Early gastric cancer can manifest with symptoms of dyspepsia of varying severity. In cancer with invasion only of the mucous membrane, complaints of dyspeptic disorders are presented by more than 50% of patients, therefore, in the presence of dyspepsia and over the age of 40 years, an endoscopic examination is recommended . In the presence of dysplastic changes in the gastric mucosa, regular endoscopic examination is necessary. The duration of symptoms before surgery for early gastric cancer ranges from 3 to 72 months. With early gastric cancer, there are no physical signs of the disease, although some patients (about 10%) have a slight pain on palpation in the upper abdominal cavity.
In the early stages of gastric cancer, the course of the disease may be asymptomatic. When non-specific complaints appear, patients often attribute them to the manifestations of functional disorders of the upper gastrointestinal tract and do not seek medical help for a long time. However, with a thorough history, even in the early stages of the development of the disease, complaints related to stomach cancer can be identified. So, a feeling of “abdominal fullness” or a slight pain at the end of a meal may indicate cancer of the antrum . Cancer symptoms may resemble those with peptic ulcer, especially when the tumor is localized by lesser curvature. A tumor of the cardiac section of the stomach in 60% of patients can manifest with dysphagia, which indicates obstruction of more than 80% of the lumen of the abdominal esophagus or cardia . With this localization of gastric cancer, there is a need for differentiation with achalasia or cancer of the esophagus. Pathognomonic symptoms of gastric cancer occur with large sizes of the primary tumor, which leads to obstruction of the lumen of the stomach, with functional disorders resulting from the involvement of a large part of the wall of the stomach in the tumor process, if bleeding occurs. More than 70% of patients report complaints for more than 6 months. before going to the doctor. The most characteristic complaints are a feeling of heaviness and pain in the epigastrium , aggravated after eating, weight loss, nausea, vomiting of recently eaten food, hematomesis , melena, anorexia, rapid satiety with food, bloating. Pain in gastric cancer can simulate tenocardia or benign pathology of the stomach, weakening after eating.
In about 10% of patients, on initial treatment, palpable lymph nodes on the neck, ascites, jaundice are detected, and formation in the abdominal cavity is palpated. However, the presence of a palpable tumor in the abdominal cavity does not always indicate unresectable gastric cancer. Metastasis of sister Mary Joseph in the form of a palpable node in the navel is a fairly frequent manifestation of advanced cancer of the stomach, is an unfavorable prognosis factor. When this symptom appears, the median survival is not more than 3.5 months. Less commonly observed are superficial thrombophlebitis of the lower extremities ( Trusso’s symptom ).
The clinical picture of gastric cancer is determined by the localization of the tumor process in the stomach.
Cancer of the proximal stomach can be manifested by dysphagia, which leads to protein starvation, hypovolemia . In the future, general symptoms in the form of weakness, fatigue, weight loss, dizziness, etc. join. Dysphagia is often accompanied by profuse salivation. Cancer of the fundus of the stomach before the onset of clinical symptoms can reach significant sizes, the appearance of a pain syndrome indicates the spread of the tumor to neighboring structures. Cancer of the middle third of the stomach for a long time does not manifest itself clinically. Patients often make general complaints. With ulceration of the tumor, subfebrile temperature can be observed, and with tumors of lesser curvature, one of the first clinical signs of the disease is gastric bleeding. The appearance or intensification of pain in cancer localized in the middle third of the stomach may indicate the spread of the tumor to the pancreas. Cancer of the lower third of the stomach in the early stages of development can manifest as dyspepsia, halitosis. As the tumor grows and stenosis of the lumen of the output section of the stomach is attached, first burp air, then vomit the food eaten the day before. In connection with the violation of the passage of food through the gastrointestinal tract, general symptoms gradually increase.