Clinical manifestations of gastric cancer

Clinical manifestations of gastric cancer
Clinical manifestations of gastric cancer

(1) Symptoms

When micro-cancer or early-stage cancer is present, there are usually no obvious subjective symptoms clinically. As the lesion develops, the tumor grows, bleeds, and affects gastric function or the overall condition, resulting in varying degrees of subjective symptoms. However, these symptoms are not unique to gastric cancer, and their manifestations are often similar to those of gastritis, gastric ulcers, or upper gastrointestinal diseases. Without special examinations, a definitive diagnosis cannot be made.

  • Stomach pain
    This is the most common symptom of gastric cancer and appears early on. Initially, there may be discomfort in the upper abdomen, bloating, heaviness, or vague pain in the pit of the stomach. These symptoms can be temporarily relieved with treatment for gastritis or ulcer disease. It is not until the further development of gastric cancer, when pain becomes more frequent and severe, even presenting with black stools and vomiting, that it attracts attention. By this time, the disease is usually in the middle or late stages, with poorer treatment outcomes. Therefore, it is essential to pay attention to the non-specific symptom of “stomach pain.” Particularly when the symptoms recur soon after treatment relief, do not wait for the typical symptoms of “pain with irregular rhythm” and “eating does not alleviate the pain.” Consider further examinations promptly to avoid missing the best treatment time. If pain persists and radiates to the back and waist, it may indicate advanced symptoms of gastric cancer invading the pancreas.
  • Loss of appetite, weight loss, and fatigue
    These symptoms can appear early on and may not be accompanied by stomach pain. When these symptoms occur together with stomach pain, they should be taken more seriously. Many patients experience fullness and belching after meals, automatically limiting their diet and gradually losing weight.
  • Malignant vomiting
    This symptom is often caused by tumor obstruction or gastric function disorders. Cardia cancer can cause difficulty in eating, and even swallowing. Antrum cancer can cause pyloric obstruction and vomiting, with the vomit having a fetid smell or containing yesterday’s food.
  • Bleeding and black stools
    Small amounts of bleeding can only be detected as positive fecal occult blood (test), while larger amounts of bleeding can cause hematemesis and black stools. When elderly people have black stools, the possibility of gastric cancer should be considered.
  • Other symptoms
    Some patients may experience diarrhea or constipation, lower abdominal discomfort, enlarged supraclavicular lymph nodes, ovarian tumors, abdominal masses, etc.

(2) Physical Signs

Generally, gastric cancer patients do not have obvious physical signs, but a few may exhibit the following conditions:

  • Upper abdominal tenderness
    Some patients may have mild tenderness in the right upper abdomen. When the lesion is large and the ulcer involves the muscular layer and serous layer of the stomach, the patient may be afraid of deep pressure on the upper abdomen and may exhibit muscle tension and rebound pain.
  • Abdominal masses
    A mass can be palpated in the upper abdominal region of the stomach, and gastric antrum cancer is more common on the right upper abdomen. The mass is firm, and when the tumor infiltrates surrounding tissues, the mobility of the mass is significantly limited. If the primary tumor is accompanied by pelvic lymph node metastasis or pelvic implantation, rectal examination through the anus can detect bladder or uterine rectal metastatic nodes, which indicate advanced disease.
  • Metastatic lymph nodes
    In addition to the lymph nodes surrounding the abdominal tumor, the left supraclavicular lymph node has the highest metastasis rate, reaching about 10%.
  • Widespread metastasis
    In the late stage of gastric cancer, liver, lung, bone, kidney, and nervous system metastases can occur. When gastric cancer invades the serous membrane, cancer cells may shed and cause widespread peritoneal implantation metastases, leading to ascites. As the condition worsens, patients may exhibit weight loss, bleeding, anemia, pyloric or intestinal obstruction; enlarged liver, jaundice, ascites, and cachexia.

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