Stomach/Gastric Cancer

Detecting gastric cancer

March 29, 2021 Word for Word Media 0Comment

Dr Ria David sheds insight on gastric cancer, how it’s detected and the treatment options available.

Gastric cancer stats and facts

Gastric (stomach) cancer represented the 16th commonest cancer in women and the 11th commonest cancer in men, in 2017, according to the National Cancer Registry. 

Most patients with gastric cancer have symptoms on presentation to their doctors. Despite advances in modern oncology, about half of these patients 

will have disease that extends beyond the locoregional (limited to a local region) territory, and only approximately half of the patients who present with locoregional disease are curable by surgery. 

Early-stage disease that is curable by surgery is sadly detected in few individuals and is most frequently detected as an incidental finding when endoscopy or CT scan is done for another reason. 

Screening programmes aren’t feasible in most parts of the world, except in regions with high incidence and prevalence of gastric cancer, like Japan, Korea, Venezuela and Chile. 

Common symptoms of locoregional disease:

  1. Abdominal pain or discomfort.
  2. Reflux symptoms and nausea.
  3. Early satiety (feeling full after eating relatively little).
  4. Dysphagia (difficulty in swallowing).
  5. Bleeding which may be obvious (vomiting up blood) or occult (passing microscopic blood which may cause blackening of the stools, referred to as melena).

Once gastric cancer has spread to other sites in the body the following symptoms may appear:

  1. Decreased appetite and weight loss. 
  2. Fatigue.
  3. Abdominal swelling due to ascites (fluid in the abdominal cavity).
  4. Liver enlargement with or without jaundice.
  5. Enlarged lymph nodes, especially in the left neck (Virchow’s node).


Investigations that may be performed in suspected cases of gastric cancer include the following:

  1. Blood tests may be helpful in identifying blood loss (anaemia), liver- and kidney dysfunction, and low albumin.
  2. Endoscopy refers to a camera that is inserted through the mouth up to the level of the first part of the duodenum (small bowel). It’s usually done, under sedation, by a surgeon or medical gastroenterologist. Tumours and other abnormalities can be identified in the oesophagus, stomach and first part of the duodenum. Biopsies may be taken at the same time.
  3. Endoscopic ultrasound can be helpful in assessing depth of tumour invasion and to assess regional nodes which may be biopsied at the same time.
  4. CT scan is usually offered to all patients to assess disease extent, identify sites of spread and to assist in staging. 
  5. PET imaging has sparked some debate among various academic bodies. It’s more sensitive than CT scan and can be useful in staging some patients with early disease who are potential surgical candidates.
  6. Histology refers to laboratory analysis of biopsy samples to confirm the diagnosis of gastric cancer and to look for biomarkers which may make a patient eligible for particular treatments, e.g. monoclonal antibodies or immunotherapy. 
  7. Laparoscopy is used to rule out peritoneal deposits (on the internal linings of the abdomen). CT and PET imaging can miss up to a third of peritoneal deposits especially if these are <5mm. In patients who may be eligible for curative surgery, it’s important to rule out peritoneal disease prior to definitive treatment. 
  8. Tumour markers are unreliable in making a diagnosis of gastric cancer and aren’t recommended in the routine workup.

Planning treatment

Once patients are fully investigated, the next step is to discuss all cases at a multi-disciplinary meeting to determine the best course of management. 

Some patients with locoregional disease may be eligible for upfront surgery. However, a significant proportion of patients benefit from neoadjuvant chemotherapy (given prior to surgery) to shrink tumours and to render them operable. 

Patients with locoregionally advanced disease who aren’t eligible for surgery, and those with metastatic disease (cancer spread to distant sites) are eligible for systemic therapy aimed at prolonged survival and enhanced quality of life. 

Novel therapies, like immunotherapy, have greatly improved the general outlook and life expectancy. However, there remains no cure for these patients.

Radiotherapy may be considered in some cases where the response to chemotherapy hasn’t been optimal or in specific situations requiring palliative treatment, e.g. bleeding, severe pain. 

Future research is focused on the optimal chemotherapy combinations, defining the role of radiotherapy and exploring the effect of treatment timing. Several clinical trials are ongoing in this regard.

Dr Ria David


Dr Ria David is a medical oncologist and specialist physician with special interests in breast-, colorectal- and haematological malignancies. She works at Oncocare at the Durban and Umhlanga offices and serves on the executive committees of the Durban Breast Cancer Forum and the Cardio-Oncology Society of Southern Africa. 

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