Symptoms and diagnosis of gastric cancer
Well, what about symptoms and diagnosis of gastric cancer? With most GI cancers the symptoms of the tumor are either related to bleeding, since all GI cancers, all carcinomas of the GI tract, begin in the mucosa. So you can get irritation in the mucosa, ulceration, what have you, and bleeding. Or the other symptom is an alteration of function. What kinds of alterations of functions can you have? Well, if you have a cardioesophageal junction lesion you can have obstruction. If you have a big lesion in the stomach, you can have early satiety if the stomach is half full of tumor so it doesn’t fill with food very well. And if you have a distal gastric cancer you can have gastric outlet obstruction. So bleeding and symptoms of obstruction or early satiety are the common things that people feel. Now the kind of bleeding you get with adenocarcinomas of the stomach is rarely if ever exsanguinating hemorrhage. If you have somebody who is bleeding massively in the ER in the upper GI tract, they are bleeding from ulcers, they are bleeding from gastritis, they are bleeding from varices, but they are not bleeding from adenocarcinoma of the stomach. There is one tumor of the stomach that will bleed massively and that’s leiomyosarcoma. Of course to make things interesting for people taking the Boards, we have changed the name of leiomyosarcoma in the last four or five years to gastrointestinal stromal tumor, so GIST. But those are the tumors that can bleed massively. If you look at the frequency of symptoms, and this has to do with early diagnosis, they are relatively non-specific; some weight loss, some abdominal pain and it’s not a direct, specific symptoms of gastric cancer. In my experience, nausea, sort of unexplained vague nausea as an early symptom is a common symptom. When you talk to people who have been diagnosed with gastric cancer and you find that they sort of modified what they ate. Sometimes they changed the timing of their meals because they sometimes felt a little bit nauseated after meals.
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This is just an endoscopic ultrasound just to show you an ultrasound of the stomach. Because this is an increasing important technique used in managing patients with gastric cancer, it becomes particularly important because, as you will see, we are beginning to use a fair amount of neoadjuvant therapy. When you use neoadjuvant therapy you have to have some monitor of how effective the treatment is going to be. You also want to know what you are starting with. This endoscopic ultrasound just shows you the various layers of a normal stomach. Endoscopic ultrasound is very effective at staging the tumor. The next is an esophageal picture with the tumor here disrupting the layers of the mucosal and submucosal layers of the esophagus. But it’s very effective at staging, so you see endoscopic ultrasound used quite frequently. And of course in other GI situations, like when you are looking for the conservative therapy of rectal cancer, endoscopic ultrasound is very useful in tumor staging.