Stomach Cancer

Symptoms: Fatigue, stomach pain, especially after eating, bloating, indigestion, nausea, vomiting, and loss of appetite.

Risk Factors: Stomach polyps, age, family history, alcohol consumption, smoking, diet, H. Pylori infection, GERD, gastritis, etc.

Prevalence: Currently, 1 million of the population worldwide is diagnosed with stomach cancer. In India, the total number of individuals suffering from IBD is approximately 34,000 persons with male-female ratio of 2:1.

Severity: Mild to Severe.

Gender affected: Both male and female populations can get affected but more common in men.

Which doctor to consult: A general physician, oncologist, gastroenterologist.

Overview: 

Stomach cancer, also known as gastric cancer, a growth of abnormal cells that start in the stomach, which is part of the digestive system responsible for breaking down food. Tumors occur as the stomach cells keep growing uncontrollably. Additionally, the malignant cells may spread to other bodily parts.

Generally, early stages of stomach cancer often have no symptoms. Some of the common symptoms may include fatigue, stomach pain, especially after eating, bloating, indigestion, nausea, vomiting, and loss of appetite. 

The exact cause is unknown, but factors that may increase the risk include Genetic changes in stomach cells, Gastroesophageal reflux disease (GERD), family history, smoking, obesity, high intake of smoked, pickled, or salty foods, helicobacter pylori infection, stomach polyps. Compared to women, men are more likely to be impacted.

For people who are more at risk, such as those who have a family history of the condition, routine screening for stomach cancer is advised. The treatment of stomach cancer mainly depends on proper diagnosis of the condition and selection of the better treatment options which include Chemotherapy to kill cancer cells, Radiation therapy, Surgery, which may involve partial or total removal of the stomach, Targeted drug therapy, and Immunotherapy.

Types of Stomach Cancer:

Stomach cancer, also known as gastric cancer, can be classified into several types based on the type of cells where the cancer begins. Here are the main types of stomach cancer:

Adenocarcinoma: This is the most common type of stomach cancer, accounting for about 90% to 95% of all cases. It starts in the glandular cells of the stomach lining that produce mucus and other fluids.

• Intestinal adenocarcinomas are usually slow-growing and more treatable.

• Diffuse adenocarcinomas are less common, faster growing, and often spread quickly to other parts of the body.

Lymphoma: These are cancers of the immune system tissue that are sometimes found in the wall of the stomach. Although rare, they can be significant.

Gastrointestinal Stromal Tumor (GIST): These rare tumors start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal.

Carcinoid Tumor: These tumors begin in the hormone-producing cells of the stomach. Most carcinoid tumors do not spread to other organs.

Other less common types: There are other less common types of stomach cancer that can also occur but are very rare.

Each type of stomach cancer can have different treatments and prognoses, so it’s crucial to identify which one it is early on. For more detailed information, you can refer to resources from health organizations and cancer centers. Remember, this information is not a substitute for professional medical advice, diagnosis, or treatment.

Symptoms:

Stomach cancer, or gastric cancer, often doesn’t cause symptoms in its early stages. However, as the disease progresses, symptoms may become more apparent. Here’s detailed information about the symptoms of stomach cancer:

Early Symptoms:

• Indigestion or a burning sensation (heartburn)

• Loss of appetite, especially for meat

• Abdominal discomfort or irritation

• Nausea and vomiting

• Advanced Symptoms:

• Bloating of the stomach after meals

• Difficulty swallowing

• Weight loss without trying

• Weakness and fatigue

• Vomiting blood or having black, tarry stools

• Pain or discomfort in the upper or middle part of the abdomen

Other Possible Symptoms:

• Anemia from occult bleeding

• Jaundice (yellowing of the skin and eyes) if the cancer spreads to the liver

• Ascites (build-up of fluid in the abdomen)

• Palpable lumps in the stomach area or lymph nodes

If you are experiencing new, severe, or persistent symptoms, it’s important to contact a healthcare provider. These symptoms can also be caused by conditions other than cancer, such as ulcers, viral gastroenteritis, or gastritis. Because symptoms can be vague and easily mistaken for other common conditions, it’s important to seek medical evaluation if you have persistent symptoms or if they worsen.

Causes and Risk factors:

Stomach cancer, also known as gastric cancer, has several risk factors associated with its development. Here’s a detailed list of risk factors:

Lifestyle Factors:

• Diet: High intake of salty, smoked, and pickled foods, as well as low consumption of fruits and vegetables, can increase the risk.

• Smoking: Tobacco use is a significant risk factor for stomach cancer.

• Alcohol Consumption: Excessive alcohol intake may also contribute to the risk.

Medical Conditions:

• Helicobacter pylori Infection: This common stomach infection is a major risk factor for stomach cancer.

• Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can increase the risk.

• Gastritis: Long-standing stomach inflammation is associated with a higher risk.

• Stomach Polyps: Certain types of polyps in the stomach can develop into cancer.

Genetic Factors:

• Family History: Having a close relative with stomach cancer increases your risk

Other Factors:

• Age: The risk increases with age, particularly after 60 years.

• Sex: Men are more likely to develop stomach cancer than women.

• Ethnicity: Certain ethnicities have higher rates of stomach cancer.

• Geography: It’s more common in East Asia, Eastern Europe, and South and Central America.

It’s important to note that having one or more risk factors does not mean you will definitely develop stomach cancer, but it may increase your chances.

Complications:

Stomach cancer can lead to several complications, particularly in its advanced stages. Here’s detailed information about the potential complications:

• Obstruction: Cancer can cause a blockage in the stomach (gastric outlet obstruction), making it difficult for food to pass through.

• Bleeding: Tumors may bleed into the stomach, leading to blood loss and anemia. This can result in fatigue, weakness, and shortness of breath.

• Metastasis: Cancer can spread (metastasize) to other parts of the body, such as the liver, lungs, bones, or the lining of the abdomen (peritoneum).

• Ascites: The spread of cancer to the peritoneum can cause fluid accumulation in the abdominal cavity, leading to swelling and discomfort.

• Jaundice: If cancer spreads to the liver, it can cause jaundice, which is characterized by yellowing of the skin and eyes.

• Cachexia: A syndrome involving weight loss, muscle atrophy, fatigue, and weakness, which is not solely due to reduced food intake.

• Pain: As the tumor grows, it can cause increasing pain in the stomach area.

• Nutritional Deficiencies: Stomach cancer can affect the body’s ability to absorb nutrients, leading to deficiencies.

• Perforation: Rarely, the tumor can cause a hole in the wall of the stomach, leading to a serious condition called peritonitis.

• Starvation: Due to difficulty in eating and the body’s increased metabolic demands, patients may experience malnutrition and starvation.

It’s important to manage these complications effectively as part of the overall treatment plan for stomach cancer. Treatments may include nutritional support, medications to control symptoms, procedures to relieve obstruction, and therapies to address metastasis. For more detailed information, it’s best to consult with healthcare professionals who specialize in cancer care.

Prevention:

Preventing stomach cancer involves a combination of lifestyle changes and medical strategies such as:

Dietary Habits:

• Increase Fruits and Vegetables: A diet rich in fruits and vegetables can lower the risk of stomach cancer.

• Limit Intake of Smoked and Salted Foods: Reducing consumption of smoked, pickled, and salty foods is recommended.

• Avoid Nitrosamines: Found in some processed meats, these compounds can increase the risk of stomach cancer.

• Consume Foods with Antioxidants: Foods high in antioxidants, like berries and kidney beans, may help prevent cell damage.

Lifestyle Changes:

• Regular Exercise: Physical activity can help maintain a healthy weight and reduce the risk of stomach cancer.

• Quit Smoking: Tobacco use is a significant risk factor for stomach cancer.

• Limit Alcohol: Excessive alcohol consumption may increase the risk.

Medical Interventions:

• Treat Helicobacter pylori Infections: Eradicating H. pylori, a bacterium linked to stomach cancer, can reduce the risk.

• Regular Medical Checkups: Especially for those with a family history or other risk factors for stomach cancer.

Environmental Factors:

• Avoid Exposure to Harmful Chemicals: Certain workplace chemicals have been associated with a higher risk of stomach cancer

Health Monitoring:

• Be Aware of Symptoms: Early detection of stomach issues can lead to better outcomes

• Genetic Counseling: If you have a family history of stomach cancer, genetic counseling may be beneficial.

Medications:

• Avoid Overuse of NSAIDs: Long-term use of certain pain relievers can increase the risk of stomach cancer.

Weight Management:

• Maintain a Healthy Weight: Obesity is a known risk factor for stomach cancer.

By adopting these preventive measures, individuals can significantly reduce their risk of developing stomach cancer. It’s important to consult with healthcare professionals for personalized advice and to discuss any concerns about stomach cancer risks.

When to visit a doctor:

It’s important to consult a doctor or oncologist or gastroenterologist if you experience symptoms that could be indicative of stomach cancer, especially if they persist or worsen. Here are some signs that should prompt a visit to a healthcare professional:

• Persistent indigestion or heartburn

• Feeling full or bloated after small meals

• Recurring stomach discomfort

• Unexplained weight loss

• Difficulty swallowing (dysphagia)

• Anemia, causing tiredness or breathlessness

• Vomiting, which may contain blood

• Dark stools caused by bleeding in the stomach

• Jaundice (yellowing of skin and eyes)

These symptoms can also be common to other conditions like GERD, gastritis, and peptic ulcers, making it difficult to diagnose stomach cancer early. However, if you notice any changes that are unusual for you or if any of the above symptoms are severe, continuous, and do not improve, it’s crucial to seek medical attention

Diagnosis:

Diagnosing stomach cancer typically involves a series of steps and tests to confirm the presence of cancer cells and determine the extent of the disease. Here’s a detailed look at the diagnostic process:

Medical History and Physical Exam:

The doctor will start by asking about your symptoms, family history, dietary habits, and other potential risk factors for stomach cancer. A physical examination may also be conducted to check for any abnormalities.

Blood Tests:

While blood tests alone cannot diagnose stomach cancer, they can detect anemia, infections, or other related conditions that might suggest cancer.

Upper Endoscopy:

This is a key diagnostic tool where a thin, flexible tube with a camera (endoscope) is inserted through the throat to examine the inside of the stomach. If suspicious areas are found, a biopsy can be performed during this procedure.

Biopsy:

A biopsy involves taking a small sample of tissue from the stomach lining for microscopic examination to check for cancer cells.

Imaging Tests: These may include:

• Barium Swallow: You swallow a barium solution that coats the lining of the stomach, making it visible on X-rays.

• CT Scan: Offers detailed cross-sectional images of the body to check for tumors or metastasis.

• PET Scan: Helps to see if the cancer has spread to lymph nodes or other areas.

• Endoscopic Ultrasound: Uses sound waves to create images of the stomach wall and nearby lymph nodes.

Laparoscopy:

A surgical procedure that allows the doctor to look inside the abdomen to check whether the cancer has spread.

Staging:

If cancer is confirmed, additional tests may be done to determine the stage of the cancer, which guides treatment options.

• Stage 0: Known as cancer in situ alternatively. The stomach lining's aberrant cells identify this stage. In the future, the cells may develop into malignant (cancerous) tissue.

• Stage 1: The thick muscle in the stomach wall has not been affected by cancer.

• Stage 2: The cancer has progressed to the stomach's deeper layers and might have reached many neighbouring lymph nodes.

• Stage 3: All of the stomach's layers and certain of its neighbouring organs, such as the spleen or colon, contain malignant cells.

• Stage 4: The cancer has progressed to distant organs such as the brain, lungs, liver, and so on. We call this metastatic, advanced, or secondary cancer.

The choice of diagnostic tests depends on the symptoms and the results of initial examinations. It’s important to follow through with the recommended tests to ensure accurate diagnosis and appropriate treatment planning. Remember, early detection and treatment are crucial for improving the chances of a successful outcome.

 Treatment:

The treatment of stomach cancer involves a combination of methods tailored to the individual’s condition, including the stage of cancer, location, and the patient’s overall health. Here’s a detailed overview of the treatment options:

Surgery:

The primary treatment for stomach cancer is surgery, which can be of different types depending on the cancer’s extent:

• Subtotal Gastrectomy: Removal of part of the stomach affected by cancer.

• Total Gastrectomy: Removal of the entire stomach, sometimes along with parts of the esophagus or small intestine, and nearby lymph nodes.

• Endoscopic Mucosal Resection: Removal of smaller, early-stage cancerous tissues using an endoscope.

• Feeding tube placement: Some patients with stomach cancer are not able to consume enough food or liquids to maintain a healthy diet. Through a short procedure, a feeding tube can be placed through the abdominal skin and into the small intestine or the distal portion of the stomach.

Chemotherapy:

Uses drugs to kill cancer cells or stop them from growing. It can be administered before surgery (neoadjuvant chemotherapy) to shrink tumors or after surgery (adjuvant chemotherapy) to eliminate remaining cancer cells. Some of the examples of medications include:

• Carboplatin

• Capecitabine

• Fluorouracil

• Irinotecan

• Oxaliplatin

• Cisplatin

• Paclitaxel

• Docetaxel

Radiation Therapy:

High-powered energy beams are used to kill cancer cells. It may be used before surgery to reduce tumor size or after to kill any remaining cancer cells.

• Prior to surgery: In order to reduce the size of the cancer and facilitate its removal, radiation treatment may be performed in conjunction with chemotherapy (chemo) for certain earlier-stage tumors.

• After surgery: Chemotherapy and radiation therapy can be used to try and eliminate any cancer cells that were not removed during surgery.

• Regarding malignancies that surgery is unable to remove: Radiation therapy can help relieve symptoms including discomfort, bleeding, and difficulty eating, as well as help limit the growth of cancer.

Targeted Therapy:

Drugs that specifically target certain aspects of cancer cells, such as proteins or genes that contribute to cancer growth and survival.

• Ramucirumab

• Entrectinib

• Regorafenib

• Trastuzumab

Immunotherapy:

Utilizes the body’s immune system to fight cancer by stimulating it to recognize and destroy cancer cells.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC):

A heated chemotherapy treatment applied directly into the abdominal cavity during surgery, aimed at destroying any remaining cancer cells.

Palliative Care:

Focuses on providing relief from the symptoms and stress of a serious illness, aiming to improve the quality of life for both the patient and the family.

Dietary Changes:

Patients are often advised to eat high-protein and high-fiber foods, while avoiding certain foods that may aggravate symptoms.

Self-Care:

Patients must follow their healthcare provider’s instructions, stay active, and not miss regular doctor visits.

It’s important to discuss all available treatment options with your healthcare provider to understand the potential benefits and risks. Each treatment plan is personalized, and decisions are made in collaboration with the patient, based on their specific circumstances and preferences. Early detection and treatment significantly improve the prognosis for stomach cancer patients.