedure involves injecting a slightly radioactive form of sugar, which tends to accumulate in cancer cells. A specialized camera then detects the radioactive signals and generates an image highlighting areas of increased metabolic activity, which may represent sites of cancer. Many modern scanners combine PET with CT imaging (PET/CT) to provide more detailed anatomic information along with metabolic PET data. While useful for detecting metastases, PET scans are not always effective for certain types of stomach cancers that do not avidly take up the radioactive tracer. Nonetheless, PET imaging can comprehensively evaluate the whole body for potential cancer spread in a single study.

Magnetic Resonance Imaging (MRI)

An MRI can show detailed images of the inside of the body using powerful magnets and radio waves. This test is not commonly used for stomach cancer but may be used in cases where cancer has spread to other areas like the liver.

Chest X-ray

A chest X-ray may be used if the cancer is suspected to have already spread to the lungs or to determine if the patient's lungs are healthy enough should surgery be required for treatment.

Other Tests

Tests like a laparoscopy may be done if the other imaging tests do not show that the cancer has spread yet and the doctors want to ascertain the condition and location of the cancer before surgery. Organ function tests may also be done to check the status of the kidney and liver if they are suspected to be infected as well.

If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your stomach cancer or from negligence during your treatment that caused you more harm, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.

Last Updated on March 8, 2024 by Michael S. Porter
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