Clinical symptomatology and diagnosis of stomach cancer

Symptoms of stomach cancer is characterized by its complexity, great diversity and seldom simple. Especially poorly expressed symptoms of cancer in the early stages of its development. In this period of stomach cancer can occur quite often asymptomatic or only with such phenomena on the basis of which it is difficult even suspect. It should be remembered that in many cases the development of stomach cancer may be preceded by long the symptoms of chronic atrophic gastritis, peptic ulcer or polypous diseases that occur in cancer. Often found stomach cancer with a completely atypical clinical course.
The symptoms of stomach cancer and the nature of their depend on many factors: the location of the tumor, the morphological features and character of its growth, involvement in neoplastic changes related bodies, from opportunistic diseases and complications and on the degree of disability of the whole organism, i.e. from the circumstances listed in part in the classification scheme.
The most characteristic clinical signs of stomach cancer are:
1. The pain in epigastralna area. It sometimes is in the nature of "crisis" and causes the patient to use immersion heaters.
2. The weight loss. Often first, no matter how reasoned.
3. Loss of appetite. As single sign it is only a short time.
4. Vomiting (sometimes mixed with blood). Rarely early in the disease, often repeated.
5. Bleeding is manifested vomiting with more or less abundant blood and tarry stools. Repeated bleeding accompanied by progressive weakness, repetition of "black stool". Sometimes it may have been loss of consciousness. From the adopted urgent measures (blood transfusion, use of cold and others) stop bleeding is easier than stopping bleeding from stomach ulcers.
6. The increased body temperature. It is approximately 33% of cases, but not as an early sign.
7. "Unreasonably" diarrhea. She later followed by vague manifestations on the part of the stomach.
8. Back pain. They mostly occur when the tumor invasion and often in the pancreas (suspected sciatica, appointed physiotherapy, most of them leading to the acceleration of growth).
9. Pain in the heart area. They can occur early in the disease and are reflex nature.
Localization of cancer of the stomach is usually clearly affects its symptoms.
In cancer of the pyloric suffers motor activity of the stomach, then the clinical picture is beginning to feel ROSLEASING stenosis of the output section of the stomach.
If the cancer affects the lesser curvature of the stomach also have the reflex of vomiting and regurgitation that appear soon after a meal and are not accompanied by delay gastric contents for a long period.
When a tumor is located in the cardiac portion of the stomach of direct its symptoms can for a long time and not to be. If the tumor is distributed under the cardia, takes her all over and tends to move to the esophagus, you begin to act symptoms difficulty in passing food (dysphagia). To this may be reinforced salivation, reflex regurgitation of food, and then hiccups associated with the contraction of the diaphragm, due to irritation of the phrenic nerve. Then, later, appear dull pain in epigastralna area, associated with the transition of the tumor to adjacent organs or developed inflammatory process. Appears anorexia, the total weight with the fall of the weights, the disappearance of fatty tissue, dehydration, loss of elasticity and skin dryness, i.e., are all signs of malnutrition, and then and cancer cachexia. No physician must not forget that the cancer cardiac zone stomach very often takes place under the form stenocardicakih attacks and there are cases of late detection of this cancer when changes in the heart and blood vessels and will not be found. This applies particularly to patients in whom, in spite of seeming pectoris, you cannot identify the other convincing signs of cardiovascular disease.
When cardialna-esophageal cancer develops from squamous epithelium (as if from the epithelium of the esophagus), clear signs of esophageal cancer (dysphagia)may not be. Dysphagia in such cases is the leading symptom of late, when the eversion of the edges of cancer development in this place scars. The General condition of the patient long as it is not suffer, and appetite may also be a long time saved.
In cases where cancer of the cardia develops from dystopia gastric epithelium on the edge of the esophagus, the tumor long-does not manifest; dysphagia arrives late or it does not happen. Long asymptomatic the development of this cancer can suddenly change the picture of neglected diseases.
Cancers of the body of the stomach, located on the front and back his sides and at the greater curvature, can often develop into "dumb"form, i.e. long exist without separate gastric symptoms. On the foreground can be General disorders: how would causeless anemia, weakness, fatigue, swelling, mental depression, independent from loss of blood, oxygen starvation and metabolic disorders. This period coincides with the collapse of the tumor; temperature can increase and intensify intoxication. Local symptoms such localization occur when the tumor reaches the output or input sections of the stomach or if she goes to the adjacent organs. Then comes the pain (in the back area, the zone of the xiphoid process, the left hypochondrium, the girdle, and so on).
Cancer of the fundus of the stomach may long be asymptomatic and begin to emerge during the transition to the diaphragm, the pleura, etc. Appeared pain sometimes mistaken for neuralgia, and if the doctor will not be subject to the examination of the patient in order to view stomach cancer, it is often installed already running period of the cancer.

Symptoms of stomach cancer can vary its growth. Exophytic growth, often despite extensive hilly tumor from the front or back wall, not from small curvature, there is only few local characteristics. Blood loss, anemia, weakness appear later. With this type of tumor growth often have a fever and intoxication due to the propensity to ulceration, infection, thrombosis and extensive decay. In the clinical course of cancer of the cardia exophytic tumors with growth cause dysphagia earlier.
Tumor endophytic, ulcerative-infiltrative growth, emerging on the background of chronic gastritis, peptic ulcer disease, or polyps, early manifested local symptoms characteristic pattern of gastritis or peptic ulcer disease. Appeared dull pain, regardless of the meal then increase with the intake of food and can irrationality, but soon joins reflex vomiting, regurgitation, because these tumors are most often develop in the output section of the stomach.
Tumors with diffuse-infiltrative growth, which include serosnye cancers (linitis plastica)are secretly for a long time without local gastric symptoms. Growth is
in the thickness of the gastric wall with a massive development of fibrous tissue. The patients have an increased appetite ("polemicheskie" form), the saturation of the missing, as the gatekeeper gaping, free food "fails". Progresses weight loss patients, there are frequent "unreasonably" diarrhea.
Also can occur asymptomatically, and some diffuse-infiltrative forms colloidal stomach cancer.
In addition, W. X. Vasilenko and M. S. Melikova (1964) classify pervichnuyu stomach cancer. When it occurs ulcerative syndrome of different duration characteristic remissions. "Niche" in these cases, neither radiologically or endoscopy is often indistinguishable from "niche" normal ulcers. The diagnosis to be confirmed only histologically, and clinically suspicious about this form of cancer occurs on the basis of a special relationship between subjective and functional symptoms, on the one hand, and the dynamics of the x-ray picture in the process of therapeutic treatment. This once again confirms the need to consider each of chronic ulcer of the stomach as the process that may potentially turn into cancer.
On the features of structure and growth of the tumor separate form with the typical characteristics. These include: stenosing cancer, saucer-like cancer, hourglass, abdulrosa form, linitis plastica etc.
Stenosing cancer in their clinical course reminds cicatricial stenosis diagnosed radiographically. Localize it in the output section of the stomach in gatekeeper, less often at the cardia. Clinically at the location of the cancer at the exit from the stomach, there is stenosis it from the extension of the stomach. This benign narrowing in connection with the former ulcer difficult to distinguish from stomach cancer. These cancers early metastasize to lymph nodes near the stomach and the liver.
Stenozirutaya form of cancer in the field of the cardia is less common. In this form there are dysphagia and supersteetion expansion of the esophagus. This more fibrous cancer (scir), quickly metastatic to the nearest lymph nodes and liver.
Cancer type "hourglass" is characterized by strong development of scar tissue. It is located in the middle section of the stomach is often caused ulcers, which itself has caused such a strain on the lesser curvature. The same changes can lead and stomach cancer on the large curvature, when it is accompanied by an abundance of scars. The clinical picture is characterized by rapid saturation, delayed food, vomiting. Tumors these relatively rarely metastasize.
Abdulrosa form of cancer is rare. Cancer grows from the mucous membrane ekzotichna and quickly, filling the stomach cavity, breaking the evacuation from it. Diagnosed easy wall of the stomach will not germinate.
The form of " creeping" of cancer developing in the submucosal layer. Clinical symptomatology it corresponds atrophic and rigid gastritis, so in such cases shown laparotomy, gastronomia and biopsy. Clinically and radiologically diagnosis very difficult.
Its for this cancer seems more benign, but in fact it behaves like infiltrating tumor, as Scherr, gives distant metastases, and after surgery or quickly begins cancer contamination, or a relapse occurs at the place resection or anastomosis.
Linitis plastica flows differently, both malignant and benign. The process extends up to the esophagus, and down, in the duodenum. As a rule, this skirr often recognized by the presence of cancer (lung, bone). With this variety of tumors of the stomach turns into nastradamus tube S. dehiscence gatekeeper, and the food in the stomach is not delayed. Symptoms diseases of the poor, and therefore the diagnosis is often delayed.
Saucer-like form of stomach cancer is localized on the lesser curvature with frequent switching to the walls of the body. Have a large ulcers with raised and turned edges. Although the extent of this tumor are and large, it spreads late. Clinically this form of stomach cancer is detected too late, because the symptoms of her meager.
Types of stomach cancer occurs flat cancer. It is characterized by its malignancy, sooner grows to serosa stomach and spreads to the abdominal membrane, causing carcinomatosis with the development of ascites.
Stomach cancer node type refers to its exophytic forms. In the tumor site is fast developing rot decay, often hidden bleeding. The tumor quickly spreads to the adjacent organs and tissues and are very prone to early and multiple metastases.
Very well mapped features of gastric cancer in the table Stevenson (1963) (table. 3).

Comparison of pathological changes in stomach cancer (Stevenson)
Common (23%) poliploidnye or Fonsny cancer Penetrating (27%) of the ulcer cancer Infiltrating (13%) on a broad basis or common cancer Not included in the classification (37%), as insufficiently clarified
In 70% in the cardia or in the bottom of the stomach 60% on the lesser curvature or preprocessor Department In 90% in preprocessor Department or the body of the stomach 50% of all cancers of the stomach in preprocessor Department
The degree of differentiation
In 70% of well-differentiated adenocarcinoma 50% moderately differentiated adenocarcinoma In 60% of the fully non-differentiated adenocarcinoma  
The defeat of the regional lymph nodes, combined with macroscopic features
65% are affected lymph nodes at the time of surgery (Koller - 60%, Ecker - 70%) 75% are affected lymph nodes at the time of surgery (Koller - 66%, Ecker - 90%) 85% are affected lymph nodes at the time of surgery (Koller -95%, Ecker -62%) In 75% of all cases of stomach cancer there are already metastases in lymph nodes by the time of the operation (Koller)
The affected area of the lymph nodes
I-23,8%; II -47,6%; III-19,1%; IV -9,5%. In 25% of affected only one host group. In 41% of the damaged two groups of nodes I - 22,2%; II - 33,3%; III - 44,5%; IV - 0 I - 3,6%; II -35,7%; III - 21,4%; IV - 39,3%. In 60% of the damaged three or four groups of lymph nodes  
Note. When lymph nodes only 8% of patients operated radically, live 5-10 years. In the absence of lymph nodes 35% of patients live 5-10 years.

Hidden occurring cancers of the stomach sometimes manifest themselves in sudden appearance of distant metastases, for example in supraclavicular lymph nodes (Virchow) or in the navel, or in the ovaries in the form of so-called tumor of Krukenberg. Gastrointestinal complaints may be absent or to be very small.
Listed above are the symptoms of stomach cancer cannot be considered early. Earlier detection of cancer of the stomach is possible, if to take into account so-called "syndrome of small signs". These include:
1) appeared an old man for the last time as if without cause weakness, fatigue, loss of ability to work;
2) reduction or complete loss of appetite, aversion to food or certain kinds of food (meat, fish);
3) phenomena "gastric discomfort, loss of feeling of satisfaction from eating and saturation combined with simultaneous feeling of fullness, the feeling of heaviness and pressure in podlojecna area (though not eaten so much), dull pain in the area of the stomach with simultaneous belching, and sometimes vomiting. Reducing the amount of food absorbed, patients become "capricious" in her choice, start to suffer from excessive salivation, spastic contractions in the stomach. In some cases they have dysphagia and pain, in particular the dissemination of the tumor in cardio;
4) progressive weight loss for no apparent related stomach disorders;
5) persistent and progressive anemia, pale skin, sometimes with a yellowish shade;
6) for mental depression, loss of interest in the environment, labour, apathy and alienation.
Such "small" symptoms may develop or among full health, or appear in patients suffering from long time chronic gastritis, a stomach ulcer and a long time already adapted to the disorders of the stomach. As a result, they pay little attention to some matter how insignificant new symptoms, the occurrence of which indicates a change of the very essence of the pathological process that already have cancer.
Diagnostics of a cancer of a stomach practically useful when it is early. However, at this time no less than 30% of patients with gastric cancer, proceed to surgery in advanced stages of the disease.
Timely diagnosis of stomach cancer is primarily a wide prophylactic medical examination of population and dispensary observation of patients suffering from the so-called "pre-cancerous diseases."
Clinical monitoring of patients with precancerous diseases of the stomach allow you wrote N. N. Elansky (1963), divide them into 2 groups: the first group is 1/3 of patients with cancer of the stomach; they have no history of gastrointestinal disease, it is evident from the appearance of cancer; the other group consists of 2/3 of patients with gastric cancer; they have gastric disease (stomach ulcers, polyps, chilijski gastritis), which develops a tumor of the stomach.
Carefully assembled history is often very important in the diagnosis of gastric cancer. This is important if not for diagnosis, at least for suspicion about the cancer. The doctor should attract the group relatively early symptoms, known under the General name "gastric discomfort".
Palpation of the abdomen at four locations, feeling the liver, supraclavicular areas, including a digital rectal exam is an integral element of a clinical study patient. For the diagnosis of gastric cancer, undoubtedly, it is important to identify any "cancerous triad" - "stomach discomfort, loss of appetite and weight loss. All this should be supported by additional methods of examination.