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Methods for diagnosing stomach cancer. Modern methods for diagnosing stomach cancer - computed tomography, fegds, ultrasound, etc.

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Endoscopic examination

Endoscopic examination is one of the most informative methods for diagnosing gastric cancer. Gastroscopy allows not only to visually determine the nature of the tumor lesion, its localization, growth pattern, and distribution along the stomach wall, but also to specifically perform a biopsy for morphological verification of the diagnosis.

In the initial stages, stomach cancers may appear as flat polypoid plaques or superficial ulcers. As the disease progresses, cancers usually take on an ulcerated appearance. The edges of such an ulcer are undermined, uneven, and the bottom is represented by necrotic tissue. Although all these signs are characteristic of a cancerous lesion, it is still possible to definitively differentiate a malignant ulcer from a benign one only with the help of a biopsy. When taking a biopsy from several places along the edges of the ulcer and surrounding areas, the accuracy of the diagnosis can reach 95%. False-negative results are usually due to errors in obtaining histological material. False-positive results are rare. The diagnostic accuracy of the method can be increased by performing a cytological examination.

For the purpose of more detailed determination of the boundaries of tumor infiltration, detection of synchronous tumors and intramural dust-like metastases in the wall of the stomach at the level of the submucosal layer, a chromoendoscopic examination of the mucous membrane of the organ is performed. To do this, stain the mucous membrane with a 0.1% solution of indigo carmine or methylthioninium chloride.

The most promising method for the comprehensive diagnosis of intramural and lymphogenous spread of the tumor process is the use of endoscopic ultrasound. For these purposes, sensors with frequencies from 7.5 to 12 MHz are used. With their help, the gastric wall is visualized as a five-layer structure with alternating echogenic and hypoechoic layers. Acoustic coupling of the sensor with the mucous membrane is achieved by filling the stomach with water.

This method allows you to determine the depth of tumor spread into the stomach wall, the presence of metastatically changed regional lymph nodes and helps to obtain puncture material from them for morphological verification of the diagnosis. The depth of cancer damage to the stomach wall can be accurately determined in 80% of cases. Early cancer limited to the mucosa and submucosa can be differentiated from other stages of cancer in more than 90% of cases. This research method is mandatory when performing endoscopic resections of the mucous membrane for early cancer.

Endoscopic ultrasound is very sensitive in assessing submucosal lesions in the stomach. Leiomyomas do not usually cause erosion or ulceration of the overlying mucosa and appear as round, hypoechoic masses with smooth margins. The tumor is usually associated with the muscle layer of the stomach. If the size of the formation exceeds 3 cm, has uneven edges, disrupts the layering of the wall and has hypoechoic zones, then a malignant lesion should be assumed.

The accuracy of endoscopic ultrasound in differentiating benign and metastatic regional lymph nodes is 50-80%.

X-ray of the stomach

X-ray of the stomach with barium sulfate (separate or with air contrast) is the main method for determining the location and extent of damage to the stomach wall (Fig. 1). The most important radiological signs of stomach cancer are:

  • the presence of a filling defect or niche within the shadow of the stomach;
  • local absence or decrease in peristalsis in the tumor area;
  • change in the relief of the mucous membrane at the location of the tumor;
  • change in the shape and size of the stomach.

Rice. 1. X-ray of the stomach for cancer. A filling defect is determined in the antrum with a barium depot (indicated
arrow).

The diagnostic capabilities of gastric radiography in detecting early cancer are limited, since the main radiological signs appear when there is significant damage to the stomach wall. X-ray examination may be considered as an additional method if scirrhous cancer is suspected.

During routine X-ray examination of the stomach, regardless of the location of the primary tumor, it is extremely important to thoroughly examine all other parts of the organ due to the possible multicentric growth of carcinoma and the presence of intramural metastases.

Extracorporeal ultrasound

Extracorporeal ultrasound of the abdominal organs, retroperitoneal space and lymphatic collectors of the cervical-supraclavicular region is a mandatory method of examining patients with gastric cancer. In women, standard testing should include the pelvic organs. Ultrasound allows you to characterize damage to the walls of the stomach (when it is filled with liquid), assess the depth of invasion, determine the spread of the tumor process to the parietal peritoneum and other organs, and identify ascites.

Computed tomography

CT scan of the upper abdomen using intravenous and intraluminal gastric contrast is used to diagnose the primary tumor and preoperatively determine the stage of cancer. CT scan can show the thickness and tumor infiltration of the stomach wall, the presence of ulcers and metastases in the liver (Fig. 2). The resolution of the method is significantly increased thanks to the use of modern spiral tomographs in combination with the ability to construct a three-dimensional image. The technique is less reliable in determining tumor invasion into nearby organs and detecting metastases in regional lymph nodes. Because of these limitations, CT often does not eliminate the need for laparotomy.

Rice. 2. CT scan of the upper abdomen. Gastric cancer (black arrow) and liver metastasis (white arrow).

Laparoscopy

Laparoscopy does not so much help in diagnosing stomach cancer (which is possible only in late stages), but is used to determine the stage of the disease and identify small subcapsular metastases in the liver and parietal peritoneum, not visible with ultrasound and CT. Thus, laparoscopy minimizes the number of exploratory laparotomies.

In order to increase the capabilities of laparoscopic diagnostics, the technique of laparoscopic ultrasound computer diagnostics is used. Thanks to the use of ultrasound, the resolution of the method is significantly increased, especially when studying the liver parenchyma and the condition of the lymph nodes of the retroperitoneal space.

Despite the high resolution of diagnostic procedures, development and optimization of research methods, a final conclusion about the true extent of the process and the possibility of performing a radical operation can often be obtained only through intraoperative examination. Taking into account the nature of the disease and modern aspects of surgical treatment tactics, such a conclusion is possible only when performing an acute revision, i.e. only after dissection of the ligamentous apparatus and mobilization of the stomach or involved structures with an assessment of the possibility of performing a monoblock combined resection.

Differential diagnosis

Differential diagnosis of gastric cancer should be carried out, first of all, with gastritis, peptic ulcer, polyps, leiomyoma, lymphoma and leiomyosarcoma of the stomach.

Differentiation of late stages of gastric cancer from these diseases is possible on the basis of the clinical picture, but is of limited value, since it practically does not allow to influence the results of treatment. The clinical picture of the initial curable stages of stomach cancer differs little from the manifestations of most diseases of the digestive system, therefore endoscopy with histological examination of a biopsy from the stomach wall is of paramount importance in differential diagnosis. Gastroscopy should be performed for any mild dyspepsia in patients over 40 years of age and in all persons regardless of age with persistent dyspepsia or any other warning sign.

Savelyev V.S.

Surgical diseases

One of the terrible diagnoses that is being diagnosed more and more often in people every year is stomach cancer. It is a tumor of the main digestive organ, which consists of malignant cells formed in the submucosal or mucous layer. A disease that is not detected in a timely manner takes a person’s life in a short time. Only a timely diagnosis of stomach cancer, consisting of a whole range of examinations, can help quickly make the correct diagnosis and carry out an adequate course of treatment.

Cancerous damage to the walls of the stomach in the initial stages of its development, just like any other, does not cause pronounced changes in a person’s well-being. Certain symptoms of stomach cancer begin to appear in the second stage of the cancer process.

Stomach cancer examination

Experts note the following very first signs that suggest that a malignant tumor is forming in the main organ of the gastrointestinal tract:

  • gastric dyspepsia, expressed by such negative sensations as constant and causeless bloating, belching or heartburn, periodic nausea, interspersed at times with vomiting;
  • loss of appetite, expressed in intolerance to any product, usually meat;
  • depression, constant lethargy, pronounced decrease in performance and sleep problems;
  • an unprovoked rise in body temperature to subfebrile (37–38°C) levels;
  • sudden weight loss.

But pain with stomach cancer does not appear immediately. At first, cancer patients experience only minor pulling sensations in the epigastric or pancreatic region (slightly above the navel), which occur regardless of food intake, but pass fairly quickly.

If the size of the malignant tumor becomes large enough, that is, the tumor begins to occupy almost the entire internal surface of the digestive organ, its volume decreases, which causes a rapid onset of saturation in the sick person. When a tumor develops in the immediate vicinity of the exit sphincter into the intestine, the patient suffers from constant heaviness in the abdomen due to the inability of a bolus of food to pass through it, and the tumor, blocking the connection with the esophagus, leads to difficulty in the swallowing reflex.

All of the above symptoms of stomach cancer associated with digestive disorders contribute to changes in the natural functioning of the digestive tract. This in turn causes a deterioration in metabolism, resulting in the appearance of some external signs. The main ones are an unpleasant, pungent odor from the mouth and a constant coating of the tongue with a dense coating of yellow or grayish color.

Must remember! You should not immediately panic when such symptoms appear, as they can accompany other, less dangerous gastrointestinal pathologies. First of all, you should contact a specialist and undergo appropriate diagnostic tests that will help identify the true root cause of anxiety symptoms. It is categorically not recommended to delay visiting a gastroenterologist in such a situation, since possible oncology of the main digestive organ is always prone to rapid development.

Early diagnosis of stomach cancer

It is very important to recognize the development of a malignant tumor process in the main digestive organ as early as possible. This is of fundamental importance due to the favorable prognosis of this disease - 90% 5-year survival rate is observed only when gastric cancer is detected and operated on in a timely manner. At later stages, based on statistical data, it does not rise above 40%.

There are no specific symptoms accompanying a stomach tumor that is just beginning to develop. A pathological condition that develops directly against the background of ailments occurring in the gastrointestinal tract, chronic gastritis or ulcers that are benign in nature, retains their main manifestations for a long time. Very often it is impossible to make a diagnosis at the initial stage of the disease. This is due to the latent course of the disease, so its development is very slow. In the rarest cases, the occurrence of the disease may be indicated by involuntary internal bleeding from the lower gastrointestinal tract.

Early diagnosis of stomach cancer is possible with direct fluoroscopy. Due to its simplicity and accessibility, this technique is currently used for preventive research. To obtain the most accurate results, large-frame gastrofluorography is used, and the images taken with its help are analyzed by two independent specialists.

The main warning signs considered initially suspicious are:

  • thickening of the mucous layer and restructuring of its relief in small areas with limited area. Their folds are always located chaotically;
  • a barium depot (accumulation of the suspension drunk by the patient before the examination) between thickened folds that is repeated repeatedly on an x-ray image. This picture is noticeable even when there is not yet a clearly defined depression between them;
  • partial smoothness of the protruding elevations of the mucous membrane, the roughness of their surface, noted in small areas, as well as jaggedness in these places of the contour of the stomach.

If specialists detect such suspicious signs on an x-ray, the patient undergoes a gastroscopy, which is necessarily performed with a targeted biopsy.

Endoscopic diagnosis of stomach cancer in the early stages is a rather difficult task, but it also gives good results. In 18% of observations, using only this study, doctors were confidently able to detect malignancy of the gastric mucosa at the initial stage, in 59% they suspected it, and in 30% they identified a macroscopic picture that was more characteristic of a benign process.

When assessing the results obtained during an endoscopic examination, early gastric cancer according to the following picture presented in the table:

MAIN TYPES OF TUMOR IN THE STOMACH FORMS CHARACTERISTIC
Bulging or protruding Polypoid Stomach cancer with this shape looks like a polyp sitting on a broad base. The defect is detected when the main organ of the gastrointestinal tract is completely filled with barium suspension. Typically, such polyps in the stomach have a diameter of no more than 1 cm and are round or irregularly oval in shape. Its contours are unclear and in places with uneven edges. The mucous membrane surrounding the polyp, with an area of ​​approximately 5 cm, has a changed relief, which is represented by uneven elevations.
Plaque-like Defects discovered after tight filling of the stomach with barium suspension appear round, without a protrusion structure, located on the relief of the mucosa. In rare cases, a single defect is discovered that has clear and even boundaries. In the center of it, a more or less deep depot of barium is usually noticeable, indicating ulceration of the tumor surface. Plaque cancer rarely reaches 2 cm in diameter.
Invasive saucer-shaped This form of malignant neoplasm occurs most often in the main digestive organ. The main reason for its appearance is the progressive manifestation of the tumor. The defect in this case is a rounded growth, in some cases reaching quite large sizes and capable of growing into neighboring organs
Surface Ulcerated (ulcerative) Ulcerated stomach cancer is also diagnosed very often, in more than half of cases of malignancy of the digestive organ. It unites tumor-like ulcerated pathologies of the stomach of different genesis, related to the primary ulcerative form. They are a consequence of the progression of a chronic ulcer or saucer cancer

Methodologically correctly performed endoscopic and x-ray examinations allow 40-50% of patients to suspect gastric cancer at a very early stage.

Reasons for diagnosis

Despite the fact that such a dangerous pathology as stomach cancer has been detected more and more often in recent years, many people are interested in the question of why experts recommend undergoing scheduled annual examinations, called screening in medical terminology. This is explained quite simply. Any oncological diseases in the early stages are practically asymptomatic or have vague signs that in no way indicate the appearance of a malignant neoplasm.

Only through early diagnosis is there a high probability that a newly emerging tumor will be detected in the main digestive organ, and if detected in the early stages, it gives positive results in 90% of cases. It is also necessary to remember that the basis for such studies as gastroscopy, endoscopy and radiography of the digestive organs, which allow timely detection of dangerous ones, is the appearance of dyspeptic gastric symptoms.

Important! If you suddenly begin to suffer from unexplained discomfort and pain in the epigastrium, loss of appetite, a temperature that often rises to subfebrile levels and constant weakness, you should immediately consult a specialist. Do not forget that such symptoms are a direct reason for undergoing diagnostics, as they may indicate the development of a malignant formation in the stomach.

Methods for diagnosing stomach cancer

As already mentioned, early detection of the development of a malignant neoplasm in the main digestive organ is very important, since only in this case do 70 out of 100 patients have a real chance of a full recovery. That is why experts recommend that people at risk undergo screening. In case of stomach cancer, such a planned annual examination, consisting of gastroscopy, can save a large number of lives.

The procedure itself does not require any special preparation, is performed on an outpatient basis and takes no more than 15 minutes. At the same time, its importance in identifying precancerous and cancerous conditions of the main organ of the gastrointestinal tract is invaluable. If, based on its results, a specialist suspects that a person, even one who does not currently have suspicious symptoms, is developing a malignant tumor, he will be assigned a special diagnosis of stomach cancer.

It consists of a whole range of measures that are aimed at not only identifying the underlying disease, but also identifying the causes that provoked its occurrence.

This examination of the stomach consists of 4 main methods:

  • Clinical. It consists of collecting the patient's medical history and compiling a medical history.
  • Physical. Includes auscultation (listening to sounds arising in the stomach) and palpation (palpation of the diseased organ). In the early stages of development of a pathological condition in the main digestive organ, using this method it is possible to identify distant signs of the disease. It is worth noting that palpation is carried out in four positions: standing, lying on the right side, on the left side and on the back.
  • Laboratory. The first step is to conduct a blood test for tumor markers in a sick person. The material for tumor markers (tumor markers are specific proteins that only cancer cells produce) is blood serum from a vein. The procedure is performed on an empty stomach, the last meal should be no later than 8 hours before blood sampling. For patients who have undergone radical therapy, this study must be repeated every three months. Based on its results, the specialist can confirm or deny the presence of malignant cells.
  • Instrumental. It is prescribed last and includes x-ray examination, fibrogastroduodenoscopy with biopsy for a detailed examination of the mucous membrane and taking a tissue sample for histology, magnetic resonance and computed tomography.

The use of these methods to identify the initial stage of malignancy of the main digestive organ allows detection at the earliest stages. This gives patients a chance for a full recovery or prolongation of life for the maximum possible period for this disease. That is why experts recommend that all people who are at risk or have a precancerous condition of the gastrointestinal tract undergo them.

Analyzes and laboratory tests

Gastric cancer is a very dangerous condition in which the chances of recovery or maximum prolongation of a person’s life directly depend on the timeliness of its detection. This pathology is very difficult to diagnose in the early stages and has such nonspecific and vague symptoms that it is impossible to make a diagnosis based on them alone.

To confirm the disease, doctors first always prescribe a number of laboratory tests:

  • General and biochemical blood tests for stomach cancer are used as additional examinations, since they do not provide a clear picture of the disease. This is due to the coincidence of some blood parameters in malignant neoplasms and gastritis. If there is a suspicion of the development of a malignancy process in the main digestive organ, they are mainly used to assess the general condition of the person. Despite this, these laboratory tests have some significance in the field of diagnosis. For example, there is a greatly reduced hemoglobin in stomach cancer, as there is hidden bleeding. When the ESR indicator increases, in the early stages it may remain within the normal range for a long time. Patients often experience persistent lekocytosis, in the presence of metastases in the bone marrow; this indicator in a blood test for gastric cancer increases significantly. Also, when donating blood for stomach cancer, a decrease in the protein content is observed, the globulin fraction is increased and the albumin fraction is decreased, and the amount of antithrombin increases. After performing a general and biochemical blood test, a cancer antigen test is taken.
  • the determination of tumor markers is a specific analysis, since these substances are products produced by normal tissues in response to the life process of the tumor. To detect them, not only a blood test for tumor markers is used, but also a urine test of a cancer patient;
  • the study of gastric juice is considered a fairly informative method, with the help of which a specialist both obtains information about the secretion and acidity of the main organ of the gastrointestinal tract, and conducts a cytological analysis of its washings, showing the presence of mutated cells. It can also be used to detect hidden bleeding;
  • identifying indicators of the blood coagulation system is necessary to check such indicators as thrombus formation. In any form of gastric cancer, it is enhanced, therefore, an increase in PTI (prothrombin index), TT (thrombin time) and APTT (activated partial thromboplastin time) indicates the development of a malignant process in the stomach;
  • examination of stool for occult blood is also mandatory, since it detects even minimal blood loss that has occurred in the lower gastrointestinal tract. If the patient is vomiting, the vomit is also examined for this indicator.

Required if there is a suspicion of the development of a malignant process in the stomach and genetic analysis. It is used to detect the mutated CDH1 gene, which indicates a person’s hereditary predisposition to stomach cancer. This method of laboratory diagnosis is used in patients in whose families there have been cases of the development of a malignant neoplasm in the main organ of the gastrointestinal tract.

Diagnosis of gastric cancer with metastases, stage 4

The advanced stage of disease development is characterized by tumor growth into all layers of the digestive organ, as well as the spread of mutated cells throughout the body. In order to detect malignant lesions of the stomach at a late stage, in addition to the main ones, additional diagnostic methods are also necessary. Among them, the main one is laparoscopy, performed under direct ultrasound guidance.

This diagnostic test is minimally invasive and performed under anesthesia. It is performed through punctures in the abdominal wall into which a camera is inserted. Using this method, a specialist has the opportunity to detect tumor growth into nearby tissues and into the liver and peritoneum.

Typically, such a diagnosis of stage 4 gastric cancer allows the specialist to identify the following unpleasant signs in the patient:

  • mutated cellular structures are in close proximity to neighboring organs;
  • the tumor has spread to nearby lymph nodes;
  • the tumor process begins to develop in nearby internal organs.

Metastases at stage 4 of this pathological condition can spread not only through lymph, affecting the lymph nodes, but also by hematogenous (through the bloodstream) or implantation (with close contact of internal organs) routes.

Differential diagnosis of stomach cancer

Due to the fact that identifying a malignant neoplasm in the main digestive organ is always difficult due to the similarity of its clinical signs with some diseases of the internal organs, a differential diagnosis of gastric cancer should always be carried out. It allows you to exclude some precancerous diseases, which include ulcers, polyps, atrophic and chronic gastritis. This is necessary due to the fact that they all have similar characteristics.

For the correct identification of a pathological condition, an adequately collected anamnesis and a complete examination of not only the gastrointestinal tract, but also other organs are of primary importance.

Differential diagnosis of stomach cancer is carried out using the following examination methods:

  • endoscopy with simultaneous taking;
  • gastrobiopsy;
  • X-ray examination;
  • detailed blood test.

After a specialist has diagnosed the pathology affecting a person, he selects adequate treatment tactics. This disease is undoubtedly very dangerous and the percentage of complete cure for patients is quite low, but all unfavorable prognoses relate directly to those people who trust their health and lives to obvious charlatans or specialists with minimal experience and low qualifications.

It is worth remembering that malignant processes occurring in the main digestive organ can either be completely eliminated, or the life of a cancer patient can be prolonged and made easier. To do this, you need very little - to find an experienced oncologist who is able to provide effective assistance at any stage of the disease.

Informative video

Like many malignant tumors, stomach cancer does not have a pathognomonic clinical picture and can be hidden for a long time. A.I. Savitsky described “small signs of stomach cancer.” These include: changes in appetite - pickiness in food, the need for more delicate foods, deterioration after eating fatty foods and aversion to meat; the appearance of hiccups, nausea, a feeling of heaviness after eating; loss of appetite; gradual weight loss. Often patients experience a decrease in interest in their surroundings and apathy appears. The most common symptom of stomach cancer is pain associated with compression of nerve fibers; it is aching and constant. Tumor growth into the liver or pancreas results in pain radiating to the right hypochondrium and back.

Cancer of the gastric outlet leads to stenosis. Food stays in the stomach for a long time and, in the absence of hydrochloric acid, undergoes rotting. In this case, patients note a feeling of fullness in the stomach, at times increased peristalsis, rotten belching, and then profuse vomiting of decomposed food. Vomiting, as a rule, brings relief and patients induce it artificially. If a tumor can be identified, it is necessary to get an idea of ​​its size and mobility. Limitation of tumor mobility is due to the transition of the process to other organs. A dense, lumpy surface of the liver often occurs when there are metastases in it. Percussion of the abdomen can reveal the presence of free fluid in the abdominal cavity, the appearance of which indicates peritoneal carcinomatosis in such patients. Ascitic fluid may also appear due to cancer metastasis to the portal of the liver or to the hepatoduodenal ligament, and icterus of the skin is observed.

The clinical course of this disease has its own characteristics, and this is primarily the so-called. “masks”: anemic, hepatic, cardiac, pulmonary, febrile, polyarthritic. This manifests the initial oncological intoxication. Enlarged lymph nodes in the appropriate clinical picture indicate the presence of metastases in them, an example of this is the lymph node in the left supraclavicular region (Virchow's lymph node).

Vaginal and rectal examination is indicated. In this case, enlarged tuberous ovaries and a dense infiltrate in the rectovesical space and perirectal tissue can be detected (Krukenberg and Schnitzler metastases).

The diagnosis of stomach cancer is confirmed by additional examination of the patient. The leading role belongs to the X-ray method of examination and fibrogastroscopy. Laparoscopy is used to determine the extent of the process and the presence of distant metastases. Changes in the blood during stomach cancer are not of a special nature. In case of stomach cancer, ESR may be accelerated and hemoglobin may decrease.

Treatment

Treatment of stomach cancer is surgical. Contraindications: oncological and general: high prevalence of the process (metastases of Virchow, Krukenberg, Schnitzler, bone, liver and cancer ascites - stage IV); severe concomitant diseases of the cardiovascular system, lungs, liver, kidneys, etc., in which it is necessary to refrain from surgery. Pain relief - general.

Types of operations:

1. Diagnostic laparotomy - to clarify the diagnosis.

2. Radical operations:

a) subtotal resection (distal and proximal);

b) gastroectomy;

c) combined resections - other organs are removed along with the affected stomach. 3. Palliative operations:

a) palliative gastrectomy;

b) gastrojejunostomy bypass;

c) gastrostomy with cardiac localization of the tumor.

4. Exploratory (trial) laparotomy - when it is not possible to perform any of the above operations.

The extent of the operation depends on the location and type of tumor. Gastric cancer usually does not spread to the duodenum and therefore the lower limit of resection is 1-2 cm distal to the pyloric sphincter. For an exophytic tumor of the antrum, it is necessary to move 5-7 cm away from the clearly defined tumor in the proximal direction. They are resected together with the stomach. the greater and lesser omentum and the gastrocolic ligament, in which the regional lymph nodes are located. The operation ends with anastomosis using the Billroth-II method as modified by Hoffmeister-Finsterer. During gastrectomy, an anastomosis is formed between the esophagus and a long loop of the jejunum with an additional Brownian anastomosis between the efferent and afferent loops. Severe complications of cancer - profuse bleeding, perforation, penetration - are indications for palliative gastrectomy.

If the surgeon discovers a cancerous tumor that does not extend beyond the stomach, but irremovable metastases are determined in the retroperitoneal lymph nodes, it is necessary to perform a gastrectomy. Removal of the primary lesion improves the patient's condition - reduces intoxication, eliminates pain and discomfort associated with eating food. In addition, metastases are more sensitive to chemotherapy than the primary tumor. This combination treatment can extend the life of patients by 2-3 years. Currently, 5-fluoro-uracil is most often used, 0.5 IV per course up to

5 g or 1.0 IV for 7 days, break 2 weeks; ftorafur 1-2 g to 50-40 g per course.

Diagnosis of cancer It is especially difficult in case of malignant transformation of a stomach ulcer. In the figure we have already schematically represented those parts of the stomach that, according to empirical data, are especially prone to the development of cancer from ulcers. A typical x-ray picture of gastric lymphosarcoma is described as diffuse thickening of the entire stomach wall.
Majority lymphosarcoma diagnosed as stomach cancer.

Suspicious for malignant neoplasm A radiological sign is also the so-called open angle of the stomach in a patient in a standing position. Normally, the angle formed by the stomach is acute; if this angle is open, i.e. there is a right angle, there is a strong suspicion of cancer, even if other typical signs have not yet been identified. This simple symptom will help in the early detection of many cases of stomach cancer.

Also gives some instructions localization. Of the 157 own observations of gastric cancer, it was distributed as follows: prepyloric region - in 70 patients, antral - in 17, lesser curvature - in 23, greater curvature - in 10, cardia - in 18, diffuse cancer - in 9 patients.
Thus, changes in the prepyloric region most suspicious.

Parietography(tomogram after the application of pneumoperitoneum and gastric distension with effervescent powder) allows you to obtain an excellent image of carcinomatous thickening of the gastric wall and primarily helps to determine the extent of the process (Porcher, Stoessel).

Differentiation between ulcer and stomach cancer is so important that it is advisable to summarize all the considerations that the doctor must take into account in each patient.

Anamnesis: frequency speaks in favor of an ulcer, but does not exclude the possibility of cancer (ulcer-cancer!). The primary occurrence of an ulcer in a patient over 50 years of age is suspicious for a malignant neoplasm.
Physical examination data and general symptoms (anemia, weight loss, accelerated ROE) in the early stages are not decisive.

The most important, but not always decisive instructions gives an x-ray examination.
Localization: ulcers of the greater curvature are more likely to be suspicious of a malignant neoplasm, and on the lesser curvature there are more often benign ulcers. Multiple ulcers are usually benign.

Anacidity is highly suspicious for cancer.
Gastroscopy and cytological examination of gastric contents are valuable only in the hands of an experienced researcher.

Benign ulcer after strict conservative treatment (rest, food every 2 hours, alkalis and sedatives), radiologically reveals a tendency to reverse development after 2-3 weeks, malignant neoplasm almost always remains without. changes.

When X-ray detection of an ulcer of the duodenum, they try to obtain an image of the ulcerative niche, which is best achieved when examined in the first oblique position, since duodenal ulcers are observed almost exclusively on the anterior and posterior walls.

To identify a niche it is necessary to ensure sufficient filling of the bulb with the contrast mass. Sometimes you have to be content with identifying the residual stain. X-rays of duodenal ulcers reveal cicatricial changes better than in the stomach. They are expressed in bulb deformations, which, depending on the degree, appear better either with tighter or weaker filling. Deformations of the bulb, depending on their appearance when transilluminated in the first oblique position, are designated as trefoil or butterfly shapes.

Depending on the location of the ulcer and the degree of cicatricial wrinkling, various characteristic x-ray patterns of duodenal ulcers (Hafter) are observed. If cicatricial changes occur at the height of ulceration, before the narrowing in the recessive area, the formation of a so-called pocket occurs. Ulcers located below the bulb are rare, their clinical symptoms correspond to classic duodenal ulcers, but these ulcers are 2 times more likely to be complicated by bleeding (Ramsdell and employees).

Every year, more than 12 million people around the world are diagnosed with a terrifying cancer, and oncology claims the lives of about 7 million people. Ukraine is in the top ten countries in terms of cancer incidence: more than 160 thousand new cases per year.

Among all cancers, stomach cancer ranks fourth in prevalence - after lung, breast and colon cancer.

Diagnosis of stomach cancer cannot be based on the etiology of this disease, because to date medicine has not been able to determine reliable scientifically based reasons for the appearance of stomach cancer in humans. But there are a great many factors that can give impetus to the transformation of cells of the gastric mucosa into a springboard for malignant neoplasms.

These are also the characteristics of human nutrition, which is dominated by fatty, fried and spicy foods. And alcohol abuse coupled with smoking. And such chronic pathologies of the stomach as ulcers, gastritis (erosive or atrophic), polyps, as well as previous surgical intervention. Often the cause of cancer, including stomach cancer, is associated with heredity, serious metabolic disorders or problems with the immune system.

Early diagnosis of stomach cancer

The earlier gastric cancer problems are identified, the greater the opportunity to successfully cope with the disease. After all, when stomach cancer is detected at its very beginning, eight out of ten patients survive. But, unfortunately, the early form of cancer can be diagnosed in no more than ten cases out of a hundred. And in more than 70% of cases of visits to medical institutions, late stages of stomach cancer are detected.

According to the unanimous opinion of doctors, early diagnosis of stomach cancer (adenocarcinoma, saucer-shaped cancer, stromal tumors, infiltrative-ulcerative, diffuse cancer) is a complex process, since in most cases, at first this insidious disease does not manifest itself in any way: there is no pain, no any functional impairment.

Oncologists define the initial stage of cancer as a primary tumor of the mucous and submucosal layers of the stomach no more than 2 cm in size. And it is usually detected during an X-ray or endoscopic examination of patients for other diseases: chronic atrophic gastritis, chronic hypertrophic polyadenomatous gastritis (Menetrier's disease), chronic ulcers stomach, adenomatous polyps or pernicious anemia (Addison-Biermer disease).

Thus, in a significant number of patients with pernicious anemia (caused by vitamin B12 deficiency and leading to atrophy of the gastric mucosa), doctors eventually diagnose stomach cancer. And the degeneration of polyps and chronic stomach ulcers into cancer reaches 20%.

Basis for determining the diagnosis of stomach cancer

Among the very first symptoms that cause specialists to suspect gastric cancer are weakness, unexplained elevated body temperature, loss of appetite and weight loss, pallor or sallow skin tone. Patients suffer from heartburn, constipation and diarrhea. However, such manifestations are characteristic of a fairly wide range of gastrointestinal diseases.

But there are also more pronounced symptoms of malignant tumors of the stomach, when patients complain of prolonged aching or nagging pain in the left hypochondrium, which begins after eating. If the tumor affects the area where the stomach passes into the duodenum (the so-called pyloric part of the stomach), then dyspepsia (a feeling of heaviness and fullness in the stomach), nausea and vomiting (from what was eaten the day before) are inevitable. All this is so serious that you need to urgently consult a doctor.

Methods for diagnosing stomach cancer

Based on data from laboratory blood tests - general and biochemical tests, it is possible to identify the patient's anemia (decreased hemoglobin levels) or a disorder of protein metabolism (as they say, “low protein”). In addition, the erythrocyte sedimentation rate (ESR) is determined, which will be increased in oncology. But it is impossible to diagnose stomach cancer using blood tests alone, and the patient is sent to take a blood test for cancer antigen, that is, for the presence of proteins (tumor markers) in the blood that are secreted only by cancer cells.

When analyzing the composition of gastric juice, it is possible to determine the content of hydrochloric acid in it: its production in the stomach during cancerous lesions of the organ is reduced to almost zero - due to atrophy of the gastric mucosa.

Therefore, without other methods for diagnosing stomach cancer, a correct diagnosis cannot be made. The main diagnostic technologies include:

  • fluoroscopy of the stomach,
  • endogastroscopy (EGD) with biopsy of stomach tissue,
  • ultrasound examination (ultrasound),
  • computed tomography (CT),
  • magnetic resonance imaging (MRI).

The generally accepted traditional X-ray examination of the stomach is effective for ulcerative-infiltrative forms of cancer (since in this case the biopsy results are often negative). X-rays can also be used to detect relapses of a cancerous tumor after surgical treatment.

Diagnosis of stomach cancer using endogastroscopy (EGD) allows you to examine the gastric mucosa, determine its condition and, most importantly, perform a biopsy of those areas of the mucosa that raise suspicion of cancer. A biopsy is the most reliable method for studying the cellular composition of tissue, and a biopsy is mandatory to confirm an oncological diagnosis.

After a comprehensive x-ray endoscopic examination, ultrasound diagnostics (ultrasound) is performed, as well as radiological diagnostics of gastric cancer (CT). These methods for diagnosing stomach cancer make it possible to detect low-quality tumors, determine their location, size and even structure.

The most common method of examining the abdominal organs is ultrasound (ultrasound). With its help, specialists identify indirect signs of stomach cancer (by changes in the shape of the organ’s outline), the tumor’s involvement of nearby organs and the presence or absence of metastases (to the liver, lymph nodes or peritoneum). Ultrasound examination is effective in the early diagnosis of stomach cancer affecting the walls of the organ.

Modern radiodiagnosis of gastric cancer - computed tomography (CT) - is aimed mainly at clarifying ultrasound data regarding the presence of metastases in internal organs located in the abdominal cavity. By imaging the stomach and its tissues from different angles, CT helps oncologists more accurately determine the stage of stomach cancer.

Magnetic resonance imaging (MRI) uses a safe magnetic field rather than X-rays to produce images. MRI diagnostics provides a clear “picture” of almost all tissues and organs. Diagnostic doctors consider MRI the most effective method for diagnosing stomach cancer and other tumors in the human body.

Diagnosis of stomach cancer is also carried out using endosonography. Specialists “look through” the walls of the stomach layer by layer and determine the stage of the cancer. This method helps to detect metastases of stomach cancer to nearby lymph nodes. In especially problematic diagnostic cases, laparoscopy is performed: a laparoscope (a type of endoscope) is inserted through a small puncture into the abdominal cavity, and with its help the doctor examines the organs. The peculiarity of this method for diagnosing stomach cancer is that a biopsy can be performed at the same time.

Differential diagnosis of stomach cancer

Differential diagnosis is widely used in medical practice, especially in cases where the “bouquet” of symptoms of the disease is so extensive that it seems that the patient has several diseases at once. The principle on which the differential diagnosis of stomach cancer (as well as any other pathology) is based is to, by excluding symptoms that do not correspond to the disease, establish the only possible disease in each specific case.

Oncologists do not hide the fact that the most difficult thing is to distinguish ulcerated forms of stomach cancer from a regular ulcer. The thing is that the clinical manifestations of both pathologies have an incredible number of similar symptoms, and the only difference is the frequency and intensity of their manifestations. At the same time, there is simply no “list” that would clearly indicate the criteria for classifying a disease as oncology.

For example, with both infiltrative ulcerative cancer and gastric ulcers, patients often complain of pain after eating, which is localized in the epigastric region (that is, in the area of ​​​​the projection of the stomach onto the anterior abdominal wall). A simple analysis of gastric juice for the level of acidity is of little help, and only the detection of a persistent form of histamine-resistant achlorhydria in a patient - a decrease in the secretory function of the stomach - gives grounds for determining malignant ulceration of the gastric mucosa.

The results of X-ray and endoscopic examination of patients with suspected gastric cancer and patients with gastric ulcers are very similar. And in this case, doctors draw a conclusion only on the data of a histological examination of gastric tissue cells taken during a biopsy. Moreover, to eliminate errors, a biopsy is done 2-3 times.