Can gastric cancer be present without GI bleeding?
February 27, 2012 3:59 PM   Subscribe

Does gastric cancer always bleed?

A loved one has been experiencing crippling stomach pain when eating. The doctor seems to be leaning towards cancer rather than an ulcer because there isn't any blood in the stool. This doesn't make sense to me, since I thought that blood was a symptom of cancer (and many ulcers). Are there gastric cancers that don't bleed at all?
posted by Kevin Street to Health & Fitness (11 answers total)
 
Not all cancerous tumors bleed, and on top of that, gastric cancer is located high enough in the digestive tract that blood can be digested before showing up in the stool, but until an endoscopy is performed, there's really no way of telling.
posted by infinitywaltz at 4:07 PM on February 27, 2012


I am not a doctor, but I've had gut issues and I can tell you that there are a lot of steps between stomach pain and a cancer diagnosis.

Also, I'd be surprised if the doctor just came out and said they suspected cancer right off the bat without doing an endoscopy. Could your relative have been confused or perhaps inferred something that was just mentioned as a possibility?

Gut stuff is the worst. It can be hard to pin down. I hope your loved one gets some answers soon.
posted by elizeh at 4:12 PM on February 27, 2012 [2 favorites]


I am a doctor but NYD and not a gastroenterologist, but there has to be some other reason aside from the pain that your loved one's physician is worried about cancer. Many people have stomach pain and very few of them have cancer. I think you need to speak directly to the doctor, with your loved one's permission, if you really want the details.

Cancers start small and progress to metastatic. Think of cancer as a continuum and not as a specific thing with specific features at all times that it exists. When a cancer first starts, it is small - the genetic mutation starts with just one cell! As it grows, it becomes something that can be physically seen, like think of a colon polyp, or a lesion on a cervix, or a mole on the skin. As it gets bigger and more invasive and accumulates more mutations, it does things like get a blood supply and it can get ulcerated and bleed. This goes for all the examples given above: colon cancer (or gastric cancer), cervical cancer, skin cancer. The fact that it bleeds when it is diagnosed doesn't mean that it didn't exist until it started bleeding - the cancer was there before, the reason why it gets detected is by doing something like bleeding, causing pain, etc. But of course there are a number of other more benign reasons you can have gastrointestinal bleeding, vaginal bleeding, or a skin lesion that bleeds.
posted by treehorn+bunny at 7:11 PM on February 27, 2012


"Also, I'd be surprised if the doctor just came out and said they suspected cancer right off the bat without doing an endoscopy. Could your relative have been confused or perhaps inferred something that was just mentioned as a possibility?"

He's a very frail senior, and they're afraid to sedate him, so I guess there won't be an endoscopy. I think they did some X-rays today (there were tests of some kind), so maybe they'll know something tomorrow. But they almost never say anything for sure, because it would be too hard on him to do invasive tests.

"I am a doctor but NYD and not a gastroenterologist, but there has to be some other reason aside from the pain that your loved one's physician is worried about cancer. Many people have stomach pain and very few of them have cancer. I think you need to speak directly to the doctor, with your loved one's permission, if you really want the details."

They found something in his liver a few months ago (too frail for a biopsy so no way to tell what it is for sure), so I guess the thinking is it might have spread from (or maybe to) the stomach. All I know is that he's had some stomach pain for years, but in the last six months or so it's become total agony. He's had ulcers before, too.

Thanks to all three of you for the informative, rational answers! I've been Googling keywords for days, getting more and more upset, and it really helps to someone explain the possibilities like this.
posted by Kevin Street at 7:59 PM on February 27, 2012


as other posters said it is the overall picture that leads to this particular Dx, especially when it isn't possible to do some of the more invasive procedures like a liver biopsy.

yes, evidence of a cancerous lesion in the upper GI tract anywhere does not have to show blood in the stool.

secondly it seems from the information you provide that the doctors are being sensitive to not over treat or be aggresive with what appears to be a serious condition. Depending on the age and other co-morbidities the team should be talking options with the patient and/or his family, e.g. pain meds absorbed elsewhere and not in the stomach, other means of making him comfortable, other means of getting essential nutrients in etc., etc.,

Here in the UK there is an amazing charity called the Mcmillan Cancer Charity which has a huge amount of info on the website about issues like this.

I am no longer clinically active.
posted by Wilder at 9:00 AM on February 28, 2012


If he's too frail for an endoscopy or biopsy, he's probably too frail for any cancer treatment anyway. So aside from just basic wanting to know (which is very understandable), there's not really any medical reason to pin it down beyond "our best guess is that it's X, based on the things we can test for."

That said, if it is just an ulcer, that is something he could be treated for even though he is so frail. So to that extent, it does make sense to try to figure out what's going on.

FWIW, there are tests to detect H. pylori (the bacteria that causes stomach ulcers) that use blood or stool samples, without need for an endoscopy. I believe there is also some kind of breath test, but I'm not sure how it works. If this was my family member, I would want to ask whether one of these had been done, or why the doctor doesn't think it's important.

I would also check to see whether my loved one was taking aspirin, ibuprofen, aleve, or other NSAIDs, as these can aggravate stomach ulcers and also bleeding in stomach cancer. A lot of seniors are on daily aspirin for heart health, and a lot of people take NSAIDs when they're in pain (like even stomach pain), so it would be good to find out what your loved one is using and make sure the MD has ok'ed it. People often forget to mention the over-the-counter medicines they take, but they are just as important as the prescription drugs.

Is someone going along to appointments with this person, to help take notes or remember to ask important questions? This is important for anyone with ongoing health issues, not just seniors. That person can also be a point of contact for the rest of the family, so that the person who isn't feeling well doesn't have to field tons of phone calls and explain the same thing over and over.

Good luck to all of you.
posted by vytae at 9:38 AM on February 28, 2012


Thank you all. And thank you for the link, Wilder. I'll take a look at it tonight. We're not in the UK, but more information certainly can't hurt.

The loved one is pretty much out of it at this point with tiredness and delirium, so I'm the only person left the doctors can talk to. I spoke with his doctor today.

"FWIW, there are tests to detect H. pylori (the bacteria that causes stomach ulcers) that use blood or stool samples, without need for an endoscopy. I believe there is also some kind of breath test, but I'm not sure how it works. If this was my family member, I would want to ask whether one of these had been done, or why the doctor doesn't think it's important."

She mentioned this, but apparently you can't do the tests if you're already on a drug that treats ulcers. (She put him on something that reduces the acid in his stomach a few days ago.) Only thing is that drug didn't work, so she consulted with a stomach specialist and switched drugs. They're of the opinion that it's cancer and he's going to die soon, but they'll try the new drug to see if it works.

I tentatively asked the doctor about how some ulcers are caused by H. pylori bacteria , and she said that the treatment for that is a "triple therapy." (She named the drugs, but it kind of flew past me at that time.) Wikipedia says that's "proton pump inhibitors such as omeprazole, lansoprazole and the antibiotics clarithromycin and amoxicillin." She didn't think it would help, but I said why not try it at this point, and I think she agreed to give it a try. So I'm pinning everything on that at this point.
posted by Kevin Street at 3:42 PM on February 28, 2012 [1 favorite]


My father has passed away. In the last three weeks or so, it looked like the pain was going down, and in the last three or four days he seemed to be pain free. But then he started to develop phlegm in his lungs and throat, and he got weaker and weaker. They don't really know what did it, but it wasn't his stomach.
posted by Kevin Street at 6:23 PM on March 31, 2012


I'm so sorry to hear of your loss. I'll be thinking of you.
posted by vytae at 2:33 PM on April 2, 2012


Today is the funeral. I don't want any this! It's like a nightmare that just won't stop.

I just want him to be alive.
posted by Kevin Street at 7:52 AM on April 4, 2012


I'm really sorry about your dad. I'm so sorry.
posted by onlyconnect at 11:05 PM on May 26, 2012


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