Treatment

Symptoms, Risk and Diagnosis

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified. Gastric cancers of the lining of the stomach is diagnosed and treated differently than the rarer gastrointestinal stromal tumors (GIST) and GI NETs.

Symptoms of Gastric Cancer

Early stage symptoms may vary from late stage gastric cancers.

Early stage symptoms:

  • Indigestion and stomach discomfort
  • A bloated feeling after eating
  • Mild nausea
  • Loss of appetite
  • Heartburn

In more advanced stages of gastric cancer, you might see:

  • Blood in the stool
  • Vomiting
  • Weight loss for no known reason
  • Stomach pain
  • Jaundice (yellowing of eyes and skin)
  • Ascites (build-up of fluid in the abdomen)
  • Trouble swallowing

Symptoms of GISTs

  • Pain or discomfort in the abdomen
  • A mass in the abdomen that you can feel with your hand
  • Nausea and vomiting
  • Vomiting blood or having blood in the stool
  • Fatigue due to anemia, a low red blood cell count

Symptoms of GI NETs

Carcinoid tumors, the most common forms of NETs, usually do not cause symptoms in the early stages. However, some patients may experience symptoms such as:

  • Facial flushing
  • Diarrhea
  • Abdominal pain
  • Asthma
  • Rash
  • Dark-colored stools (which indicate intestinal bleeding)

Risk Factors for Gastric Cancers

  • Having any of the following medical conditions:
    • Helicobacter pylori (H. pylori) infection of the stomach
    • Chronic gastritis (inflammation of the stomach)
    • Pernicious anemia
    • Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines)
    • Familial adenomatous polyposis (FAP) or gastric polyps
  • Eating a diet high in salted, smoked foods and low in fruits and vegetables
  • Eating foods that have not been prepared or stored properly
  • Being older or male
  • Smoking cigarettes
  • Having a mother, father, sister, or brother who has had stomach cancer

Risk Factors for GIST

  • Neurofibromatosis type 1 (NF1): This rare genetic condition also causes brown spots and tumors on the skin, freckling in skin areas not exposed to the sun, tumors on the nerves, and developmental changes in the nervous system, muscles, bone, and skin.
  • Carney triad: Another rare disorder, it is marked by tumors of the gastrointestinal tract (usually the stomach), tumors that form in the head, neck, and torso, cartilage in the lungs, and sometimes in the adrenal glands and esophagus. It is most common in young females.

    ·      Neurofibromatosis type 1 (NF1): This rare genetic condition also causes brown spots and tumors on the skin, freckling in skin areas not exposed to the sun, tumors on the nerves, and developmental changes in the nervous system, muscles, bone, and skin.

    ·      Carney triad: Another rare disorder, it is marked by tumors of the gastrointestinal tract (usually the stomach), tumors that form in the head, neck, and torso, cartilage in the lungs, and sometimes in the adrenal glands and esophagus. It is most common in young females.

    • Neurofibromatosis type 1 (NF1): This rare genetic condition also causes brown spots and tumors on the skin, freckling in skin areas not exposed to the sun, tumors on the nerves, and developmental changes in the nervous system, muscles, bone, and skin.
    • Carney triad: Another rare disorder, it is marked by tumors of the gastrointestinal tract (usually the stomach), tumors that form in the head, neck, and torso, cartilage in the lungs, and sometimes in the adrenal glands and esophagus. It is most common in young females.

Risk Factors for GI NETs

  • A family history of multiple endocrine neoplasia type 1 (MEN1) syndrome, a rare genetic disorder that can cause the parathyroid glands, pituitary gland, and pancreas to produce too many hormones
  • Certain conditions that affect that stomach’s ability to produce stomach acid
  • Smoking

Making a diagnosis of stomach cancer may involve different approaches. The following tests and procedures may be used:

  1. Physical exam and history to examine the patient’s past illnesses and treatments, and any signs of disease, or abnormalities
  2. Blood chemistry studies: A blood sample is checked to measure the amounts of certain substances like glucose released into the blood by different organs. An unusually higher or lower than normal amount can be a sign of disease in the organ that makes it.
  3. Complete Blood Count: A sample of blood is checked for the following: the number of red blood cells, white blood cells, and platelets; the amount of hemoglobin (the protein that carries oxygen) in the red blood cells, and the portion of the sample made up of red blood cells.
  4. CEA (carcinoembryonic antigen) assay: This substance is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gastric cancer or other conditions.
  5. Upper endoscopy: An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An ultrasound probe at the end of the endoscope is often used to bounce high-energy sound waves (ultrasound) off internal tissues or organs for better visualization.
  6. Biopsy: A biopsy of the stomach is usually done during the endoscopy. The sample of tissue may be checked to measure how many HER2 genes there are and how much HER2 protein is being made. If there are more HER2 genes or higher levels of HER2 protein than normal, the cancer is called HER2 positive, and has other options for treatment, such as targeted therapy with a monoclonal antibody that targets the HER2 protein.
  7. Upper GI Series: Also called a barium swallow, this test involves a series of X-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound), which coats the esophagus and stomach, showing abnormalities on X-ray.
  8. CT scan (CAT scan): The scan, with or without contrast dye, allows a series of detailed pictures of areas inside the body, taken from different angles.
  9. PET scan (positron emission tomography scan): In this procedure used to find malignant tumor cells in the body, a small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time (PET-CT).

Staging of Gastric Cancer

Staging for gastric adenocarcinoma is ranked 0 through IV and recurrent, meaning the cancer comes back after treatment. Most staging is done during diagnosis.

Prognosis

The prognosis (chance of recovery) depends on the following:

  • The stage of the cancer
  • Whether the cancer has spread outside the stomach
  • The patient’s age and general health
  • Whether the cancer has recurred.

Gastric cancer is best controlled before it has spread and can be removed by surgery. Clinical trials are a good option for getting the latest treatment.