How to diagnose stomach cancer

Modern medicine knows exactly how to define stomach cancer because it has many methods that allow differential diagnosis and detect a tumor at an early stage of development.

The patient can not independently exclude this diagnosis, as there are no specific symptoms that accurately indicate the presence of pathology. The disease can also manifest as atrophic gastritis, ulcers and other diseases of the intestinal and gastric tract. In order to recognize the cancer of the stomach, it is necessary to undergo a series of studies.

What allows to suspect the development of the oncological process

Diagnosis of stomach cancer begins with assessing the patient's complaints, studying the history of his illness and family history, primary examination. It is possible to suspect the disease already at the primary reception, especially if the patient has been diagnosed with other diseases of the gastrointestinal tract, which can be a factor in the development of oncology, and if the symptoms differ from those that were chronic.

Malignant tumor of the gastric mucosa is manifested by lack of appetite, weakness, weight loss, pain in the area of ​​the xiphoid process, nausea and vomiting, impaired swallowing, flatulence, gastric bleeding. But at an early stage of the disease, clinical symptoms are rare, more often gastric carcinoma is suspected when the tumor sprouts into the submucosa.

In the late stage of oncology, the appearance of the patient changes( the face becomes earthy in color, the sclera slightly turns yellow, the skin is dry, the eyes are dull, and there is no subcutaneous tissue).These symptoms are not specific and can occur with various diseases of the gastrointestinal tract, so the diagnosis can be confirmed only after receiving the results of a biopsy.

During the palpation of the stomach, the doctor can detect the tumor, of course, if it is already large enough( more than 2 cm).If the tumor is still small, and the tissue stratification is insignificant, then it will not be able to feel it. Palpation should be performed several times: when the patient is standing, lies on his back, and also in the position on the left and right sides.

It is impossible to palpate the tumor on the back of the stomach, as well as if it is deep in the hypochondrium, or because of abdominal obesity. If the tumor is probed, it does not always mean that it can not be surgically removed.

After a preliminary examination of the patient, laboratory and hardware studies are appointed, which will allow an accurate diagnosis. Difficulties in differential diagnosis appear only if the tumor grows in the submucosa layer.

Methods for diagnosis of stomach cancer

Diagnosis of stomach cancer includes the following studies:

• gastroscopy with biopsy sampling;
• radiograph of the stomach;
• abdominal ultrasound;
• study for oncomarkers;
• fecal occult blood test.

Diagnosis of stomach cancer begins with a laboratory blood test. This is the first stage, because it is the simplest. With oncology, the hemoglobin level is significantly reduced due to internal bleeding, the erythrocyte sedimentation rate is also increased, the number of red and white blood cells varies.

Biochemistry of blood shows the level of protein, immature element cells and mutating cells. Further, the presence of cancer markers in the blood is determined. It is impossible to diagnose an oncology for blood analysis, however, the study makes it possible to determine the need for further research.

The diagnosis of "stomach cancer" is based on the histological examination of the tumor. Gastroscopy is performed to detect a tumor, determine its size and surface character, and also to collect a biopsy specimen. The remaining studies allow to establish the stage of development of the disease and the presence of metastases in the lymph nodes and in other organs and tissues( pancreas, small intestine, lungs, liver).

Gastroscopy

When gastroscopy can visualize the mucosa of the esophagus and stomach, take a material to study the acidity of gastric juice and the presence of Helicobacter pylori infection, as well as for histochemical and cytological analysis. The study is carried out using a flexible tube( fibroesophagogastroscope), which is introduced into the stomach through the mouth.

With gastroscopy, it is possible to dissect strictures, moxibustion, removal of polyps and foreign bodies

In the presence of cancer cells on the gastric mucosa, the concentration of hydrochloric acid in gastric juice decreases. This leads to the fact that the food is longer digested and the patient's weight decreases. The study shows that the gastric juice has a high pH level. However, this pathology can be observed with hypoacid gastritis, but the presence of protein confirms the presence of the tumor.

The patient is placed on the couch on the left side, the oropharynx is anesthetized, then the mouthpiece is inserted and the endoscope is inserted into the pharynx, then into the esophagus and stomach. For a better view of the body, portions of air are delivered to the stomach, which spreads the folds, and also suction of gastric juice and mucus.

In turn, starting from the subcardial department, the inner surface of the stomach is inspected. With cancer of the stomach, the mucosa is not pale pink, but grayish white, while the mucosa of the posterior wall is smoothed. When a tumor is found from different parts of it, the tissue for histological examination is plucked.

The procedure is contraindicated in patients with severe esophageal stenosis, chemical burns of the esophagus, phlegmous esophagitis, aortic aneurysm, hemorrhagic diathesis. Also, the conduct of gastroscopy is questionable if the patient has a strong deformity of the spine, a large goiter, cardiopulmonary insufficiency, hemophilia, mental disorder.

Definition of tissue type

Material taken during gastroscopy is sent for histological examination to find out the type of tissue. In the laboratory, a specialist under a microscope examines the sample and makes a pathological conclusion, which indicates the tissue structure, size, type of cell growth.

To distinguish a benign tumor from a malignant one is possible only after studying a biopsy under a microscope

Benign and malignant tumors have a different structure. Benign tumors are the same structure as the organ from which they were taken. Cancer tissue, as a rule, does not have a capsule, so its growth is rapid.

The second sign of cancerous tumors is its simpler structure( specific function and differentiation are lost).There is also a large number of mitoses. When diagnosing gastric cancer, only positive histology results are taken into account, since negative ones do not indicate the absence of a tumor.

Additional studies of

Since the clinic of stomach cancer is not specific and manifests itself even with a significant tissue damage, more than 70% of patients learn about oncology only after the onset of III or IV stage of the disease. But it is possible to recognize stomach cancer earlier, if you periodically undergo a preventive medical examination.

If a tumor is detected at stage 0 or stage 1, when there are no metastases yet and it does not grow into the submucosa, it is likely that the entire cancerous tissue will be surgically excised. According to statistics, stomach cancer is more often affected by men than women, tumor growth usually begins at the age of 40-70 years.

Predisposing factors include Helicobacter pylori infection, smoking, chronic and atrophic gastritis, peptic ulcer, pernicious anemia, stomach surgery, gastric adenoma and genetic predisposition. Therefore, this category of patients should more closely monitor their health.

Radiography

Since gastric cancer quickly metastasizes, it is necessary to check other organs that may be involved in the pathological process. Increased mediastinal lymph nodes and lung metastases can be determined by lung radiography.

On the roentgenogram, there are hidden leaky infectious, inflammatory, tumor, dystrophic processes. With neoplasms in the picture, cavities are noticeable. If a tumor is detected, further diagnosis is required.

Contrast radiography of the stomach allows you to see the outlines of the tumor. The examinee is given a drink of a contrast agent( barium), which fills the organ and allows to assess the structural features of the walls of the stomach and functional characteristics. With a tumor in the picture, defects in the walls of the organ and their structural changes are visible.

US

Ultrasound of the abdominal cavity makes it possible to ascertain the spread of the tumor process. Scanning of the parenchyma of the liver, pancreas, gall bladder and its ducts, spleen, as well as retroperitoneal space and vessels, allows to evaluate their internal structures, contours, location, besides, it allows to detect the presence of fluid, inflammation, neoplasm or damage.

ultrasound can detect cancer before the onset of clinical symptoms, and also clarifies the dynamics and nature of the changes, so it evaluates the effectiveness of treatment, determines complications. In the diagnosis of gastrointestinal diseases, the accuracy of the study is 98-99%, but additional tests are required to refine the data.

When preparing for ultrasound for several days, you need to adhere to a diet that will help reduce gassing in the intestine

To eliminate flatulence, can be prescribed the intake of enzymes or preparations that reduce fermentation. It is necessary that the air in the digestive tract does not worsen the visualization.10-12 hours before the study should refrain from eating.

Tomography

Multislice computed tomography( MSCT) or positron emission tomography( PET) can also be used for detailed visualization of the tumor. MSCT visualizes the liver, pancreas, lymph nodes, spleen, abdominal vessels, gall bladder in two- and three-dimensional space, and using a large number of detectors makes it possible to reduce the dose of radiation and accelerate the study, while increasing the resolution of the image.

With PET, radioactive glucose is introduced into the body, which accumulates in the tumor cells and allows visualization of the malignant process that has gone beyond the boundaries of the stomach. The examination allows you to diagnose stomach cancer at an early stage.

Definition of oncomarkers

During the laboratory blood test, specific specific oncomarkers are searched. These are special substances( enzymes, hormones, antigens, proteins) that are synthesized in cancer cells and released into the bloodstream. Detection of these substances allows at an early stage of the process to suspect the presence of a tumor.

In the diagnosis of gastric cancer, the CA19,9 marker is significant( it is found in stomach and pancreatic cancer), and since the tumor quickly metastases, the presence of a marker of liver cancer( AFP) and lung cancer Cyfra 21-1 is also checked.

The normal value of the glycoprotein is CA19.9 to 34 U / ml. An increase in this indicator is characteristic of pancreatic carcinoma( in 70% of cases), less often the level of antigen increases with cancer of the rectum, liver, stomach, gall bladder, bile ducts, ovaries, but can also increase with inflammation of the liver, pancreas or biliary tract.

The level of the marker up to 150 U / ml can reach patients with hepatitis, cholecystitis, cirrhosis, pancreatitis, cystic fibrosis, cholelithiasis. There is not always a link between the number of markers in the blood with the size of the tumor, so the diagnosis of greater concentration changes over time, because it allows you to determine at an early stage a relapse or beginning of metastasis, and also progresses cancer or represses.

To determine the concentration of oncomarkers, venous blood from the ulnar vein is taken. Special preparation before the analysis is not required, but it is recommended not to eat 3-4 hours prior to blood donation and not to smoke for half an hour. The results of the study will be ready the next day.

Detection of oncomarkers does not mean the presence of cancer, but only speaks about its possible development.

Study of feces for latent blood

The study of feces for occult blood helps in determining the latent gastric bleeding. Normally there is no blood in the excrement, but with the development of pathological processes, for example, varicose veins of the esophagus, polyps in the intestine, ulcer, neoplasm, bleeding begins.

The fact is that the vessels on the surface of the tumor are fragile and are injured by mechanical action, but not always hemoglobin in the feces is so much that the color of the feces changes. The study of feces for occult blood helps to detect GI tract cancer at an early stage, which means that the prognosis for recovery is more favorable.

Laparoscopy

Diagnostic laparoscopy allows a more detailed examination of the tumor and allows to determine whether it can be removed surgically. The physician visually determines the level of tumor germination, see if there is ingrowth into neighboring organs. During the operation, if necessary, a biopsy specimen is taken for histological examination.

This diagnostic method is especially valuable in complex diagnostic cases. The choice of treatment tactics depends on the stage of the disease, the magnitude of the tumor, the degree of damage to other organs and lymph nodes, general immunity and concomitant pathologies. In therapy, three methods are used: stomach surgery( complete or partial resection), radiation therapy and chemotherapy.

These methods are most often combined. Early diagnosis of gastric cancer increases the chance of a favorable prognosis, so do not ignore the often occurring dyspepsia and preventive medical examinations.