Gastric Cancer: Symptoms and Treatment

Recognizing Gastric Cancer: Symptoms and Diagnosis

Gastric cancer develops when malignant cells form in the lining of the stomach, often remaining asymptomatic in its early stages. Recognizing gastric cancer symptoms can be challenging because they frequently resemble less severe gastrointestinal conditions. However, awareness is a powerful tool for prompting early evaluation and improving survival rates. Common early symptoms include persistent indigestion or heartburn, unexplained weight loss, abdominal pain or discomfort (especially above the navel), feeling full quickly after eating small amounts (early satiety), nausea or vomiting (sometimes with blood), difficulty swallowing (dysphagia), fatigue due to anemia, and noticeable swelling or fluid build-up in the abdomen. As the disease advances, these symptoms may intensify or be joined by others such as black stools (a sign of bleeding), vomiting blood, jaundice (yellowing of skin or eyes), and more severe pain.

The risk factors for gastric cancer include chronic infection with Helicobacter pylori bacteria—a well-known cause of stomach ulcers—as well as smoking, heavy alcohol use, diets high in salted or smoked foods, family history of gastric cancer, prior stomach surgery for non-cancerous conditions, certain genetic conditions (such as hereditary diffuse gastric cancer syndrome), obesity, and advanced age. Men are generally at higher risk than women.

Diagnosis begins with a thorough medical history review and physical exam. Physicians may recommend laboratory tests to check for anemia or abnormal liver function. The gold standard diagnostic tool is upper endoscopy (esophagogastroduodenoscopy or EGD), where a flexible tube with a camera examines the stomach lining directly and allows tissue biopsies for microscopic analysis. Additional imaging studies—such as CT scans of the abdomen and pelvis, PET scans to identify distant metastases, endoscopic ultrasound (EUS) to assess tumor depth and nearby lymph node involvement—help determine the stage of disease.

Staging is critical in guiding treatment decisions for gastric cancer. The TNM system evaluates tumor size (T), lymph node involvement (N), and metastasis (M). Early-stage gastric cancers are limited to the inner lining; advanced cases may spread through the stomach wall into adjacent organs or distant sites such as liver or lungs.

Raising awareness about symptoms is essential because many cases are detected late due to vague early signs. Public health campaigns emphasizing risk factors—particularly H. pylori infection screening in high-risk populations—and improved access to diagnostic tools can contribute to earlier detection and better outcomes.

For individuals experiencing persistent gastrointestinal symptoms that do not respond to usual treatments or who have multiple risk factors for gastric cancer, timely consultation with healthcare professionals is recommended. Early diagnosis not only expands potential treatment options but also dramatically increases long-term survival rates.

Modern Gastric Cancer Treatment: Comparing Tevimbra, Vyloy & Stivarga

Advancements in medical science have significantly expanded the range of gastric cancer treatments available today. Once limited mainly to surgical resection and traditional chemotherapy regimens, modern approaches now incorporate targeted therapy agents and immunotherapies designed to attack cancer cells more precisely while sparing healthy tissue. Tailoring treatment according to tumor type, stage, patient health status, molecular markers, and individual preferences has become the standard of care.

The cornerstone of curative therapy for localized gastric cancer remains surgical removal of all visible tumors along with surrounding lymph nodes—a procedure known as gastrectomy (partial or total). For some early-stage cancers confined to superficial layers, endoscopic mucosal resection may suffice without major surgery. Adjuvant therapies—such as chemotherapy or chemoradiotherapy administered after surgery—are frequently employed to eradicate microscopic disease and reduce recurrence risk.

For advanced or metastatic disease where surgery cannot provide cure, systemic therapies are primary options:

1. **Chemotherapy**: Standard regimens often combine drugs like fluoropyrimidines (5-FU or capecitabine) with platinum-based compounds (cisplatin or oxaliplatin). These agents disrupt DNA synthesis in rapidly dividing cells but can cause side effects including nausea, fatigue, low blood cell counts, neuropathy, and hair loss.

2. **Targeted Therapy**: Certain subtypes of gastric cancer overexpress specific proteins such as HER2/neu or VEGF receptors.

- *Trastuzumab* targets HER2-positive tumors; used alongside chemotherapy improves survival for selected patients.

- *Ramucirumab* blocks VEGF receptors involved in blood vessel formation essential for tumor growth; effective alone or with chemotherapy after initial regimens fail.

3. **Immunotherapy**: Immuno-oncologic drugs harness the body’s immune system against malignant cells by inhibiting pathways that enable tumor evasion.

- *Pembrolizumab* and *nivolumab* target PD-1/PD-L1 checkpoints; approved for certain advanced gastric cancers expressing PD-L1 protein or after multiple lines of chemotherapy.

4. **Novel Agents: Tevimbra (tislelizumab), Vyloy (zolbetuximab), & Stivarga (regorafenib)**

- **Tevimbra** is an anti-PD-1 monoclonal antibody recently approved for unresectable or metastatic gastric/gastroesophageal junction adenocarcinoma whose tumors express PD-L1. Clinical trials demonstrate improved overall survival compared to standard chemotherapy alone when used as first-line therapy in eligible patients. Tevimbra acts by blocking immune checkpoint pathways that tumors exploit to escape immune detection—thereby reinvigorating T-cell activity against malignancy.

- **Vyloy** represents another innovative approach; it targets Claudin 18.2—a cell surface protein highly expressed in certain types of gastric adenocarcinoma but rare elsewhere in normal tissues. By binding selectively to this protein on tumor cells, Vyloy enables direct cytotoxic attacks via antibody-dependent cellular cytotoxicity mechanisms while minimizing collateral damage to healthy tissues. Early-phase clinical studies have shown promising response rates in patients whose tumors test positive for Claudin 18.2 expression.

- **Stivarga** is an oral multikinase inhibitor approved for patients with previously treated metastatic colorectal cancers but also studied off-label and within clinical trials for refractory advanced gastric cancers. It works by inhibiting multiple kinases involved in tumor proliferation and angiogenesis—including VEGFRs—which slows tumor growth and spread. While it offers another option after standard therapies fail, side effects such as hand-foot skin reactions, hypertension, fatigue, diarrhea, and liver dysfunction require close monitoring by oncology teams.

**Comparing Tevimbra vs Vyloy vs Stivarga for Gastric Cancer:**

- *Efficacy*: Each agent offers benefits within specific patient subsets:

- Tevimbra shows notable efficacy in PD-L1 positive advanced cases as first-line therapy combined with chemo.

- Vyloy’s effectiveness depends on Claudin 18.2 positivity; ideal for patients whose tumors express this unique marker.

- Stivarga is generally reserved for late-stage settings after other treatment failures; provides modest survival benefit but broader applicability regardless of biomarker status.

- *Safety Profiles*: All can cause immune-related adverse events (Tevimbra), infusion reactions (Vyloy), or targeted therapy toxicity profiles (Stivarga)—necessitating individualized risk-benefit discussion between clinicians and patients.

- *Personalized Medicine*: An emerging theme is matching treatment choice to tumor biology—testing for PD-L1 expression guides Tevimbra use; Claudin 18.2 testing determines Vyloy eligibility; Stivarga suits those lacking actionable biomarkers but able to tolerate multikinase inhibition side effects.

In summary: The landscape of gastric cancer treatment continues evolving rapidly with targeted therapies like Vyloy and immunotherapies like Tevimbra joining established agents such as Stivarga in providing hope even for advanced disease stages once considered untreatable. Participation in clinical trials may further expand access to cutting-edge medications while contributing valuable data toward future breakthroughs.

Patients should work closely with multidisciplinary teams—including oncologists specializing in gastrointestinal malignancies—to develop personalized treatment strategies based on latest evidence-based guidelines and individual health needs.