Do you always feel a sense of bloating and discomfort in your stomach after every meal, as though your stomach is crying out for help? If over-the-counter stomach medicine doesn’t help relieve the pain, it might be a wake-up call, especially when other stomach cancer symptoms such as loss of appetite, persistent indigestion and changes in the color and/or consistency of stool also appear. Apart from these common symptoms, some rare international medical cases have shown that even black palms could also be an symptom of early-stage stomach cancer. Learn about stomach cancer symptoms below and do not dismiss stomach pain as a trivial matter!

An overview of common stomach cancer symptoms

Early stage Persistent stomach pain, Loss of appetite, Persistent indigestion, Abdominal bloating
Middle stage Dark stool or blood in the stool
Mid to late stage Difficulty swallowing, vomiting undigested food, vomiting blood
Late stage (or spread to other organs)Fatigue, back pain, weight loss

Early-stage stomach cancer symptoms

Stomach cancer develops slowly over time and its incubation period can be as long as 10 to 20 years. At present, the cause of stomach cancer is unknown, but studies have suggested a possible association between stomach cancer and helicobacter pylori or long-lasting stomach ulcers. There are striking similarities in symptoms between early-stage stomach cancer and stomach ulcers, including intermittent mild abdominal pain, accompanied by heartburn, hiccups, indigestion, abdominal bloating, nausea and loss of appetite, etc. When medication can no longer ease the symptoms, most patients will visit a doctor for diagnosis and treatment. If stomach cancer is detected early at this stage, the survival rate of stomach cancer is as high as 80% to 90%.

Middle-stage stomach cancer symptoms

When the disease has progressed to the middle stage, ulcers in the stomach may become more severe and slow down the movement of food in the stomach, aggravating the problem of indigestion. If the tumor grows in the body within the greater curvature of the stomach, the tumor’s surface tissues could become necrotic, shed and bleed due to a lack of blood supply, leading to internal hemorrhage that results in dark or bloody stool.

Mid- to late-stage stomach cancer symptoms

In the mid- to late-stage stomach cancer, internal hemorrhage may become more serious due to the tumor invading the blood vessels of the stomach. Patients at this stage may vomit blood, in addition to frequent nausea and vomiting. If the tumor has grown to the upper part of the stomach (near the cardia), symptoms such as sternum pain, blocked esophagus, and difficulty swallowing may occur. If the tumor grows in the lower part of the stomach (near the pylorus), food cannot pass through the stomach to the duodenum, leading to loss of appetite and stomach cramps, and the patient may even vomit undigested food.

Late-stage stomach cancer symptoms

For late-stage stomach cancer, the tumor might have already spread to tissues at the back area. As a result, a majority of patients experience back pain and long-term lack of energy, leading to rapid weight loss, fatigue and general weakness, etc.

Rare international case studies: paying attention to darkening palms may help in early diagnosis

As mentioned above, symptoms of early-stage stomach cancer are very similar to those of general stomach problems, which makes it easy for patients to miss the signs. In recent years, medical professionals have discovered that some stomach cancer patients in places such as India and Southeastern China experienced a condition characterized by darkened skin in folds and creases with a thick, velvety texture, before other common symptoms such as indigestion, abdominal bloating, nausea or loss of appetite occurred. This skin condition is known as “acanthosis nigricans”. Although cases like these are relatively rare, it could be a new clue for the diagnosis of early-stage stomach cancer, propelling patients to undergo screening for stomach cancer at an early stage. The detailed information about the cases is as follows:

In 2014, two relevant cases were found in India [1]. A 43-year-old male farmer experienced fatigue, high fever, loss of appetite and weight loss. His condition was thought to be caused by parasitosis and anemia until treatment of these two conditions failed to cure him. The doctor later found out that the patient not only felt a constant sense of bloating and discomfort in his upper abdomen after food, but also developed a skin condition, causing his palms to darken with a velvety, thick texture. In the same year, there was a 51-year-old female diabetic patient who experienced similar conditions in her upper abdomen. She lost about 6 kg in 3 months and had acanthosis nigricans on her palms and back. Both of these patients were diagnosed with stomach cancer after gastroscopy.

In 2017, there was a 74-year-old male farmer in Southeastern China[2] who experienced the symptoms of acanthosis nigricans on his face, fingers, palms, feet and several other parts of his body for a consecutive period of 7 months. Common symptoms such as heartburn and abdominal bloating occurred subsequently. The patient was soon diagnosed with stomach cancer. After tumor resection, the patient’s skin condition improved slightly. However, he died from cachexia (meaning that the patient had symptoms of metabolic disorder and malnutrition) after 3 months.

Acanthosis nigricans is rare in Hong Kong. In general, patients with diabetes have a higher risk of developing this condition. Previous studies also indicated that this type of skin disease is commonly associated with lung and stomach tumors. Nevertheless, what exactly is the relationship between black acanthosis nigricans and cancer? At this moment, the medical community still has no definitive answer and further research is required for confirmation.

Early-stage stomach cancer patients have 80%-90% survival rates

To keep stomach cancer at bay, gastroscopy is the primary method to detect stomach cancer currently. Through gastroscopy, the doctor checks whether there are tumor tissues in the stomach and collects a sample of tissue for genetic testing; thereafter, he/she devises a personal treatment plan suitable for the patient if the result is positive. Individuals who have a family history of stomach cancer are recommended to undergo gastroscopy once a year when they reach 40 years of age. For the general public, despite a lack of census on stomach cancer in Hong Kong currently, over 50,000 people have undergone gastroscopy in private medical centers alone in a year, according to a recent report of the insurance industry. This result reflects heightened public awareness of stomach cancer.

Treatment methods differ across stages of stomach cancer, or rather the depth of the location of the tumor. Surgery is the primary treatment method for early-stage stomach cancer, with the five-year survival rate reaching 80%-90%. Clinically speaking, most of the stomach cancer cases in Hong Kong were diagnosed at stages III and IV, some of which the cancer has spread to other parts of the body. The limited efficacy of first-line and second-line chemotherapy in these stages has increased the difficulty in treatment. Fortunately, the rise of new-generation targeted drugs and immunotherapies has brought new hopes to patients with late-stage stomach cancer on the road of treatment.

In most situations, occasional stomach pain does not result in immediate life-threatening health risks (such as functional abdominal pain, commonly known as “stomach anxiety”, suffered by about 60%-70% of patients with stomach pain). Regardless, it is advisable to go for a proper check-up early to identify the cause of your stomach pain and treat it accordingly, so that you may be rid of the trouble caused by stomach pain, can savor the taste of delicacies and enjoy your life to the fullest.

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Dr. Kwong Wai Kay, Philip

SPECIALIST IN CLINICAL ONCOLOGY