Symptoms of Stomach Cancer
Gastric cancer is often asymptomatic in early stages, but when symptoms appear in advanced disease, the most common presentations include weight loss, abdominal pain, dysphagia, vomiting, early satiety, and iron deficiency anemia. 1
Early-Stage Disease Presentation
- Early gastric cancer typically produces no symptoms or only nonspecific gastrointestinal complaints. 1, 2
- Approximately 95% of patients with early gastric cancer present with vague, nonspecific gastrointestinal symptoms that are often indistinguishable from benign dyspepsia. 2
- More than half of patients (53.3%) with early gastric cancer are initially treated for presumed benign disease for up to 48 months before the correct diagnosis is made. 2
- The absence of alarm symptoms does not exclude gastric cancer, as symptoms of early-stage cancer may be identical to those of benign dyspepsia. 3
Advanced Disease Symptoms
When gastric cancer becomes symptomatic, the following features are most common: 1
- Weight loss - one of the most frequent presenting symptoms in advanced disease 1
- Abdominal pain - commonly reported but nonspecific 4
- Dysphagia (difficulty swallowing) - particularly with tumors of the gastric cardia or gastroesophageal junction 1
- Vomiting - indicates possible gastric outlet obstruction 1
- Early satiety (feeling full quickly after eating) 1
- Iron deficiency anemia - from chronic occult bleeding 1
- Asthenia (weakness/fatigue) 1
- Indigestion/dyspepsia 1
Prognostic Significance of Symptoms
Certain alarm symptoms carry independent prognostic significance and correlate with more advanced disease: 3
- Dysphagia, weight loss, and palpable abdominal mass are major independent prognostic factors strongly associated with decreased survival. 3
- The presence of multiple alarm symptoms correlates with higher risk of death. 3
- Gastrointestinal bleeding and vomiting do not appear to have significant prognostic impact on survival. 3
- Duration of symptoms does not significantly affect prognosis. 3
Critical Clinical Pitfall
The presence of alarm symptoms often indicates advanced, potentially inoperable disease, while their absence does not exclude cancer. 3 This creates a diagnostic dilemma: alarm symptoms lack sufficient sensitivity to detect early, curable gastric cancer, yet by the time they appear, approximately 60% of patients are no longer eligible for curative treatment due to late presentation. 1
Geographic Variation in Presentation
- In the United States, more than 90% of patients present with symptoms at diagnosis, with only 13% having localized disease, 15-25% having locally advanced disease, and 35-65% having metastatic disease at presentation. 4
- In contrast, countries with screening programs (Japan, Korea) detect a higher proportion of asymptomatic early-stage cancers through routine endoscopy. 1, 4
When to Suspect Gastric Cancer
Endoscopic evaluation should be pursued in: 1, 5
- Any patient with dysphagia (at any age) 1
- Patients aged 55 years or older with new-onset dyspepsia (less than one year duration) 1, 5
- Any patient with alarm symptoms: weight loss, anemia, anorexia, palpable abdominal mass, or jaundice 1
- Patients with persistent upper gastrointestinal symptoms despite negative initial endoscopy, as advanced gastric cancer can be missed in 10% of initial examinations 5, 6