Arthur Winer, MD, is a specialty care physician at Inova Schar Cancer Institute. Dr. Winer is board-certified in internal medicine, hematology and medical oncology. He is a practicing gastrointestinal medical oncologist and has clinical interests in colorectal, esophageal, gastrointestinal, liver and pancreatic cancers.
When it comes to symptoms and screenings, the most common forms of cancer of the liver, stomach and esophagus have several similarities and some key differences.
But the most obvious similarity is that, for the general U.S. population*, there is no screening recommendation for any of those cancers (*There are screening recommendations for adults in certain other parts of the world, where diet or exposure can increase risk for some of these cancers). Men with an average risk for colon cancer are counseled to begin screenings at age 45, and women with an average risk for breast cancer are recommended to start annual mammograms at age 40.
There’s no parallel with liver, stomach or esophageal cancer for the general population given that these cancers are not as common, although some patients with risk factors may be recommended for screening.
But it’s important for patients to recognize the symptoms that would prompt a screening for these diseases and what the screenings entail. That is what I will cover in this post.
Symptoms: A patient with stomach cancer may exhibit issues with eating and weight loss, and they also could experience abdominal pain.
Of course, those are common symptoms for a variety of maladies — a brief period of weight loss or abdominal pain is unlikely to be related to cancer. When these symptoms persist for weeks or months, however, they could indicate something more serious.
Bleeding is another common symptom of stomach cancer (and of esophageal cancer, too). The sign a patient might see is a dark black, tarry stool when using the bathroom.
Screening: Besides the symptoms detailed above, a doctor may recommend screening for stomach cancer if a patient has inherited one of the rare genetic conditions that can cause gastro-esophageal cancer.
The genes that could exhibit an inherited mutation include the CDH1 gene and the BRCA gene. BRCA is better-known in the context of breast cancer, but certain mutations of the gene can cause stomach cancer.
Lynch Syndrome is another genetic condition correlated with increased stomach cancer risk.
Patients who carry one of these mutations and who inherited it from their parents are good candidates to seek consultation at the Inova Saville Cancer Screening and Prevention Center. There, a physician will discuss with them when might be the right time to begin screenings.
The screening for stomach cancer is performed via endoscopy, with the doctor checking the stomach for cancerous or precancerous lesions. If found, they could be treated immediately or monitored for potential treatment later.
For a genetic carrier, endoscopies are usually scheduled on roughly an annual basis. If the endoscopy detects an abnormality, the next steps are typically a CAT scan, additional blood tests and seeing specialists such as surgeons, a radiation oncologist or a medical oncologist.
Symptoms: The most common symptom of esophageal cancer is having trouble swallowing — food might feel like it gets “stuck” as the patient swallows.
If a patient is coughing up or vomiting blood or has black stool due to bleeding, that could also be a symptom. And weight loss could be, as well — though, as noted above, weight loss on its own, especially for a short period of time, could be a symptom of many other conditions.
Unlike liver and stomach cancer, there are no genetic mutations that are considered risk factors for esophageal cancer. However, two behaviors are significant risk factors: smoking and drinking. Both behaviors increase the chances that someone could develop esophageal cancer.
(More broadly, a message I come back to often is simple: People should stop smoking and reduce, if not stop, drinking. Those behaviors are connected with cancers beyond the liver, stomach and esophagus, and stopping is often the best thing a patient can do for themselves.)
Smoking and drinking are the most common causes of one of the subtypes of esophagus cancer, squamous cell carcinoma of the esophagus. Another type of esophagus cancer, adenocarcinoma, is related to acid reflux and being overweight.
For patients with chronic acid reflux, if untreated, it could develop into a condition known as Barrett’s Esophagus, which involves a change in the esophagus’ lining. Barrett’s is associated with higher risk of esophageal cancer, so patients with the condition may be recommended to have regular endoscopies.
Screening: The most common screening for esophageal cancer is an upper endoscopy, which examines the upper part of the digestive system.
Patients having trouble swallowing may undergo a barium swallow test, in which they swallow a thick liquid and X-rays are taken.
CAT scans, PET scans or an MRI can be prescribed, as well, depending on what is discovered in initial screenings.
Symptoms: Most liver cancer is detected before symptoms develop. Frequently, it is discovered because a patient has a risk factor such as cirrhosis or hepatitis. Both diseases can make a patient more likely to develop liver cancer, so doctors will recommend a screening via ultrasound. That can be the moment that cancer is detected.
In the rare case where a patient exhibits symptoms related to liver cancer, it is either due to the cancer having grown very large and causing belly pain and weight loss, or the cancer having metastasized and the patient’s belly swelling.
A swollen belly is not a surefire sign of cancer — the scarring from cirrhosis can also cause the same symptoms. But liver cancer can make cirrhosis-caused swelling worse.
Screening: Liver cancer screenings are typically done by ultrasound, a CAT scan or even an MRI. Most commonly, the screening will start with an ultrasound.
For patients with risk factors for liver cancer, a doctor — a primary care physician, a gastroenterologist or a hepatologist — may recommend an ultrasound of the liver every six months to a year.
If a patient has scarring of the liver from cirrhosis, a doctor may recommend a liver cancer blood test, known as alpha-fetoprotein or AFP, as well.