after eating, and a sense of fullness after eating
only a small amount of food. Early stomach can-
cers often cause microscopic bleeding that a FECAL
OCCULT BLOOD TEST(FOBT) can detect. As the cancer
becomes more advanced, symptoms may include
- PAINin the upper left abdomen
- VOMITINGafter meals
- dyspepsia that does not go away with antacids,
eating, or medications to reduce acid in the
stomach - unintended weight loss
- blood in the vomit or in the stools, which may
manifest as “coffee grounds” or tarry stools - fatigue and weakness
The diagnostic path may include BARIUM SWAL-
LOW, upper gastrointestinal ENDOSCOPYwith biopsy,
and COMPUTED TOMOGRAPHY(CT) SCANor MAGNETIC
RESONANCE IMAGING(MRI). The biopsy confirms the
diagnosis and identifies the kind of cancer. The
pathologic examination of the tissue sample also
establishes the extent to which the cancer likely
has spread, called cancer staging. The cancer’s
stage helps determine treatment options and pro-
tocols (standards of practice), and expectations
about outlook (prognosis).Treatment Options and Outlook
The main treatment for nearly all stages of stom-
ach cancer is surgery to remove the cancerous
tumor, involved tissues, and adjacent structures
such as LYMPH NODESand fatty tissue. Surgery is
curative for stomach cancer detected very early
(stage 0). For stage 1, 2, and 3 stomach cancers
oncologists recommend CHEMOTHERAPYand RADIA-
TION THERAPY after surgery. The chemotherapy
drugs commonly used to treat stomach cancer are
5FU, cisplatin, epirubicin, and etoposide, which
the oncologist may administer individually (partic-
ularly 5FU for stage 1 cancers) or in combination
with one another.
The surgical options for stomach cancer include- endoscopic resection, in which the surgeon
removes the tumor and a safe margin of stom-
ach tissue endoscopically
stomach cancer 91BASIC STAGING OF STOMACH CANCERStage Meaning Treatment Protocol
stage 0 CANCERis in its earliest stages, completely confined endoscopic resection, partial GASTRECTOMY, or total
to the gastric epithelium (lining of the STOMACH); gastrectomy to remove the cancerous tumor
also called CARCINOMAin situ
stage 1 cancer involves the gastric mucosa but remains partial or total gastrectomy with removal of
confined to the stomach adjacent fatty tissue and lymph nodes
stage 2 cancer extends into and beyond the MUSCLElayers of partial or total gastrectomy with extensive removal
the stomach and may involve up to 15 adjacent of adjacent fatty tissue and lymph nodes
LYMPH NODES RADIATION THERAPYor CHEMOTHERAPY; occasionally a
combination of both
stage 3 cancer extends beyond the stomach into adjacent total gastrectomy with extensive removal of
lymph nodes and nearby organs such as the SPLEEN, adjacent fatty tissue and lymph nodes
LIVER, PANCREAS, or intestine surgery to remove tumors in other organs
radiation therapy and chemotherapy
stage 4 cancer has spread from the stomach to other organs palliative surgery, chemotherapy, or radiation
throughout the body therapy to relieve symptoms, obstruction, and
bleeding that may occur