Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked

Abstract

The use of alarm symptoms to select dyspeptics for endoscopy identifies patients with advanced and usually incurable esophagogastric cancer. Patients with early curable cancers often have only dyspeptic symptoms, and their diagnosis will be delayed until the symptoms of advanced cancer develop.

Role of symptoms in diagnosis and outcome of gastric cancer

“…Patients presenting with alarm symptoms were comparable to those with uncomplicated dyspepsia as far as concerns age, sex and pathology of gastric cancer, but more frequently showed a proximal site and more advanced TNM stage [19] . These findings have been confirmed by Stephens, who also showed that the number of alarm symptoms, at presentation, correlated with the stage of the tumour, in that patients with the greatest number of alarm symptoms presented with the most advanced disease [39] and by Bowrey, in a more recent study, in which approximately 50% of the patients with alarm symptoms had stage Ⅳ disease [40] . Indeed, the relationship between symptoms and stage of cancer is conceivable if we consider the profile of symptoms in early gastric cancer which are not unlike those of benign gastric ulcer rather than advanced cancer.…”

“…Indeed, several studies have assessed the prognostic value of specific alarm symptoms in gastric cancer, demonstrating that these may be independently related to the survival of patients with gastric cancer and that, an increased number of alarm symptoms and specific symptoms are closely correlated to the risk of death. Studies that evaluated the impact of alarm symptoms on gastric cancer survival showed that the presence of at least one alarm symptom might reduce the 5-year survival rate by an average of 26% [19,39,40] . We have also shown that the www.wjgnet.com risk of death is nearly threefold in patients with at least one alarm symptom compared with that in patients with uncomplicated dyspepsia [19] .…”

“…We have also shown that the www.wjgnet.com risk of death is nearly threefold in patients with at least one alarm symptom compared with that in patients with uncomplicated dyspepsia [19] . Moreover, Stephens and Bowrey reported that the median survival for patients with alarm symptoms, from presentation to death, ranged from 7 to 11 mo vs 24 to 39 mo for patients without alarm symptoms [39,40] . These dismal prognostic data in gastric cancer patients with alarm symptoms are not completely new.…”

Knowledge about Gastric Carcinoma in North of Iran, A High Prevalent Region for Gastric Carcinoma: A Population-Based Telephone Survey

“…As the early gastric cancer is asymptomatic or has non-specific symptoms, its diagnosis is usually made in the advance stages with a reported 5-year survival rate of less than 30% in most series. The symptoms presents with dyspepsia, abdominal fullness, upper abdominal discomfort, and alarm sings as weight loss, dysphagia, gastrointestinal bleeding, palpable mass and anemia which make patients refer to physicians for more assessments (Bowrey et al, 2006;Maconi et al, 2008). Undoubtedly primary and secondary preventive activities decrease the burden of cancer patients to the hospital and minimize human suffering (Puri et al, 2010).…”

To whom and when the upper gastrointestinal endoscopy is indicated in gastroesophageal reflux disease? What is the role of routine esophageal biopsy? Which endoscopic esophagitis classification should be used?

“…The negative predictive value of the specified alarm symptoms is above 90%. More specifically, Bowrey (13) investigated the relationship between esophagogastric cancer and alarm symptoms. It is reported that the incidence of cancer begins to increase as of 55 years of age (p<0.0001), and alarm symptoms were present in 85% of cancer cases.…”