Stages of Stomach Cancer

After gastric cancer has been diagnosed, tests are done to find out if cancer cells have spread within the stomach or to other parts of the body.

The process used to find out if cancer has spread within the stomach or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process: B-hCG (beta-human chorionic gonadotropin), CA-125, and CEA (carcinoembryonic antigen) assays: Tests that measure the levels of ß-hCG, CA-125, and CEA in the blood. These substances are released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, they can be a sign of gastric cancer or other conditions. Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to remove lymph nodes or take tissue samples for biopsy. PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells. ******

The following stages are used for gastric cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, cancer is found only in the inside lining of the mucosal (innermost) layer of the stomach wall. Stage 0 is also called carcinoma in situ.

Stage I

Stage I gastric cancer is divided into stage IA and stage IB, depending on where the cancer has spread. Stage IA: Cancer has spread completely through the mucosal (innermost) layer of the stomach wall. Stage IB: Cancer has spread: completely through the mucosal (innermost) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or to the muscularis (middle) layer of the stomach wall.

Stage II

In stage II gastric cancer, cancer has spread: completely through the mucosal (innermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or to the muscularis (middle) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or to the serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs.

Stage III

Stage III gastric cancer is divided into stage IIIA and stage IIIB depending on where the cancer has spread. Stage IIIA: Cancer has spread to: the muscularis (middle) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or the serosal (outermost) layer of the stomach wall and is found in 1 to 6 lymph nodes near the tumor; or organs next to the stomach but not to lymph nodes or other parts of the body. Stage IIIB: Cancer has spread to the serosal (outermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor.

Stage IV

In stage IV, cancer has spread to: organs next to the stomach and to at least one lymph node; or more than 15 lymph nodes; or other parts of the body.

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More information on stomach cancer

What is Stomach Cancer?
Symptoms of Stomach Cancer
Diagnosing Stomach Cancer
Treating Stomach (Gastric) Cancer

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Information adapted from the National Cancer Institute

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Symptoms of a Hiatal Hernia

Fifty percent of hiatal hernia patients don't experience any symptoms. For the other fifty percent of patients, the following symptoms may occur. Heartburn (which is worse when bending over or lying down shortly after eating) Regurgitation (backflow of stomach contents into the back of the throat Vomiting Gastric reflux (backflow of stomach contents into the esophagus) A sour or bitter taste in the mouth Frequent belching Frequent hiccups Chest pain radiating from below the breastbone (the sternum) Feeling of pressure in the chest A bloated feeling after eating Abdominal discomfort Abdominal pressure, especially soon after eating Discomfort or pain in the stomach Discomfort or pain in the esophagus Gas Unexplained coughing Difficulty swallowing

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Stomach Pain Symptoms Tell You

If you are suffering from stomach pain, you need to find the cause before you can start a treatment. Listed below are a few of the conditions that can cause stomach pain. As always, you should discuss your symptoms with your doctor for an evaluation to diagnose the cause.

Heartburn

Heartburn is a digestive symptom that occurs when stomach acid comes into contact with the lining of the esophagus, causing irritation.

The symptoms of heartburn include a burning sensation behind your breastbone that may also travel to your throat. Other symptoms may include chest pain, difficulty swallowing, persistent cough, and a sour taste in the mouth. Symptoms can get worse soon after you eat or if you lie down shorty after eating.

There are various causes of heartburn. These causes include eating foods that can trigger heartburn, pregnancy, asthma, diabetes, and hiatal hernias.

You can eliminate the heartburn in a number of ways, including chewing gum (although for some patients this worsens the pain), drinking seltzer, or taking an antacid. If you have frequent heartburn, you should see your doctor for evaluation. If you are diagnosed with gastroesophageal reflux disease (GERD), your doctor may suggest the use of H2 blockers or proton pump inhibitors (PPIs) for relief from heartburn. First steps, however, will be to make some lifestyle modifications and avoid foods that can cause heartburn.

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Peptic Ulcer

A peptic ulcer is an erosion or sore that forms either in the lining of the stomach (gastric ulcer) or in the lining of the duodenum (duodenal ulcer).

Symptoms of a peptic ulcer vary from patient to patient, but can include a burning or gnawing pain in your stomach that often feels worse when your stomach is empty, and better after you have eaten.

The most frequent cause of a peptic ulcer is Helicobacter pylori (H. pylori). Other causes of peptic ulcers may include alcohol and non-steroidal anti-inflammatory drugs (NSAIDs). The most common NSAIDs are aspirin, ibuprofen, and naproxen sodium.

Treatment of peptic ulcers depends on the cause. If the cause is H. pylori, the standard treatment is antibiotics. A proton pump inhibitor may also be prescribed. If NSAIDS are the cause of your ulcer, you should stop taking them. During the healing process for an NSAID-induced ulcer, your doctor may recommend the use of antacids to neutralize the acid, and H2-blockers or proton pump inhibitors to reduce stomach acid production.

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Gallstones

There are two types of gallstones -- cholesterol stones and pigment stones. Cholesterol stones are the most common type of gallstone, occurring in approximately 80% of patients with gallstones. Cholesterol stones are made mostly of hardened cholesterol, and are usually yellowish-green in color. Pigment stones are made of bilirubin, and are usually small and dark in color.

Symptoms of gallstones can include pain in the upper abdomen that rapidly worsens and can last from a few minutes to a few hours, nausea and/or vomiting, and heartburn. Gallstone pain often feels sharper and more localized than heartburn or ulcer pain. If the pain doesn't go away within a few hours, or if you are vomiting or have a fever, you should go to your doctor.

Causes of gallstones are usually the result of too much cholesterol or bilirubin in the bile. There are risk factors for developing gallstones, and these can be a combination of factors, including heredity, body chemistry, body type, gender, and maybe even diet.

Treatment of gallstones depends partly on whether you are experiencing symptoms or not. If you have symptoms, especially severe pain, surgical removal of the gallbladder is the most common treatment. If you have no symptoms, you and your doctor may decide that no treatment is needed.

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