I. Diagnostic Points

I. Diagnostic Points

1. Early Diagnosis

Relies primarily on barium meal X-ray and gastroscopy with biopsy; therefore, anyone with the following conditions should promptly undergo barium meal X-ray and gastroscopy with biopsy to confirm the diagnosis.

① Patients, especially males, who develop dyspeptic symptoms after the age of 40;

② Even if it appears to be a benign ulcer, but still lacks gastric acid upon maximal stimulation test;

③ Chronic atrophic gastritis of the antrum, especially with intestinal metaplasia and atypical hyperplasia;

④ Gastric ulcer patients whose symptoms do not improve after 4–6 weeks of strict medical treatment, or whose ulcers are found to be unhealed or even enlarging on follow-up X-rays, should immediately undergo gastroscopy;

⑤ Gastric polyps, especially multiple polyps and cauliflower-like polyps, should all undergo biopsy;

⑥ Patients with pernicious anemia.

Additionally, there are some early warning signs of gastric cancer, such as:

① Loss of the usual pattern of gastric pain episodes, markedly different from before;

② Previously, gastric pain could be relieved by eating or taking medication, but recently, despite eating or taking medication, relief is still elusive, or even worse;

③ Previously, gastric ailments had little impact on appetite, physical strength, or weight, but now there is loss of appetite, fatigue, and significant weight loss;

④ Persistent hematochezia or hematemesis requires high vigilance;

⑤ More than 5 years after Billroth II gastric surgery, if symptoms such as dyspepsia, emaciation, anemia, and gastric bleeding appear, along with unexplained upper abdominal distension, discomfort, fatigue, and weight loss, immediate attention is required.

Anyone experiencing any of these signs should not take them lightly and should promptly go to the hospital for gastroscopy and other examinations to confirm the diagnosis and receive timely treatment. It must be emphasized that diagnostic tests performed in clinical practice sometimes need to be repeated to detect tumors in time; biopsies must be taken from at least six suspicious mucosal sites; if the diagnosis remains unclear after examination but gastric cancer is still highly suspected, the pros and cons should be carefully weighed, and exploratory laparotomy and corresponding surgical procedures should be seriously considered.

2. Auxiliary Examinations

(1) Barium meal X-ray: Using compression technique and double-contrast barium-air method, subtle mucosal lesions can be clearly visualized.

① Early gastric cancer shows localized mucosal rigidity or brush-like appearance, with slight protrusions or shallow depressions, or granular small lesions, and disruption or disappearance of gastric microzones.

② Mid-to-late stage gastric cancer shows stiff gastric wall, interrupted mucosal folds, lost peristalsis, filling defects, cancerous niche shadows, irregular surface, and narrowing of the gastric cavity with signs of obstruction.

(2) Fiber gastroscopy: Combined with brushing off shed cells and taking tissue biopsies, fiber gastroscopy is the most reliable method for diagnosing gastric cancer. The combined use of all three can achieve a diagnostic accuracy of over 95%. Biopsies must take at least six samples to minimize the risk of missed diagnoses.

(3) Laboratory Tests:

① Fecal occult blood test: Often shows persistent positivity, rarely turning negative even after medical treatment. Although the fecal occult blood test is a routine minor procedure, it is a meaningful indicator for early diagnosis of gastric cancer and even other gastrointestinal tumors, being convenient, inexpensive, and easy to monitor and retest over the long term. Professor Wang Yongtai from the Second Affiliated Hospital of Lanzhou Medical College has considerable experience in this regard, having many real-life examples where he traced gastrointestinal tumors based on long-term positive results from fecal occult blood tests.

② Carcinoembryonic antigen (CEA) testing. Serum CEA testing has no diagnostic value, but CEA detected in gastric juice shows a 50% increase, with levels exceeding 100 ng/ml considered diagnostically significant.