Understanding Gastric and GEJ Cancer
Gastric cancer, which is also called stomach cancer, is the fourth leading cause of cancer-related deaths worldwide. It begins when cells in the lining of the stomach grow in an abnormal, uncontrolled way. Gastric cancer often develops slowly over many years, starting with small changes in the stomach lining. If left untreated, these cells may form a tumor and spread to other parts of the body.
Risk factors for developing stomach cancer include being infected with a bacteria called Helicobacter pylori, smoking, following certain diets high in smoked or salted foods, having a family history of stomach cancer, and having some genetic conditions.
Gastric and gastroesophageal junction (GEJ) cancers can be too complicated for many health care providers to treat in North America. This is mainly because it can be difficult to diagnose in its early stages without the experience required to handle patients’ complete spectrum of care needs. It can also pose a problem for those living in rural communities, where diagnosis and treatment can be even more challenging.
Local doctors may rarely see stomach cancer, and the care it requires is complex. These factors can contribute to delays in diagnosis and reduced access to quality treatment, making it necessary to travel to larger hospitals or cancer centers for specialized care.
The stomach’s main job is to help digest food, and it rarely shows any signs or symptoms when stomach cancer is present in its earliest stages. But when stomach cancer really starts to grow, it can cause symptoms that may initially seem minor or overlap with other conditions, which adds to the challenge of early detection. This is why it’s important to check with the right doctor about symptoms that continue for more than a few weeks, especially since screening for stomach cancer is not currently routine in the United States. Signs and symptoms may include the following:
- Persistent stomach pain, heartburn, or indigestion
- A feeling of fullness after only eating small amounts
- Unexplained weight loss
- Nausea or vomiting
- Loss of appetite or trouble swallowing
- Fatigue or weakness
- Bloody stools (which may also appear black or tarry)
The Gastric and Gastroesophageal Junction Cancer Care Program provides clear, comprehensive guidance about the tests and exams used to accurately diagnose gastric and GEJ cancers. Through the program, patients receive detailed information on how these tests determine whether cancer is present and, if so, its stage. By offering this support, the program helps patients make informed decisions and ensures their care plan aligns with best practices.
Doctors use staging to describe how far the cancer has advanced. Determining the stage can help guide treatment decisions. With gastric cancer, it’s in an early stage when it’s only in the stomach lining. It’s in a locally advanced stage when it has grown deeper into the stomach wall or nearby areas. It is considered to be in an advanced or metastatic stage when it has spread to other parts of the body.
To properly diagnose and stage stomach cancer tumors, doctors use the following studies for evaluation:
Upper Endoscopy
To determine if a patient even has gastric cancer, a doctor will first perform an upper endoscopy. For this procedure, a small camera that is attached to a thin, flexible tube gets gently passed by mouth into the esophagus and stomach. This allows the doctor to carefully scan for any growths or areas of concern. If a growth or abnormal area is discovered, the doctor will take a tiny sample, which is also called a biopsy. From there, pathologists will review the sample to identify the nature of the growth or abnormal area.
Patients who have an upper endoscopy will be sedated and need to avoid food and drinks several hours before the procedure. Most spend 1-2 hours at the designated medical center for their upper endoscopy, which allows for check-in, preparation, and recovery after sedation. However, the actual procedure will only take about 10-20 minutes, even if a biopsy is needed. Biopsy results will be available several days later, and the doctor will go over the results at that time
Upper Endoscopy With Ultrasound (EUS)
If cancer is confirmed in the stomach from a previous biopsy, doctors frequently recommend a specialized endoscopy with ultrasound to evaluate the extent of the cancer. It allows them to see how deep the cancer goes and whether it has spread to any nearby organs.
Patients who have an upper endoscopy with ultrasound (EUS) will also be sedated and spend at least two hours at the designated medical center, which allows for check-in, preparation, and recovery after sedation. However, the actual procedure will only take about 20-30 minutes.
Laparoscopy
A laparoscopy is a minimally invasive surgical procedure that helps to check if the stomach cancer has spread to the lining of the abdominal cavity (also called peritoneal metastases). This information shows whether the cancer is resectable, which means it can be safely removed with surgery. Its results also help to guide the best treatment plan.
For this minor surgical procedure, the patient is put to sleep in an operating room under general anesthesia. So, food and drinks must be avoided several hours before it begins. During the procedure, a thin, flexible tube that is attached to a small camera called a laparoscope gets inserted into 2-3 small cuts in the abdomen to look inside and see if the cancer has spread. The doctor may also take fluid or tissue samples for further testing.
Most patients spend 3-5 hours at the designated medical center when getting a laparoscopy, which allows for check-in, preparation, and recovery after sedation. In some instances, an overnight stay is needed. However, the actual procedure will only take about 30-60 minutes.
Radiologic Imaging
CT scan. Along with the EUS, doctors may also recommend a computed tomography (CT) scan of the chest, abdomen, and pelvis. For a CT scan, patients receive a special dye through an IV that highlights the organs and shows the areas where the cancer may have spread. Patients should plan on spending up to an hour at the designated medical center for this imaging test, which includes checking in and receiving the IV. But the actual scan takes about 10-30 minutes.
PET scan. A positron emission tomography (PET) scan may be ordered to further assess the stage of the cancer. This is another type of imaging test that can show whether the cancer has spread to other parts of the body. For this scan, a slightly radioactive form of sugar that is known to collect in cancer cells is injected into the patient’s vein through the hand or arm. Though a PET scan is not as detailed as a CT scan or an MRI, it will show all the possible areas of the body where the cancer may have spread on one image. Patients should plan on spending about 2-3 hours at the designated medical center for this procedure, which allows the radioactive sugar to have time to travel through the body. But the actual scan takes about 30-45 minutes.
Once stomach cancer is finally diagnosed and staged, there will be many factors that must be considered. Facing a stomach cancer diagnosis can be overwhelming, especially in rural communities where resources may feel limited. Our program is built to help you navigate your journey and provide resources for you to better manage your condition.