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  • Gastric Cancer Symptoms

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    The stomach cancer never develops on healthy soil. The emergence of it is always preceded by various pathological processes, called precancerous. As has been proved by many years of experience, the diagnosis of stomach cancer , especially its early forms, is a very difficult task for both the therapist and the surgeon. These difficulties are primarily due to the extreme variety of clinical manifestations of this disease and the absence of a distinct specific pattern.

    Gastric cancer occurs as a result of the growth of malignant cells in the tissues lining the stomach. More than 90 percent of cancers in the stomach are adenocarcinomas that arise from cells lining the walls of the stomach;Lymphomas account for 3 to 7 percent of cancers in the stomach. Adenocarcinomas often cause symptoms only after they grow too large and can not be surgically removed;therefore, early detection greatly increases the possibility of timely treatment. How to treat tumors with folk remedies look here.

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    • Although the cause of stomach tumors is unknown, environmental factors may play a role. In geographical areas where cancer of the rectum and large intestine is widespread, stomach cancer is rare.

    • Consumption of foods containing nitrates or nitrites( chemicals commonly used as preservatives) may increase the risk of stomach cancer. Salted, pickled, cooked on fire or smoked products, obviously, constitute the highest risk for the development of cancer. Low intake of fruits and vegetables can also increase the risk of stomach cancer.

    • Surgical removal of part of the stomach( gastrectomy), chronic inflammation of the tissues lining the stomach( gastritis), or pernicious anemia increases the likelihood of developing gastric cancer. Hereditary factors can play a role. For unknown reasons, stomach cancer is more common in people with blood of group A.

    • Infection with the bacterium Helicobacter pylori also causes stomach cancer, especially in those who are infected at a young age.

    One type of lymphoma is obviously also associated with infection with the bacterium Helicobacter pylori.

    It should be noted that the clinical manifestation of stomach cancer is not limited to symptoms of gastric pathology. On the foreground are common violations of the body. First of all, they consist in violations from protective mechanisms, neurohumoral regulation, into intoxication, etc. The variety of clinical signs of stomach cancer depends on the precancerous background on which they arise, from the localization of the process in the stomach, as well as from the macroscopic form, the stage of the diseaseand the histological structure of the tumor. All this requires a thoughtful approach to the patient's complaints and a correct evaluation of the objective state. Special difficulties occur in the so-called masked forms of stomach cancer, often occurring under the guise of other diseases, for example, pernicious anemia, angina pectoris, lung diseases. Knowledge of the features of the clinic is important in establishing the diagnosis of cancer and especially its early forms.

    Localization of stomach cancer .Different parts of the stomach are affected by malignant neoplasms unevenly often. It depends on the functional and morphological features of the stomach and the localization of pathological processes against which cancer develops. Since they affect most often the antral-pyloric department and small curvature( gastritis, polyposis and ulcer), malignant neoplasms are more often located in these departments.

    Most often, the cancer is localized in the area of ​​the pyloric part of the stomach and small curvature;it averages 74% of all stomach tumors. Only in 26% of cases does the cancer affect the rest of the stomach.

    Since it is impossible to establish their localization in multiple malignant tumors, these forms must be attributed to total gastric lesions.

    Symptomatology of stomach cancer is extremely complex and diverse. All symptoms of the disease must be divided into two large groups: local and general. Both those, and others reveal since the anamnesis. Of course, it is necessary to agree with AV Melnikov, who denies the existence of the so-called hidden or asymptomatic cancer, since if a patient seeks a doctor for help, he has a number of symptoms that he himself noticed and whose development is more or less prolongedtime watched.

    Most often, patients complain of pain. According to the data of the majority of authors, it occurs in 80-86% of patients, and according to the data of AI Sayenko( 1968), in 95.1% of patients. Localized mainly in the epigastric region, the pain does not have a characteristic irradiation, as for example in case of peptic ulcer, but with neglected forms of cancer( with germination in the pancreas, diaphragm, liver) can irradiate in the lower back, right shoulder blade, heart. The nature of pain is different. It can occur immediately after a meal, 2-3 hours after a meal or at night;Sometimes it appears after eating fatty foods, but more often it does not associate with the nature of food. There is also no periodicity of pain, although patients sometimes notice improvement in general condition. A peculiarity of pain in stomach cancer is that it, as a rule, is not acute and strong, but is dull and permanent. Sometimes the pain is hardly palpable. Patients at the same time note the feeling of pressure and support in the epigastric region. Cases of stomach cancer accompanied by very severe pain of gastralgic type are described. The appearance of severe and constant pain, especially radiating in the back, indicates the neglect of the disease, the germination of cancer into the pancreas, retroperitoneal tissue.

    An extremely important symptom that should alert a doctor is a change in the nature of pain in a patient suffering from peptic ulcer. Changing the periodicity of pain, its irradiation are extremely alarming symptoms, especially if they are joined by general weakness, emaciation, loss of appetite, a decrease in the acidity of the gastric juice.

    Patients with gastric cancer often develop dyspeptic syndrome. It is characterized by the appearance of nausea, heartburn, a feeling of overflow and heaviness in the epigastric region immediately after eating, belching or spitting up food eaten. Not always these symptoms occur simultaneously. Often you can identify one of them, but in most cases they are somehow combined. According to some authors, eructation occurs in 68% of patients, nausea - in 10.3-20%, heartburn - in 6.3%, vomiting - in 28-48%.Vomiting can have a different character: eaten food, stomach contents, stagnant gastric contents( with tumor stenosis and stasis), acidic gastric contents( with a significant content of free hydrochloric acid in patients with gastric cancer with increased or normal secretory function).Rarely there is a bloody vomiting of coffee grounds or with an admixture of scarlet blood or vomiting of contents with putrefactive, gangrenous odor( a sign of tumor disintegration).All these signs can have not only diagnostic, but also prognostic significance. But more often there is a belching of food or air, sometimes with the smell of a rotten egg, which testifies to the stenosis of the gatekeeper, the delay of food in the stomach and fermentation of it.

    The frequent symptoms of stomach cancer are the difficulty of passing a dense food, excessive salivation or, conversely, dry mouth, regurgitation of freshly swallowed food.

    Thus, all of the above symptoms of gastric discomfort are quite common. The frequency of their occurrence depends on the macroscopic form of the tumor, the localization and the stage of development of the process. The more neglected the form of the disease, the more symptoms and the more vivid they manifest, although there is no absolute parallel between the prescription of the disease and the severity of the symptoms detected.

    Common signs of stomach cancer include, first of all, such as general weakness, loss of appetite and weight loss. According to AI Saenko, they are found in 75% of patients with different stages of the process. Very often, the appearance of these signs is preceded by a short febrile illness, taking place with a subfebrile temperature, with which patients are associated with a worsening of appetite. In some cases, patients have an aversion to any food, for example meat, bread, etc. These symptoms may be the first manifestations of the disease. However, in some patients they appear rather late. A. V. Melnikov considers it expedient to distinguish a triad of signs, which he calls a "cancer triad": weight loss, loss of appetite and gastric discomfort. According to the author, this triad is of great importance in the recognition of stomach cancer.

    Given the crucial importance of early diagnosis of stomach cancer, AI Savitsky believes that in assessing the symptoms of the disease, it is necessary to proceed not from individual, clearly manifested symptoms characterizing predominantly developed and often neglected forms of the process, but to take into account a number of small, sometimes subtle, signs. The author calls the complex of these symptoms "a syndrome of small signs."It is characterized by:

    1) unmotivated general weakness, fast fatigue, reduced ability to work;

    2) persistent decline or loss of appetite, up to aversion to food or some of its types;

    3) gastric discomfort, which is accompanied by a feeling of rapid saturation and overfilling of the stomach or propping up in the epigastric region, the appearance of unpleasant, mild pain, often belching or eating food etc.;

    4) unmotivated progressive weight loss;

    5) a stable, gradually increasing anemization of the patient;

    6) mental depression.

    It should be noted that such phenomena were observed only in seriously ill patients with a generalized process. Therefore, we do not attach special importance to this syndrome. In general, the detection of small signs and syndromes is of great importance, since in a significant number of patients they appear at an earlier stage of the disease. It should be borne in mind that in some cases, a clearly expressed picture of the disease may become blurred, but small signs still remain. This is most often observed with the use of therapeutic agents that reduce gastritis, which always accompany stomach cancer.

    V. Kh. Vasilenko, highlighting latent( painless) forms of stomach cancer and form with pain syndrome, gives small signs of the disease of great importance, especially in the differentiation of cancer and ulcers.

    As noted, the clinical manifestations of cancer mostly depend on the localization of the process, the background on which it develops, and the macroscopic structure of the tumor. The most vivid picture of the disease occurs with cancer of the pyloric part of the stomach. In this case, such symptoms as pain, nausea, heaviness in the epigastric region, sensation of stomach overflow, vomiting or regurgitation of eaten food, weight loss, general weakness appear to the fore. If the tumor seizes the pylorus and its stenosis occurs, which is most often observed with cirrus and less often - ulcerative infiltrative forms of cancer, then, in addition to these symptoms, there is a feeling of rolling in the epigastric region, profuse vomiting of undigested food, belching rotten. Over time, the phenomenon of stenosis increases and becomes permanent, which leads to severe depletion of patients. With ulcerative infiltrative and saucer-like ulcerous forms of cancer, vomiting occurs most often with an admixture of blood due to gastric bleeding. The pain in such cases is much stronger than with the skirre, as infection and the phenomena of exacerbation of gastritis join the ulceration of the tumor!

    In cases where there is infiltration of the pylorus without stenosis and he constantly yawns, diarrhea, pain in the epigastric region immediately after eating occurs in the patients. These phenomena soon diminish or disappear. There may be reflex vomit, which is explained by the short-term spasm of the pylorus. Polypoid tumors can also cause vomiting and severe paroxysmal pain due to temporary blockage of the pyloric tumor, and sometimes the mucosal prolapse in the pylorus. Due to ulceration of the tumor, vomit can be more or less heavily colored with blood, but there is no bloody vomiting.

    With cancer of the body of the stomach( small curvature, anterior and posterior walls), the clinical picture is very diverse and depends on the shape of the tumor. The most early appearance of saucer-ulcerous cancer. The emergence and development of it from the very beginning is accompanied by pain, arising during and after meals. The pain may be acute or dull, but it is constant and does not depend on the time of the meal, nor on its nature. Due to constant bleeding and intoxication, anemia, general weakness, exhaustion, fatigue increase. Vomiting, as a rule, is absent, but if it happens, the vomit masses are always colored with blood. Sometimes there is heavy bleeding. Ulcerative-infiltrative forms, like saucer-ulcerative, are often accompanied by severe pain, sometimes radiating into the back. As a result of the disintegration of the tumor, attachment of infection, exacerbation of gastritis, and often lymphadenitis in patients, the body temperature rises to subfebrile digits. However, tumors located in the body of the stomach can last for a fairly long time latently, since they do not infiltrate neither the pylorus nor the esophagus. This is especially true for the scirrer, which develops without ulceration. Such patients often have bulimia caused by the gaping pylorus, diarrhea, pain in the epigastric region, associated with the growth of the tumor in neighboring organs. With the development of the tumor, intoxication is increasing. However, often scirrhous tumors that capture the entire stomach from the gatekeeper to the cardiac part are not accompanied by significant local and general disorders. The tumor is usually manifested by an increasing general weakness, progressive thinning and diarrhea.

    Polypous tumors of the body of the stomach, as well as the scirrus, also do not appear for a long time with local symptoms. Growing up to large and sometimes huge sizes and ulcerating, they cause pain regardless of food intake, nausea, sometimes vomiting with an admixture of blood. Although the symptoms of intoxication with these forms are insignificant, but the phenomena of anemia, protein and water starvation are due to the constant prolonged bleeding and abundant loss of protein and liquid.

    No less diverse clinical course is characterized by tumors of the bottom and cardial part of the stomach. If they are located on a small curvature of the cardial part and ulcerated, there is pain in eating, sometimes very strong, so that patients are afraid to eat and quickly become depleted. Tumors of the bottom of the stomach do not appear for a long time;pain is noted with the germination of the diaphragm, retroperitoneal tissue, pancreas or liver. Often the pain radiates to the heart, which leads the doctor to a false idea of ​​angina.

    Tumors that pass to the esophagus, stenose it, cause difficulty in passing at first thick, then semi-liquid and liquid food. Such an increase in symptoms is very characteristic of tumors of the cardiac part of the stomach. Simultaneously, more or less severe pain occurs during meals, excessive salivation, regurgitation of not only swallowed food, but also liquid. Sometimes patients complain of pain and a feeling of pressure behind the sternum, which is a consequence of esophagus germination and the development of esophagitis. However, the symptoms of dysphagia and pain arise not only due to the transition of the tumor to the esophagus, but more often as a result of the concomitant esophagitis cancer. Significantly less can be observed skirr. Polyposis tumors were not detected. Features of tumor localization and their macroscopic forms cause a relatively slow increase in symptoms. In patients, depletion and anemia develop slowly, but with the development of dysphagia these symptoms increase rapidly. The main sign of cancer of the cardiac part of the stomach is protein and water starvation, often accompanied by a slight increase in body temperature.

    The clinical picture of stomach cancer is even more complicated when the tumor of neighboring organs grows. The presence of these complications does not always indicate inoperability, although it is an indication of the neglect of the process.

    In cancer of the pyloric part of the stomach, the tumor most often grows into the pancreas, the large and small omentum, the transverse colon or its mesentery. In such cases, pain in the epigastric region increases significantly, radiates into the back, and sometimes becomes diffuse. Germination of the tumor in the transverse colon without perforation can cause partial obstruction. In the case of perforation, patients develop a fecal odor from the mouth, sometimes vomiting is observed with the smell of stool. The condition of such patients sharply worsens, cachexia develops rapidly.

    Germination of the tumor in the liver or its gates may be accompanied by jaundice, but the stool is almost always colored normally, as there is usually no complete obstruction of the bile ducts.

    Dissemination of the tumor along the peritoneum is accompanied by the appearance of ascites, spilled pain throughout the abdomen. Intoxication and anemia of patients develop rapidly.

    As can be seen from the above, the clinical manifestations of stomach cancer are very complex and diverse. They depend on the anatomical shape of the tumor, its location and distribution. All this testifies to the need for an individual approach to the evaluation of each symptom, a skilful comparison of them for a correct diagnosis. We must strive for the earliest possible diagnosis to ensure the performance of a radical operation. Therefore, patients, especially those over the age of 40, who present certain, even minor complaints, must be subjected to a purposeful examination.

    In stomach cancer, especially in its early forms, the general appearance of the patient initially does not change noticeably. During the examination, first of all, it is necessary to pay attention to the coloration of the skin and mucous membranes. Often the facial skin is pale, and with severe intoxication or with stenosing forms of cancer of the pyloric or cardiac part, it has an earthy tinge.

    Laxity and dryness of the skin indicate a rapid thinning and violation of water-salt and protein metabolism. In cases of neglected disease, with the presence of metastases at the gates of the liver, jaundice of the skin and sclera may occur.

    In patients with low nutritional status, it is often possible to see the contours of the tumor, its displacement during respiration or peristalsis of the stomach. In the presence of stenosing forms of cancer, peristalsis and antiperistaltic of the stomach are clearly visible. In the absence of depletion and the presence of a large tumor in the epigastric region, protrusion is visible. Especially it is noticeable in cases of tumor germination into neighboring organs( liver, transverse colon).The presence of metastases in the left lobe of the liver is also often determined by examination in the form of a larger or smaller protrusion in the epigastric region.

    The shape of the abdomen is not less important for establishing the diagnosis. A bulging stomach, a strained abdominal wall with a stretched shiny skin and enlarged veins testify to the presence of ascites due to dissemination of the process along the peritoneum or metastases to the gates of the liver.

    For palpatory examination of the abdominal cavity organs it is expedient to use the classical technique of VP Obraztsov.

    As the studies of a number of authors have shown, when localized in the pyloric part of the stomach, the tumor is palpated most often, in approximately 70-80% of patients. At the same time, in the epigastric region, a denser, bumpy, often mobile tumor is probed with a greater or lesser magnitude, the contours of which can not always be determined. The palpability of the tumor also depends on its macroscopic structure. So, skirr is determined most often, since it is more often localized in the pyloric part of the stomach and differs in a dense consistency. Yaw-infiltrative tumors are also often palpable. However, saucer-like and polypous tumors are palpated much less often, in about 30% of patients, which is due to their milder consistency and location in the higher parts of the stomach.

    We can not agree with the researchers who state that the palpability of the tumor is a sign of its inoperability. According to AV Melnikov( 1960), operations were performed in 80-87% of those patients who had large palpable swelling. The palpation of the tumor in the left hypochondrium also does not indicate its inoperability, but is a sign of damage to the body of the stomach. In such cases, the lower pole of the tumor is determined, and the rest of it goes to the left hypochondrium and is inaccessible to palpation. If this tumor is mobile, then most patients can perform the operation, most often a total gastrectomy.

    To assess the operability of the patient, it is also necessary to examine other organs, in particular the liver. The dense serrated edge of the liver, tuberous surface and soreness in palpation testify to the presence of matastases in it. Sometimes, with palpation of the abdominal cavity, several tumors can be detected, which in combination with a number of other signs may indicate a generalization of the process.

    When examining a patient, one should never forget about the need to examine the navel and supraclavicular areas, where it is often possible to detect tumor metastases. Detection in the left supraclavicular area at the site of attachment of the nodding muscle of one or more dense lymph nodes indicates Virchow metastases. It is extremely important to examine the abdominal cavity for the presence of ascitic fluid in it.

    The final stage of the physical examination is a gynecological examination and finger research of the rectum, which allows to exclude the metastases of Schnitzler or Krukenberg.

    • Surgery to remove as much of the tumor as possible is the main way to fight stomach cancer. Some or all of the stomach, nearby lymph nodes, pancreas and spleen can also be removed if there is a suspicion that the cancer has spread to these areas.

    • Radiation therapy can be used in place of or in addition to surgery to reduce pain and bleeding.

    • The percentage of survivors with gastric lymphomas increases with the combination of surgery and chemotherapy. With lymphoma caused by the bacterium Helicobacter pylori, treatment with some antibiotics and inhibitors of gastric acid secretion( such as omeprazole) can lead to complete regression of the tumor.

    • Consult a doctor if you feel any symptoms of stomach cancer.