Diagnosis of gastric cancer: basic methods

Annually an intimidating cancer diagnosis is put more than 12 million people around the world, and oncology takes the lives of about 7 million people. Ukraine - in the first ten countries in terms of the incidence of cancer: more than 160 thousand new cases per year.

Among all cancers, stomach cancer is the fourth most common - after lung, breast and colon cancer.

Diagnosis of stomach cancer can not be based on the etiology of this disease, because reliable scientific reasons for the appearance of a human stomach cancer to date, medicine could not be determined. But the factors that can give impetus to the transformation of the cells of the gastric mucosa into the foothold of the malignant neoplasm are a great many.

These are the features of human nutrition, in which fatty, fried and spicy food predominates. And alcohol abuse along with smoking. And such chronic pathologies of the stomach as an ulcer, gastritis (erosive or atrophic), polyps, as well as the surgical intervention that took place. Often, the cause of cancer, including the stomach, is associated with heredity, a serious metabolic disorder or immune system problems.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Early diagnosis of stomach cancer

The earlier oncological stomach problems were identified, the more opportunities to successfully cope with the disease. After all, if you detect stomach cancer at the very beginning of it, eight patients out of ten survive. But, unfortunately, the early form of cancer can be diagnosed in no more than ten cases out of a hundred. And in more than 70% of cases of appeals to medical institutions, late stages of stomach cancer are noted.

According to the unanimous opinion of doctors, early diagnosis of stomach cancer (adenocarcinoma, saucer-like cancer, stromal tumors, infiltrative-ulcerative, diffuse cancer) is a complex process, as in most cases this insidious disease does not manifest itself in the first place: there is neither pain nor any functional disorders.

The oncologists define the initial stage of cancer as a primary tumor of the mucous and submucous layers of the stomach, not more than 2 cm in size. And usually it is detected during X-ray or endoscopic examination of patients for other diseases: chronic atrophic gastritis, chronic hypertrophic polyadenomatous gastritis (Menetriae's disease), chronic ulcer stomach, adenomatous polyps or pernicious anemia (Addison-Birmer disease).

So, in a significant number of patients with pernicious anemia (caused by vitamin B12 deficiency and leading to gastric mucosa atrophy), eventually the doctors diagnose stomach cancer. And the degeneration of polyps and chronic gastric ulcers in cancer reaches 20%.

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The basis for the diagnosis of gastric cancer

Among the earliest symptoms on which experts suspect a cancer of the stomach, there is a state of weakness, an unexplained elevated body temperature, loss of appetite and weight loss, pallor or an earthy skin tone. Patients suffer from heartburn, constipation and diarrhea. However, such manifestations are inherent in a fairly wide range of gastrointestinal diseases.

But there are more expressed symptoms of stomach cancer, when patients complain of prolonged aching or pulling pains left to the hypochondrium, which begin after eating. If the tumor touches the area where the stomach passes into the duodenum (the so-called pyloric part of the stomach), then dyspepsia (feeling of heaviness and fullness of the stomach), nausea and vomiting (eaten on the eve) are imminent. All this is so serious that you need to see a doctor urgently.

Methods for diagnosis of gastric cancer

Based on the data of laboratory blood tests - general and biochemical analyzes, it is possible to identify the patient's anemia (a decrease in hemoglobin level) or a violation of protein metabolism (as they say, "reduced protein"). In addition, the erythrocyte sedimentation rate (ESR) is determined, which will be increased in case of oncology. But only on these blood tests, gastric cancer diagnosis is impossible, and the patient is sent to give a blood test for cancer antigen, that is, for the presence of proteins (oncomarkers) in the blood that are secreted only by cancer cells.

When analyzing the composition of gastric juice, you can determine the content of hydrochloric acid in it: its production in the stomach with cancerous organ damage is reduced to almost zero - due to atrophy of the gastric mucosa.

Therefore, without other methods of diagnosis of stomach cancer, a correct diagnosis can not be made. The main diagnostic technologies include:

• fluoroscopy of the stomach,
• endogastroscopy (EGDS) with a biopsy of the stomach tissue,
• ultrasound (ultrasound),
• computed tomography (CT),
• magnetic resonance imaging (MRI).

Conventional traditional x-ray study of the stomach is effective for ulcerative infiltrative form of cancer (since in this case the results of biopsy are often negative). With the help of an X-ray, it is also possible to detect recurrences of a cancerous tumor after its operative treatment.

Diagnosis of gastric cancer by the method of endogastroscopy (EGDS) allows you to examine the gastric mucosa, find out its condition and, most importantly, conduct a biopsy of those parts of the mucosa that cause suspicion of cancer. It is the biopsy that is the most reliable method for studying the cellular composition of the tissue, and carrying out a biopsy is necessary to confirm the oncological diagnosis.

After a comprehensive X-ray-endoscopic examination, ultrasound diagnosis (ultrasound) is performed, as well as radiation diagnostics of stomach cancer (CT). These methods of diagnosis of stomach cancer can detect poor-quality tumors, determine their location, size and even structure.

The most common method of examining the abdominal organs is ultrasound (ultrasound). With its help, specialists reveal indirect signs of stomach cancer (by changes in the shape of the body), seizure of the tumor of nearby organs and the presence or absence of metastases (in the liver, lymph nodes or peritoneum). Ultrasound is effective in the early diagnosis of stomach cancer that affects the walls of the body.

Modern radiation diagnosis of gastric cancer - computed tomography (CT) - is mainly aimed at clarifying the ultrasound data regarding the presence of metastases of internal organs located in the abdominal cavity. Thanks to the image of the stomach and its tissues in various angles, CT helps oncologists more accurately establish the stage of stomach cancer.

The method of magnetic resonance imaging (MRI) for imaging uses not X-rays, but a safe magnetic field. MRT-diagnostics gives a clear "picture" of almost all tissues and organs. Doctors-diagnosticians consider MRI to be the most effective method for diagnosing cancer of the stomach and other neoplasms in the human body.

Diagnosis of gastric cancer is also carried out by endosonography. Experts layer by layer "look through" the walls of the stomach and determine the stage of the oncological disease. This method helps to detect metastases of stomach cancer in the nearby lymph nodes. In especially problematic cases of diagnosis, laparoscopy is done: through a small puncture into the abdominal cavity a laparoscope (a kind of endoscope) is introduced, and with it the doctor examines the organs. The peculiarity of this method of diagnosis of gastric cancer is that simultaneously it is possible to conduct a biopsy.

Differential diagnosis of stomach cancer

Differential diagnosis is widely used in medical practice, especially in cases where the "bouquet" of symptoms of the disease is so extensive that it seems that the patient has several diseases at once. The principle on which differential diagnosis of gastric cancer is based (as well as any other pathology) is to establish the only possible disease in each case by eliminating symptoms that are not appropriate for the disease.

Oncologists do not hide the fact that it is most difficult to distinguish between ulcerated forms of stomach cancer and an ordinary ulcer. The thing is that in the clinical manifestations of both pathologies an incredible number of similar symptoms, and the only difference lies in the frequency and intensity of their manifestations. At the same time, the "list", in which the criteria of attributing the disease to oncology, clearly do not exist.

For example, with infiltrative ulcer cancer and gastric ulcer patients often complain of pain after eating, which are localized in the epigastric region (that is, in the area of the projection of the stomach on the anterior abdominal wall). A simple analysis of gastric juice on the level of acidity does not help much, and only the detection of a stable form of histamine-resistant achlorhydria in a patient - a decrease in the secretory function of the stomach - gives grounds for the determination of malignant ulceration of the gastric mucosa.

Very similar results of X-ray and endoscopic examination of patients with suspected gastric cancer and patients with stomach ulcers. And in this case, the doctors make a conclusion only on the histological examination of the cells of the gastric tissue taken during the biopsy. And to exclude the error biopsy done 2-3 times.

Differential diagnosis of stomach cancer helps doctors to understand and in the case of a benign polyp of the stomach and the cancer that has arisen on the site of this polyp. Endogastroscopy (EGDS) with a biopsy of the stomach tissue also comes to the aid here, since, as practice shows, X-ray examination does not reveal even the usual polyps of the stomach in a half of cases.

As you can see, in the arsenal of modern medicine there are many methods of diagnosing stomach cancer. And doctors can identify oncology and prescribe adequate treatment. The main thing is to pay attention to your health, to turn to any suspicion of cancer on time and not to take this diagnosis as a verdict.

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