Why a stomach cancer diagnosis is often delayed: people ignore early symptoms, doctors say
- Stomach cancer is slow to develop, with initial symptoms benign – strange hunger pangs and hiccups. Lower your risk with lifestyle changes
For many patients, a stomach cancer diagnosis comes as a shock.
You would not hesitate to see a doctor if you began to vomit blood, started to pass bloody or very black stools, or had really severe abdominal pain. All of these can be a sign of stomach cancer – but usually at an advanced stage.
Yet few people see a doctor about the common, though seemingly benign symptoms that may signal the early stage of this typically slow-developing disease.
A 55-year-old doctor in the US state of Nebraska recalls having unusual hunger pangs while trying to sleep between hospital shifts – and feeling hungry even though he knew he shouldn’t be. Eating did not quell his hunger.
He was diagnosed with stage 2 stomach cancer, and his is one of six stories of survivors posted on The University of Texas MD Anderson Centre cancer education website.
Even hiccups may be a sign of stomach cancer. They start when the nerves around the diaphragm becoming irritated. This can happen for a number of reasons, including the build-up of fluid in the abdomen and inflammation of the oesophagus – the long tube that carries food from the throat to the stomach.
A 62-year-old architect from Nevada had a sudden case of indigestion and developed a “weird hiccup” after eating too much, the University of Texas website recounts. He was diagnosed with stage 3 stomach cancer: there was a tumour the size of a golf ball at the top of his stomach.
Fatigue can be another symptom – but who doesn’t feel tired in today’s fast-paced world?
Hong Kong gastroenterologist Dr Choi Wai Lok describes the two primary types of stomach cancer, based on the tumour’s location. Cardiac stomach cancer is in the top part of the organ, near where it connects to the oesophagus, while non-cardiac stomach cancer is at other end of the stomach.
Reflux disease and obesity are risk factors for cardiac stomach cancer, Choi says.
About 4.4 billion people are estimated to have this bacteria worldwide. It is the cause of about 40 per cent of non-cardiac-type stomach cancers in the UK, Choi says, and notes that about half of Hong Kong’s population has it.
Between one and three people out of 100 who have this bacteria later develop stomach cancer.
The UK’s National Health Service urges eating no more than 70g (2.5 oz) a day of them if you cannot give them up altogether.
Some risk factors for stomach cancer are modifiable, while others are not, Choi says.
The modifiable risks are things you can do something about – you can stop smoking, cut down on your drinking, eat healthily and avoid smoked, preserved and processed meats.
According to the World Cancer Research Fund, stomach cancer is the fifth most common cancer worldwide, the fourth most common among men and seventh in women. In 2020, China had the third highest mortality rate from stomach cancer in the world.
Wong warns that sufferers might see no early signs of cancer, or experience only minor ones such as the bloating and discomfort you might experience with a peptic ulcer, say.
Choi says that often, stomach cancer symptoms are rather non-specific. This is the greatest danger: because it can be difficult to detect in its early stages – with symptoms being dismissed as common gastrointestinal problems – the cancer can spread beyond the primary site, making it more difficult to treat.
Wong says an endoscopy with biopsy is the “gold standard” for the diagnosis of stomach cancer. An endoscopic ultrasound is useful in understanding what stage the cancer is at.
A new screening test, he says, can detect the micro-RNA of tumours in a person’s blood sample. Micro-RNA comprises small molecules that help cells control the kinds and amounts of proteins they make.
Depending on the tumour’s location – and whether the stomach cancer has spread and if so, to where – treatment can involve surgery, radiation, chemotherapy, targeted therapy and immunotherapy.
Recent research has demonstrated a novel approach – and promising development – in the way chemotherapy drugs are administered. A study found that heating these drugs and administering them directly into a patient’s abdominal cavity meant they could receive a higher dose that achieves better results, destroying more cancer cells.
For most patients diagnosed with stage 4 gastric cancer, the median survival time is around 13 months, said surgical oncologist Dr Travis Grotz, the study’s lead author. However, using drugs in the manner described meant “more than half (55 per cent) of our patients are still alive three years after surgery”.
Studies suggest that deaths from stomach cancer may be declining in some parts of the world. The American Cancer Society reports that the number of new cases of stomach cancer – which for much of the 20th century was a leading cause of cancer death in the United States – has been dropping by about 1.5 per cent a year over the past decade.
But the incidence of stomach cancer in other parts of the world – especially East Asia – is rising, especially in people under the age of 50.
You can do as much harm to your gut eating the wrong sorts of foods, it turns out, as you can serve it well by eating the right ones.
