Stomach Cancer: How to Catch It Sooner

A dull ache in the stomach can be easy to brush off as indigestion or stress. But in some cases, persistent or unusual symptoms may point to something more serious, such as stomach – or gastric – cancer.

In Singapore, it is the eighth most common cancer in men and 10th most common in women, says Mount Alvernia Hospital gastroenterologist Reuben Wong. As it often causes few or no symptoms early on, many cases, he adds, are only diagnosed at stage three or four.

Here, he explains the signs, risk factors and treatment options.

Q: What are the signs of stomach cancer, and who is more at risk?
As the cancer progresses, some people may feel upper abdominal pain or discomfort that does not go away. Others may vomit blood or pass black, tar-like stools that look dark, sticky and thick – possible signs of bleeding in the stomach.

In later stages, the tumour may block part of the stomach. This can lead to vomiting or feeling full after eating only a small amount. Other signs to spot include unexplained weight loss or low levels of red blood cells.

Several factors can raise one’s risk. These include a diet high in salt or preserved foods, smoking and excessive alcohol intake. A person may also have a higher risk if a first-degree relative – such as a parent, sibling or child – has had stomach cancer.

Q: How is stomach cancer diagnosed, and when is screening important?
The main test used to diagnose stomach cancer is an endoscopy. During the procedure, a thin, flexible tube called a gastroscope is passed through the mouth and into the stomach.

This allows the doctor to look directly at the stomach lining for ulcers, tumours or inflammation. Small tissue samples, or biopsies, can also be taken and checked under a microscope.

Endoscopy is not widely used as routine screening for everyone, unlike colonoscopy for colorectal cancer. However, doctors may recommend gastroscopy – to check the stomach lining more closely – in people at higher risk.

Testing for Helicobacter pylori may also be useful, as the infection is a known risk factor for stomach cancer. This can be done through a breath or stool test.

Doctors will recommend suitable screening based on a person’s symptoms and risk factors.

Q: How is stomach cancer treated, and has treatment improved?
Treatment depends on how early the cancer is found and whether it has spread. Where possible, the aim is to remove the tumour.

In the past, treatment often involved open surgery, together with chemotherapy or radiotherapy. Today, doctors have more ways to treat stomach cancer, especially when it is detected early.

For some small, localised cancers, the tumour may be removed through an endoscope. In suitable cases, surgery can also be done using keyhole or robotic techniques, which are less invasive than traditional open surgery.

Moreover, chemotherapy may now be combined with newer medicines, including targeted therapy and immunotherapy, for selected patients.

In some more advanced cases, treatment may be given before surgery to shrink the tumour and make an operation possible.

With earlier detection and the right treatment plan, patients may have more options and better outcomes.