Gastric Cancer Screening

Barium swallow is considered an older technology for gastric cancer screening. The way it works is that the patient drinks an X-ray dye that coats the stomach. Then x-rays are taken that shows the stomach in outline (Figure 1). The radiologist then looks at this indirect outline of the stomach to look for growths or ulcers. 

Figure 1: Barium Swallow outline of the stomach

Gastroscopy, though more invasive, allows one to look directly at the lining of the stomach. For this reason, we can see even early changes that are not visible on the barium swallow. There has to be a larger structural change to be seen on barium swallow - it can’t see early changes that may show up only as just an abnormal discolouration with very little physical change (Figure 2). This can only be seen on gastroscopy as we can look much more closely and can even add different filers to highlight changes. The cancer in the figure is very subtle.

Figure 2: Early gastric cancer on endoscopy under different filtered light.

So, gastroscopy will be able to detect earlier changes so that we can either, prevent change to cancer, or catch cancer early. As well, if there is are changes, we can immediately biopsy the area. It is superior to barium swallow.

What is important as well is that there are very few people trained to detect early gastric cancer in Canada as it is seldom seen here. The quality of barium swallow here is not as good as in Japan (it is rather poor outside of hospitals). Even in hospital, the radiologists are not trained to do gastric cancer screening.

Catching gastric cancer early is extremely important. The earlier it is caught, the better the outcome. That is one of the reasons why it is much better treated in Japan - it is caught early, In the US and Canada, most of the cases are found late. If you look at Figure 3, you can see 53% of cases in Japan are early (Localized), whereas in the US (and Canada), it is only 27%. Most are discovered to already have regional spread or distant spread.

Figure 3: distribution of gastric cancer cases in Japan vs. US

For especially the Japanese and Korean clients, it is very important to have screening done by doctors trained to deal with gastric cancer. Dr Woo is one of the few Vancouver based Surgeons with a training in gastric cancer.