I. Clinical manifestations of early gastric cancer are mostly asymptomatic or with only slight symptoms. When the clinical symptoms are obvious, the lesion is already in advanced stage. Therefore, we should be very alert to the early symptoms of gastric cancer so as not to delay the diagnosis and treatment.
(1) With the development of early gastric cancer, the function and circumstance of stomach gradually change, and these symptoms are often non-specific, may appear from time to time, and may exist for a long time. Such as epigastric distension, dull pain, vague pain, nausea, loss of appetite, belching and lethargy, etc.; a few ulcer type (type IIc and type III) early gastric cancer may also have ulcer-like symptoms, rhythmic pain and acid reflux, which can be relieved by medical treatment, etc. In some patients, gastric cancer coexists with or occurs on the basis of certain benign lesions (such as chronic atrophic gastritis, peptic ulcer, etc.), and the symptoms of these benign gastric diseases have existed for a long time or recurrently, which makes patients and doctors relax their alertness to gastric cancer and delay the diagnosis. Some early gastric cancers may also present with symptoms such as vomiting blood, black stool, or difficulty in swallowing.
①Upper abdominal discomfort.
It is the most common initial symptom of gastric cancer, about 80% of patients have this symptom, similar to dyspepsia. If abdominal pain occurs, it is usually mild and irregular at the beginning, but cannot be relieved after eating, and gradually worsens. Some of them can have rhythmic pain, especially sinus gastric cancer is more obvious, and even can be relieved by eating or taking medicine. The pain sensation is dull in the elderly, and the main complaint is abdominal distension. These symptoms are often not taken seriously by patients, and are easily mistaken for gastritis or ulcer disease when they seek medical attention. Therefore, middle-aged patients should be given further examination if they have the following conditions to avoid missing the diagnosis: A. No previous history of gastric disease, but recent unexplained epigastric discomfort or pain, which is ineffective after treatment; B. Previous history of gastric ulcer and recent change in the regularity of epigastric pain with increasing degree. If the symptoms are relieved, but there is another episode within a short period of time, the possibility of gastric cancer should also be considered and further examination should be conducted in time.
②Loss of appetite or loss of appetite.
Nearly 50% of gastric cancer patients have obvious symptoms of loss of appetite or loss of appetite, and some of them restrict eating on their own because too much food will cause abdominal distension or pain. Unexplained anorexia and weight loss are probably the initial symptoms of early gastric cancer, which need to be taken seriously. Patients with early gastric cancer usually have no obvious positive signs, and most of them only have deep pressure pain in the upper abdomen in addition to weak general condition.
(2) Progressive stage gastric cancer gastric cancer lesion is a progressive process from small to large, from superficial to deep, from no metastasis to metastasis, so there is no obvious boundary between early stage, progressive stage and even late stage, not only that, there is often a great crossover of symptoms between stages, some patients have already reached the progressive stage but the symptoms are not obvious yet, some have more prominent symptoms although they are in the early stage, and some patients are diagnosed with symptoms of organ metastasis or symptoms of comorbidity. Some patients present with symptoms of organ metastasis or comorbidities. According to domestic statistics, the common symptoms of progressive gastric cancer are as follows
① Abdominal pain.
When gastric cancer develops and expands, especially when the infiltration penetrates the plasma membrane and invades the pancreas or the transverse colon mesentery, continuous severe pain may appear and radiates to the lower back. Very few patients with perforated cancer ulcers may also have severe abdominal pain and signs of peritoneal irritation.
②Loss of appetite and wasting.
The absorption of toxins from cancer can make patients increasingly appear wasting, weakness, anemia and malnutrition, which are often progressively aggravated and finally manifest as cachexia.
③ Nausea and vomiting.
It is also one of the more common symptoms, which can occur in early stage. Gastric sinus cancer may also show symptoms of pyloric obstruction.
④Vomiting blood and black stool.
When ulcers are formed on the surface of cancer, vomiting blood and black stool will appear. 1/3 of gastric cancer patients often have small amount of bleeding, which is mostly manifested as positive fecal occult blood, and some of them may have intermittent black stool, but there are also those who visit the doctor with large amount of vomiting blood.
⑤ Diarrhea.
It may be related to low gastric acid, and the stool may be paste-like or even have five-shift diarrhea. When advanced gastric cancer involves the colon, it often causes diarrhea and bloody stools.
(6) Difficulty in swallowing.
After the cancer grows up, obstructive symptoms may appear, pancreatic or fundic cancer may cause dysphagia, and sinus cancer may cause pyloric obstruction.
2.Signs: Early gastric cancer may not have any signs. Or there is only pressure pain in the upper abdomen. In middle and late stage gastric cancer, most of the epigastric pressure pains are obvious. 1/3 of the patients can have palpable lumps in the abdomen, which are hard, with unsmooth surface and tenderness, especially the lumps are more easily found in the wasted patients with gastric sinus cancer. As for metastases such as prerectal masses, umbilical masses, enlarged supraclavicular lymph nodes and ascites, they are more evidence of advanced gastric cancer.
Upper abdominal mass, anterior rectal palpable mass, umbilical mass, left supraclavicular lymph node enlargement, left axillary lymph node enlargement and ascites often suggest the presence of distant metastasis. The clinical manifestations are often complicated by the corresponding signs depending on the metastatic sites. For example, liver metastasis may lead to liver enlargement and jaundice, ovarian metastasis may lead to ovarian enlargement and large amount of ascites, and lung metastasis may lead to respiratory distress.
In addition, gastric cancer with cancer syndrome can be an important sign, such as thrombophlebitis, dermatomyositis, etc. Advanced patients may have fever, cachexia, etc.