Gastric cancer--delay in diagnosis and its causes

Over a period of 1 year 83 patients, admitted to Nottingham hospitals with gastric neoplasms, were interviewed in order to identify the extent of delay in diagnosis and the possible causes. The mean age was 71 (S.D. +/- 10) and there was a male preponderance of 1.8:1. The median delay from onset of symptoms to diagnosis was 22 weeks (IQR 14-35). Delay by the patient after the onset of symptoms before seeking medical help was 4 weeks (IQR 2-12). Family doctor delay was 7 weeks (IQR 3-14) and this was caused by trial of medication and radiological investigations. The hospital delay of 3 weeks (IQR 2-7) was due to patients waiting for multiple out-patient investigations, inadequate investigation of iron-deficiency anaemia, failure to follow-up gastric ulcers and difficulty in getting histological confirmation of clinically suspicious lesions. Seventeen (20%) patients were treated with a H2-receptor antagonist (Cimetidine). There was no significant difference in the delay caused by Cimetidine when compared with that due to antacids (Mann-Whitney U = 232, P greater than 0.5), and there was no difference in survival between these patients and those not treated with Cimetidine (chi 2 = 1.9, P less than 0.1). In this study only one of 80 patients had an early gastric cancer, which supports the view that gastric carcinoma is asymptomatic in its early stages and mass screening of the population would be the only way to detect carcinoma at this stage in its development. Family doctor delay can be reduced by immediate referral of patients to hospital for investigation prior to commencing medication. Hospital delay can be improved by avoiding duplication of investigations, fully investigating iron-deficiency anaemia and following up gastric ulcers with endoscopy and biopsy till fully healed.