Diagnosis and Prognosis of Stomach Cancer

]]> Review of Medical History

Your doctor will ask you about the symptoms you’ve been experiencing, as well as:

• Medical history (concentrating on various medical conditions or previous surgeries that may increase your risk of developing stomach cancer)
• History of tobacco and alcohol use
• Dietary intake
• The presence of stomach cancer or other associated conditions in your family
• Any occupational exposures you may have had

Physical Exam

Your doctor will perform a complete physical examination, concentrating on the abdominal exam. He or she will check whether you have any of the following:

• Tenderness or discomfort during the exam
• Free fluid within the abdomen
• Masses that can be felt
• An enlarged or abnormally hard liver

Testing

Further testing to help with the diagnosis includes the following:

]]> Cytology

Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.

In the case of stomach cancer, cytology involves looking at cells in fluid or from a thin needle biopsy, under the microscope. The pathologist may be able to make the diagnosis of cancer with this small sample and may be able to tell your doctor the specific type of cancer and how aggressive it may look.

Staging

Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (eg, surgery or chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0-1) imply a favorable prognosis, whereas high staging classifications (4-5) imply an unfavorable prognosis.

Staging of stomach cancer cells considers several factors:

• How deeply the cancer cells have penetrated the layers of the stomach
• If cancer is present in the lymph nodes surrounding the stomach
• If there are cancer cells in neighboring organs and tissue
• If cancer has invaded distant organs or tissues within the body

Tests used to stage stomach cancer include the following, which may be done in your doctor's office or at an outpatient clinic:

• Blood tests —Blood tests can reveal symptoms of cancer or its spread, such as a nemia]]> or problems with liver function.
• ]]>Chest x-ray]]> —A chest x-ray is a series of standard x-ray images of your chest. It is important to examine the lungs for metastatic cancer.
• ]]>Abdominal computed tomography (CT) scan]]> —An abdominal CT scan can reveal the following:
  • Presence of a tumor
  • Lymph node enlargement, which may be a sign of cancer spread
  • Abnormalities in other organs or tissues throughout the abdomen that might indicate metastases
• Pelvic computed tomography (CT) scan —A pelvic CT can demonstrate metastatic spread of stomach cancer by identifying any of the following:
  • Enlarged lymph nodes
  • Presence of tumors in the ovaries or other organs
  • Other tissue abnormalities
• Endoscopic ultrasonography —An endoscope (thin, flexible, lighted scope) is passed through the mouth, down the esophagus, and into the stomach and intestine. A tiny ultrasound unit at the tip of the endoscope bounces sound waves off of the adjacent organs to generate ultrasound images of the intestinal tract and surrounding tissues.
• ]]>Laparoscopy]]> —Tiny incisions are made in the abdomen, allowing a scope to be passed into the abdomen. Your doctor can use this scope to examine the lining of your abdomen (peritoneum) and your liver, as well as other abdominal organs and tissue. Tiny tools can be passed through the laparoscope to take biopsy samples; the tissue samples will be checked for cancer cells.
• Peritoneal lavage —Saline solution (salt water) is washed through your abdomen and then suctioned out. The saline is then examined under a microscope for the presence of cancer cells.

Prognosis

Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages.

Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation.

Most patients (about 66%) are at Stage III or Stage IV at the time of diagnosis. The remaining 34% are evenly divided between Stages I and II. Because stomach cancer is usually at a relatively advanced stage at the time of diagnosis, only about 22% of patients with stomach cancer survive for five years after diagnosis.

Survival rates for patients who are diagnosed in the earlier stages of stomach cancer depend in part on the location of the stomach cancer. The five-year survival rate for patients who have cancer in the part of their stomach closest to the esophagus is 10% to 15%. The five-year survival rate for patients who have cancer in the part of their stomach closest to the intestine is about 50%.