What are the symptoms of stomach cancer?

Symptoms of Stomach Cancer

Gastric cancer is often asymptomatic in early stages, but in advanced disease, common signs and symptoms include dysphagia, asthenia, indigestion, vomiting, weight loss, early satiety and/or iron deficiency anaemia. 1

Common Symptoms in Advanced Gastric Cancer

• Alarm symptoms that should prompt urgent investigation include:

  • Weight loss 1
  • Vomiting 1
  • Anorexia 1
  • Dysphagia (difficulty swallowing) 1
  • Iron deficiency anaemia 1
  • Early satiety (feeling full quickly) 1
  • Indigestion (especially when persistent or new onset) 1
  • Asthenia (weakness/fatigue) 1
  • Upper abdominal mass 1

• Non-specific symptoms that may be present:

  • Dyspepsia (especially in patients aged 55 years or more) 1
  • Continuous symptoms since onset 1
  • Recent onset of dyspepsia (less than one year ago) 1

Clinical Considerations

• Approximately 60% of people with gastric cancer are not eligible for curative treatment due to late presentation or comorbidities 1
• Symptomatic presentation is a poor predictor of pathology as "dyspepsia" is very common 1
• The majority of patients present with advanced disease with alarm symptoms 1
• Even advanced gastric cancer can sometimes be missed during endoscopy, particularly when located in the cardia, greater curvature of the body, or with certain histological types (signet ring cell or poorly differentiated adenocarcinoma) 2

High-Risk Features That Should Prompt Investigation

• Dyspepsia in patients aged 55 years or more 1
• Family history of upper gastrointestinal cancer in more than one first-degree relative 1
• History of Barrett's oesophagus 1
• Pernicious anaemia 1
• Peptic ulcer surgery over 20 years ago 1
• Known dysplasia, atrophic gastritis, or intestinal metaplasia 1
• Jaundice 1

Diagnostic Approach

• Endoscopic examination with forceps biopsies is the gold standard for diagnosing gastric cancer 1
• Multiple biopsies (5-8) should be taken to provide adequate material for histological interpretation 1
• If a patient continues to complain of upper gastrointestinal symptoms despite normal endoscopy findings, repeated endoscopy and/or additional diagnostic studies should be considered 2

Prevention and Early Detection

• Regular screening is only recommended in high-risk regions or for individuals with specific risk factors 1
• Individuals with intestinal metaplasia, family history of gastric cancer, or persistent H. pylori-associated gastritis should undergo endoscopic surveillance with guided biopsies every 3 years 1
• If a familial cancer syndrome is suspected, referral to a geneticist for assessment is recommended 1

Early recognition of these symptoms, especially in combination, is crucial as early detection significantly improves treatment outcomes and survival rates 3.