Stomach Cancer

1 What is Stomach Cancer?

The cancer of stomach cells is called stomach canceror gastric cancer. Stomach is a part of digestive system where digestion of the ingested food takes place. 

Stomach cancer or gastric cancer often refer to the cancer that begins in the mucus-producing cells on the interior of the stomach, also called adenocarcinoma. Adenocarcinoma is the most common type of stomach cancer. Stomach cancer is less common in the US as compared to China and Japan.

2 Symptoms

Signs and symptoms of stomach cancer include:

  • Fatigue 
  • Feeling full and bloated after eating 
  • Severe persistent heartburn 
  • Severe indigestion 
  • Persistent nausea and vomiting
  • Abdominal pain 
  • Unexplained Weight Loss
  • When to see a Doctor
  • Talk to your doctor if any of the above signs and symptoms bother you.

3 Causes

The exact cause of stomach cancer has not been fully established. However, a strong link has been observed between stomach cancerand a diet high in smoked, salted and pickled foods.  Cancer begins due mutations in the DNA. 

The mutated genes instruct cells to grow and divide at an uncontrolled rate causing accumulation of cancerous cells form a tumor. The tumor invades nearby cells often cutting their nutrient supply and eventually killing them. 

Sometime, the cancer cells can break off from the site of origin and may spread throughout the body (metastasis)

Types of stomach cancer

Stomach cancer is categorized according to the type of the cells involved. The types of stomach cancer are:

  • Cancer that begins in the glandular cells (adenocarcinoma): Glandular cells are those that secrete protective mucus throughout the interior lining of the stomach. The mucus layer protects stomach from gastric acid.Adenocarcinoma is the most common type of stomach cancers.
  • Cancer that begins in immune system cells (lymphoma):Lymphoma is a rare type of cancer cell that occurs when immune cells present in the walls of the stomach turn cancerous.
  • Cancer that begins in hormone-producing cells (carcinoid cancer): It’s also a rare condition that occurs when hormone-producing cells develop into cancerous types. 
  • Cancer that begins in nervous system tissues: Also called gastrointestinal stromal tumor (GIST), it develops in certain nervous system cells found in your stomach. GIST is a rare form of stomach cancer. 

Since all forms of cancer other than Adenocarcinoma are rare, the term stomach cancer generally refers to adenocarcinoma.

4 Making a Diagnosis

Seek medical help if you experience any signs or symptoms of stomach cancer in order to receive a diagnosis. If suspected of having stomach cancer, your doctor may refer you to a specialist (gastroenterologist). If cancer is diagnosed, you may be referred to a cancer specialist (oncologist) or a surgeon who specializes in operating on the digestive tract.

Here's some tips to be followed to make the doctor appointment clear, concise and more fruitful:

  • What you can do
  • Note down your symptoms.
  • Write down key medical information.
  • Make a list of all medications, vitamins or supplements that you're taking. 
  • List out the factors that improve or worsen your signs and symptoms. 
  • Some relevant questions that you might want to ask your doctor: 
  • Do I have stomach cancer? If yes, in which stage it is.
  • What are the tests that I have to go through? 
  • What are the treatment options available and what are the benefits and risks of each option? 
  • How will treatment affect my daily routine? 
  • What will be the cost of my treatment and will my insurance cover it? 
  • Are there brochures or other informational leaflets for me? 
  • What websites do you recommend? 
  • Apart from these, you may ask any question that strikes your mind at the time of appointment.
  • What to expect from your doctor?
  • Your doctor may ask you questions like:
  • When was the first time you started experiencing the symptoms? 
  • Are your symptoms severe? 
  • Is there factor that improves or worsens your symptoms?
  • Apart from examining the apparent signs and symptoms of the disease, you doctor may recommend following Diagnosticmethods:
  • Endoscopy Tests: It is a non-surgical test used to examine a person’s digestive tract. A thin, flexible tube containing a tiny camera is inserted into your stomach through the mouth. If any signs of cancer are observed, a piece of tissue can be collected for analysis (biopsy). 
  • Imaging tests: Some common imaging tests employed are Computerized Tomography (CT) scan and a special type of X-ray exam called a Barium swallow.
  • Stage of Stomach Cancer

Following tests and procedures can be used todetermine the stage of cancer: 

  • Imaging tests: Tests may include CT and positron emission tomography (PET). 
  • Exploratory surgery. Laparoscopic surgery is done to examine abnormal growths in the stomach.

Stages of stomach cancer 

  • Stage I: The cancer is limited to interior lining of the stomach. 
  • Stage II: The cancer has spread deeper into the muscle layer of the stomach wall. 
  • Stage III: The cancer has spread to all the layers of the stomach.
  • Stage IV:At this stage, the tumor has dislodged from the site of origin and spread to distant areas of the body.

5 Treatment

Treatment methods for stomach cancer include:

  • Surgery:Depending upon the stages and severity of the tumors, various surgical options can be used to removeall or most of the stomach cancer:
  • Removing early-stage tumors from the stomach lining: A procedure called endoscopic mucosal resection can be used to surgically remove very small tumors that have not yet spread to deeper layers of the stomach. 
  • Removing a portion of the stomach (subtotal gastrectomy): The cancerous portion of the stomach is surgically removed.
  • Removing the entire stomach (total gastrectomy): This method is used in cases of advanced stomach cancer in which the entire stomach and surrounding tissues are surgically removed. The esophagus is then directly connected to the small intestines.
  • Removing lymph nodes to look for cancer:Affected lymph nodes in the stomach are removed and symptoms of cancer are examined.
  • Surgery to relieve signs and symptoms:Surgeries do not cure advanced cancers. However, they can relieve the associated signs and symptoms.  After surgery, your risk of infection and bleeding may increase. You may also encounter digestive problems when some or all of the stomach is removed.
  • Radiation therapy: Radiation therapy uses ionizing radiations like X-rays to destroy cancer cells or to  shrink the tumor before surgery (neoadjuvant radiation) so that it can be easily removed.  Alternately, radiation therapy mayalso be used after surgery (adjuvant radiation) to destroy the cells that have not been removed by surgery. Radiation is often combined with chemotherapy.You may experience symptoms like diarrhea, indigestion, nausea and vomiting during radiation therapy.
  • Chemotherapy: Chemotherapy utilizes chemical agents to kill cancer cells. Neoadjuvant chemotherapy refers to the use of chemical agents before surgery to help shrink a tumor so that it can be easily removed or after surgery (adjuvant chemotherapy).  Adjuvant chemotherapy refers to the use of chemical agents after surgery to kill any cancer cells that have been left behind even after surgery. In cases of advanced stomach cancer, chemotherapy alone can be used to help relieve signs and symptoms. 
  • Targeted therapy:Targeted therapy uses drugs to target specific biomolecules present in the cancer cells that are responsible for development of cancer.  Targeted drugs used to treat stomach cancer include: 
    • Trastuzumab (Herceptin) for stomach cancer cells that produce too much HER2. 
    • Imatinib (Gleevec) for a rare form of stomach cancer called gastrointestinal stromal tumor. 
    • Sunitinib (Sutent) for gastrointestinal stromal tumor. 
  • Clinical trials: Clinical trials are the studies conducted to find out new methods or approaches to treat a disease or a condition. You can be a part of the clinical trial if you complete the criteria for participation. Clinical trials do not guarantee cure and can be associated with side effects not known earlier.

6 Prevention

The following ways might help you prevent stomach cancer:

  • Increase fruit and vegetable intake. 
  • Choose a wide variety of colorful fruits and vegetables.
  • Take salty and smoked foods in limit.
  • Stop smoking: If you are a smoker, quit and if not, don’t start. Studies have shown a clear link between smoking and various types of cancer including that of stomach.Talk to your doctor about smoking cessation strategies relevant to you.

Ask your doctor about your risk of stomach cancer. 

Talk with your doctor if you have an increased risk of stomach cancer. Together you may consider periodic endoscopy to look for signs of stomach cancer.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with stomach cancer.

Cancer diagnosis can be a devastating and life changing news for patients and their families. We bring you some ideas to help you cope:

  • Ask your doctor about your cancer, including your treatment options and, if you like, your prognosis. 
  • Socialize and spend quality time with your friends and family as they provide you emotional as well as other support whenever needed.
  • Join a support group or a counseling class.
  • Access other related information from National Cancer Institute and the American Cancer Society.

8 Risks and Complications

Factors that increase your risk of stomach cancer include: 

  • A diet high in Salty and smoked foods
  • Limited intake of fruits and vegetables 
  • Intake of food contaminated by aflatoxin fungus 
  • Family history of cancer
  • Helicobacter pylori Infection
  • Long-term stomach inflammation 
  • Pernicious anemia 
  • Smoking 
  • Stomach polyps

9 Related Clinical Trials