Diagnosis

The outcome of each diagnostic position is the patient interview (anamnesis). During this interview, one must especially search for the above-mentioned symptoms and ask about the frequent cases of stomach cancer in the family. The existing risk factors such as nicotine and alcohol consumption should always be asked.During the physical examination, in rare cases the tumor can already be palpated in the abdomen.

Occasionally, the Virchow gland (lymph node) in the clavicle pit can be palpated. When analyzing the blood (laboratory values), certain blood values may indicate a tumor disease. For example, a low blood pigment content (haemoglobin) in the blood may indicate chronic blood loss due to tumorous bleeding.

The hemoccult test is used to look for blood admixtures in the stool, which occur in the case of chronic blood loss in the gastrointestinal tract. So-called tumor markers are substances in the blood that are frequently found in some types of cancer and can therefore indicate the presence of cancer. They do not play a significant role in the initial diagnosis of a stomach carcinoma, as there are no reliable tumor markers for this disease.

However, if a certain tumor marker value is found elevated before surgery, which disappears after surgery, this marker can be used as a control marker to quickly diagnose a recurrence of the tumor (tumor recurrence) using a blood test. In order to be able to ensure the diagnosis of stomach cancer, a gastroscopy must be performed.

Stomach cancer
Large Curvature
Duodenum (duodenum)
Small Curvature
Oesophagus

The “endoscopy” (endoscopy) of the stomach is the method of choice for direct assessment and classification of mucous membrane damage and should be performed as soon as possible if a stomach tumor is suspected.

During this examination, images from the esophagus and stomach are transmitted to a monitor via a tube camera (endoscope), which the patient must “swallow”. During the endoscopy, tissue samples (biopsy) can also be taken from suspicious mucous membrane areas and from ulcers. Several samples (5-10) must be taken from a suspicious area in order not to miss any malignant tissue changes.

Tissue assessment under the microscope (histological findings) is far more meaningful than the (macroscopic) findings recorded with the naked eye. Only in the fine tissue (histological examination) can the suspected tumor be proven and the type of tumor determined. In addition, the spread of the tumor into the layers of the stomach wall can be determined.

In this non-invasive imaging examination, the oesophagus is X-rayed while the patient swallows an X-ray contrast medium. The contrast medium is applied to the stomach and intestinal walls, whereupon they become accessible for evaluation. The typical finding in gastric cancer is a tumor node that protrudes into the inside of the stomach.

However, it is not uncommon to see a similar image to that of an ulcer (peptic ulcer), so that no clear diagnosis can be made. This examination also allows a good assessment of the degree of narrowing (stenosis) caused by a tumor. Compared to gastroscopy, the assessment of mucous membrane changes is limited. Especially the evaluation between benign and malignant changes is not possible. For this purpose, the direct evaluation of the inside of the stomach through endoscopy with tissue sampling (PE) is necessary.