Editorial
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 28, 2008; 14(8): 1149-1155
Published online Feb 28, 2008. doi: 10.3748/wjg.14.1149
Role of symptoms in diagnosis and outcome of gastric cancer
Giovanni Maconi, Gianpiero Manes, Gabriele Bianchi Porro
Giovanni Maconi, Gianpiero Manes, Gabriele Bianchi Porro, Department of Clinical Sciences, Chair of Gastroenterology, L. Sacco University Hospital, Via G.B. Grassi, 74, Milan 20157, Italy
Correspondence to: Professor Giovanni Maconi, Department of Clinical Sciences, “L. Sacco” University Hospital, Via G.B. Grassi, 74, Milan 20157, Italy. giovanni.maconi@unimi.it
Telephone: +39-2-39042486
Fax: +39-2-39042232
Received: October 14, 2007
Revised: January 14, 2008
Published online: February 28, 2008
Abstract

Gastric cancer is one of the most common cancers and the second most common cause of cancer deaths worldwide. Apart from Japan, where screening programmes have resulted in early diagnosis in asymptomatic patients, in most countries the diagnosis of gastric cancers is invariably made on account on dyspeptic and alarm symptoms, which may also be of prognostic significance when reported by the patient at diagnosis. However, their use as selection criteria for endoscopy seems to be inconsistent since alarm symptoms are not sufficiently sensitive to detect malignancies. In fact, the overall prevalence of these symptoms in dyspeptic patients is high, while the prevalence of gastro-intestinal cancer is very low. Moreover, symptoms of early stage cancer may be indistinguishable from those of benign dyspepsia, while the presence of alarm symptoms may imply an advanced and often inoperable disease. The features of dyspeptic and alarm symptoms may reflect the pathology of the tumour and be of prognostic value in suggesting site, stage and aggressiveness of cancer. Alarm symptoms in gastric cancer are independently related to survival and an increased number, as well as specific alarm symptoms, are closely correlated to the risk of death.Dysphagia, weight loss and a palpable abdominal mass appear to be major independent prognostic factors in gastric cancer, while gastro-intestinal bleeding, vomiting and also duration of symptoms, do not seem to have a relevant prognostic impact on survival in gastric cancer.

Keywords: Gastric cancer; Symptoms; Diagnosis; Survival; Cancer stage; Alarm symptoms; Dyspepsia