How Can I Confirm The Diagnosis
Evaluation of the patient with dyspepsia
When PUD is suspected, the physician must decide whether to treat the patient empirically or to pursue a definitive diagnosis. A definitive diagnosis for dyspepsia should be pursued if the patient manifests any alarm features that may portend the presence of malignancy these include age above 45 years, weight loss, overt GI bleeding or occult GI blood loss, anemia, dysphagia, recurrent vomiting, or a family history of GI cancer. Moreover, the presence of severe pain may warrant a more thorough evaluation.
If a patient with dyspepsia does not manifest any of these worrisome features, then current guidelines recommend a strategy known as test-and-treat. In this schema, the patient is tested for Helicobacter pylori infection, and if positive, the infection is treated . If symptoms resolve, no further evaluation is generally needed.
Persistent symptoms after treatment implies that H. pylori-associated PUD was not necessarily the cause of the patients dyspepsia, and it is recommended at this point that additional diagnostic testing be performed. This strategy, while effective, is not without risk. The majority of patients with dyspepsia do not have a peptic ulcer, and because only approximately 10% of patients with H. pylori infection develop ulcer disease, the presence of the organism does not provide definite evidence that the patients symptoms are due to infection.
Making a definitive diagnosis of PUD
Why Choose The University Of Kansas Cancer Center For Stomach Cancer Diagnosis And Treatment
For a diagnosis as crucial as stomach cancer, there are many benefits to trusting our cancer team with your care. Our cancer center is 1 of only 71 NCI-designated cancer centers nationwide, and we have experts for diagnosing and treating stomach cancer. We are a pioneer in new clinical trial research that leads to innovative treatments. In addition, our hospital continues to rank as the best in Kansas City and in Kansas according to U.S. News & World Report.
Stomach Cancer Vs Ulcer Symptoms
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Can You Treat Stomach Cancer By Changing Your Diet
Using a healthy diet to treat stomach cancer is not enough to cure cancer, but you can talk to your doctor about using it as part of a medical plan to improve your overall health. Those who eat a diet rich in produce like fresh fruits and vegetables and whole grains may decrease their risk for stomach cancer. However, some studies show that increasing plant-based foods reduces the risk of fatal stomach cancer in men, but not women. Talk with your healthcare provider about your dietary options.
What Is Gastric Cancer
Gastric cancer, or cancer of the stomach, was once considered a single entity. Now, scientists divide this cancer into two main classes: gastric cardia cancer and non-cardia gastric cancer .
Gastric cancer is the second most common cause of cancer-related deaths in the world, killing approximately 738,000 people in 2008 . Gastric cancer is less common in the United States and other Western countries than in countries in Asia and South America.
Overall gastric cancer incidence is decreasing. However, this decline is mainly in the rates of non-cardia gastric cancer . Gastric cardia cancer, which was once very uncommon, has risen in incidence in recent decades .
Infection with H. pylori is the primary identified cause of gastric cancer. Other risk factors for gastric cancer include chronic gastritis older age male sex a diet high in salted, smoked, or poorly preserved foods and low in fruits and vegetables tobacco smoking pernicious anemia a history of stomach surgery for benign conditions and a family history of stomach cancer .
H. pylori has different associations with the two main classes of gastric cancer. Whereas people infected with H. pylori have an increased risk of non-cardia gastric cancer, their risk of gastric cardia cancer is not increased and may even be decreased.
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What To Do If You Have Stomach Cancer Or Ulcer Symptoms
- If you have burning pain in your upper stomach that is relieved by eating or taking antacids, call a health-care professional for an appointment. Don’t assume you have an ulcer. Certain other conditions can cause similar symptoms.
- If you vomit blood or have other signs of gastrointestinal bleeding, go to an emergency department right away. Peptic ulcers can cause massive bleeding, which requires blood transfusion or surgery.
- Severe abdominal pain suggests perforation or tearing of an ulcer. This is an emergency that may require surgery to fix a hole in your stomach.
- Vomiting and abdominal pain also can be a sign of an obstruction, another complication of peptic ulcers. This also may require emergency surgery.
Medical History Physical Exam And Tests To Look For Bleeding
When taking your medical history, the doctor will ask about your symptoms and possible risk factors to see if they might suggest stomach cancer or another cause. The physical examcan give your doctor information about possible signs of stomach cancer or other health problems. In particular, the doctor will feel your belly for anything abnormal.
The doctor might order a blood test to look for anemia , which could be caused by the cancer bleeding into the stomach. A test might also be done to look for blood in your stool that can’t be seen by the naked eye, which could also be a sign of bleeding in the stomach.
If your doctor thinks you might have stomach cancer or another type of stomach problem, he or she will likely refer you to a gastroenterologist , who will examine you and might do further testing.
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What Are Stomach Cancer Treatments
Many treatments can fight stomach cancer. The one you and your doctor choose will depend on how long you’ve had the disease or how much it has spread in your body, called the stage of your cancer:
Stage 0. This is when the inside lining of your stomach has a group of unhealthy cells that may turn into cancer. Surgery usually cures it. Your doctor may remove part or all of your stomach, as well as nearby lymph nodes — small organs that are part of your body’s germ-fighting system.
Stage I. At this point, you have a tumor in your stomach’s lining, and it may have spread into your lymph nodes. As with stage 0, you’ll likely have surgery to remove part or all of your stomach and nearby lymph nodes. You might also get chemotherapy or chemoradiation. These treatments can be used before surgery to shrink the tumor and afterward to kill any cancer that’s left.
Chemotherapy uses drugs to attack cancer cells. Chemoradiation is chemo plus radiation therapy, which destroys cancer cells with beams of high energy.
Stage II. Cancer has spread into deeper layers of the stomach and maybe into nearby lymph nodes. Surgery to remove part or all of your stomach, as well as nearby lymph nodes, is still the main treatment. You’re very likely to get chemo or chemoradiation beforehand, and you might get one of them after, too.
You usually have surgery to remove your entire stomach, along with chemo or chemoradiation. This can sometimes cure it. If not, it can at least help with symptoms.
H Pylori Increases The Risk Of Stomach Cancer Especially A Type Called Non
Some stomach cancer cases in the UK are caused by these bacteria. But, as H. pylori infection has become much less common in the UK, stomach cancer rates have dropped.
In the UK, there are other ways to reduce stomach cancer risk that are likely to have a bigger impact than treating H. pylori. This includes stopping smoking, and eating a healthy, balanced diet, high in foods with lots of fibre, like wholegrains, and low in red and processed meat.
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What Other Diseases Conditions Or Complications Should I Look For In Patients With Peptic Ulcer Disease
Risk factors for PUD
The major risk factors for peptic ulcer include the use of NSAIDS and infection with H. pylori. Less commonly, peptic ulcer may be a manifestation of the Zollinger-Ellison Syndrome due to a gastrin-secreting tumor. Although most individuals with ZES present with symptoms similar to ordinary peptic ulcer, the diagnosis should be suspected in patients with peptic ulcer , accompanied by chronic diarrhea and/or severe GERD, and in patients with manifestations of the MEN-1 syndrome.
Gastric ulcer may be associated with adenocarcinoma, signet ring carcinoma, leiomyosarcoma, lymphoma, and other neoplasms. Rarer causes of gastric ulcer include Crohns disease , sarcoidosis, eosinophilic gastritis, fungal infections, secondary syphilis, and tuberculosis. The risk of an infectious etiology for gastric ulcer is significantly increased in immunocompromised patients .
Complications of PUD
The most common complication of PUD is upper GI hemorrhage other complications include perforation and gastric outlet obstruction, both of which are far less prevalent than hemorrhage.
If perforation is suspected , evidence of pneumoperitoneum should be sought with an upright chest or abdominal X-rays if these are negative and suspicion is still high, a CT scan can demonstrate small amounts of free air in the peritoneum. A gastrograffin UGI radiograph can also demonstrate perforation, but this test is rarely used at present.
List of complications of PUD
Effect Of Vascular Endothelial Growth Factor
Jones et al. and Suzuki et al. stated that enhanced vascular endothelial growth factor gene expression was identified to contribute to the healing of peptic ulcer, whereas Takahashi et al. and Maeda et al. reported that gastric cancer frequently displayed high levels of VEGF expression associated with intramucosal microvessel density, and Feng et al. indicated that high levels of VEGF expression have also been observed in gastric premalignant lesions such as chronic atrophic gastritis and intestinal metaplasia. Moreover, Tahara et al. indicated that the VEGF 1612A polymorphism was associated with an increased risk of gastric cancer.
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Purpose Of Stomach Ulcer Surgery
Peptic ulcers can cause pain, stomach discomfort, abdominal cramps, decreased appetite, hematemesis, gastrointestinal bleeding, iron deficiency anemia , and malnutrition.
Generally, the condition can be effectively treated with medication and lifestyle changes, rather than with surgical intervention. Smoking and alcohol use can contribute to stomach ulcers, and stopping these habits can help an ulcer heal. Sometimes dietary modifications, like avoiding spicy foods, can help control symptoms.
Treatments for gastric ulcers include proton pump inhibitors and antibiotics to eradicateHelicobacter pylori, a bacteria that is commonly associated with stomach ulcers.
Surgical management may be needed for complications of peptic ulcer disease or for treatment of a stomach ulcer that doesn’t improve despite conservative management.
Issues that may warrant surgical intervention for the treatment of peptic ulcer disease include:
These issues can cause persistent and serious health problems. Stomach ulcer surgery would be done to alleviate your symptoms and prevent consequences to your overall health.
What Is A Stomach Ulcer
Stomach ulcers, also commonly known as gastric ulcers, are open and painful sores that develop on the stomachs lining.
Stomach ulcers come under the category of peptic ulcer disease. Peptic ulcers are trouble for both the stomach and small intestines. These are also known as duodenal ulcers.
When the digestive acids start to eat away the tissues that line and protect the stomach, that is when it causes an ulcer to occur. It usually happens when the thick layer of mucous protecting the stomach is stripped off or reduced, allowing the digestive acids to flow into the tissues.
Stomach ulcers are usually easily curable. However, if ignored or failed to seek proper treatment for it, they can cause severe damage to your health and body.
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Ways Of Diagnosing Stomach Cancer Include:
Upper GI series
Also called barium swallow, this test examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum .
A fluid called barium a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray is swallowed. X-rays are then taken to evaluate the digestive organs.
Esophagogastroduodenoscopy
Also called EGD or upper endoscopy, this procedure allows us to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows us to view the inside of this area of your body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy .
Endoscopic ultrasound
This imaging technique uses sound waves to create a computer image of the wall of the esophagus and stomach, as well as nearby lymph nodes. A small transducer that emits sound waves and receives their echoes is placed on the tip of an endoscope. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach so that we can see the inside of this area of the body, as well as insert instruments to remove a sample of tissue for biopsy.
Computed tomography scan
Fecal occult blood test
Causes Of Stomach Ulcer
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What Causes Stomach Cancer
Scientists donât know exactly what makes cancer cells start growing in the stomach. But they do know a few things that can raise your risk for the disease. One of them is infection with a common bacteria, H. pylori, which causes ulcers. Inflammation in your gut called gastritis, a certain type of long-lasting anemia called pernicious anemia, and growths in your stomach called polyps also can make you more likely to get cancer.
Other things that seem to play a role in raising the risk include:
Various H Pylori Strains
It is gradually becoming clear that there is a wide variety of H. pylori infections, and that there are some bacterial strains that may well be more likely to cause duodenal ulcer disease, and others that may promote the development of gastric cancer .
Fig. 1
Risk factors of gastric cancer and duodenal ulcer. Hp, Helicobacter pylori IL, interleukin TNF, tumor necrosis factor HSP, heat shock protein
Elder et al. proposed that cimetidine is converted to its nitroso analog which structurally resembles other known gastric carcinogens, but Muscroft et al. contended that cimetidine is unlikely to cause gastric cancer, as a result of their finding low concentrations of gastric juice nitrite in patients taking the drug.
Lin et al. reported on the anticancer activity of cimetidine , and noted that the perioperative use of cimetidine in gastric cancer patients could help restore diminished cellular immunity. Milito and Fais , Dillman et al. , and Jiang et al. were in agreement with this opinion, but Langman et al. reported that cimetidine did not show significantly more influence on the survival of patients with gastric cancer than placebo. Therefore, further investigation is required into the effects of cimetidine.
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What Treatments Are Available For Stomach Cancer
Surgery to remove the tumor is the only means of curing stomach cancer. A cure can be achieved in 80% or more of patients with tiny early stomach cancers unfortunately, such cases are uncommon outside Japan. For the majority of patients, surgery involves removing part or all of the stomach, depending upon the exact location of the tumor.
Surgery may also be necessary in patients who cannot be cured, as this may be the only means of relieving distressing symptoms such as a blockage of the stomach.
Chemotherapy and radiotherapy treatment given after surgery are not very effective in preventing recurrence of the disease or improving survival. Recently, however, better results have been obtained by giving chemotherapy pre-operatively.
For patients with inoperable tumors, it is sometimes possible to control symptoms by laser therapy performed using an endoscope. Similarly, difficulty swallowing or an obstruction between the stomach and duodenum can sometimes be controlled by inserting an expandable metallic tube through the blocked region to hold it open. Some improvement in symptoms may also be obtained with chemotherapy.
Having Another Type Of Cancer
Your risk of developing stomach cancer is increased if you’ve had another type of cancer, such as cancer of the oesophagus or non-Hodgkin lymphoma .
For men, the risk of getting stomach cancer is increased after having prostate cancer, bladder cancer, breast cancer or testicular cancer. For women, the risk of developing stomach cancer increases after having ovarian cancer, breast cancer or cervical cancer.
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Common Early Signs Of Stomach Cancer
More than 7 in 100,000 people are diagnosed with stomach cancer each year, while 3 in 100,000 die from the disease. About 0.8% of all men and women will be diagnosed with stomach cancer at some point in their life. As of 2017, 116,525 in the United States were living with stomach cancer.
In 2020, the National Cancer Institute estimates 27,600 new cases of stomach cancer will be diagnosed, which is roughly 1.5% of all new cancer cases. The NCI also projects 11,010 deaths from stomach cancer in 2020, which is 1.8% of all cancer deaths.
Because stomach cancer affects men and women differently, and can be difficult to diagnose, it is crucial to understand its unique traits and the illnesses it can mimic. This article covers the signs and symptoms of stomach cancer, the different disease stages, primary causes, warning signs and how to manage it.