Stomach Cancer

STOMACH CANCER

Stomach (gastric) cancer, is one that forms in tissues lining the stomach. Sited in the upper abdomen between the esophagus and small intestine, the stomach functions as a reservoir where food is stored and partially digested after it is eaten. When food enters the stomach from the esophagus, the stomach churns the food and releases digestive juices to process the food before it enters the small intestine.

Stomach cancer happens when cells in the stomach become abnormal and begin to multiply. Most cancers of the stomach are adenocarcinomas. This means that they originate from the mucosal tissue lining the inside of the stomach. Over time the abnormal cells may spread to invade more in-depth into the stomach wall or eventually spread to nearby tissues or organs.

Usually, stomach cancer grows slowly throughout several years causing very few, sometimes no symptoms.

TYPES OF STOMACH CANCERS

• Gastrointestinal stromal tumor (GIST)

These are rare tumors that begin in very early forms of cells in the wall of the stomach called interstitial cells of Cajal. Some of these tumors are benign (non-cancerous), however, others are cancerous. Although GISTs can be found anywhere in the digestive tract, they are mostly found in the stomach.

• Adenocarcinoma

A stomach cancer or gastric cancer almost always is an adenocarcinoma. These are cancers that develop from the cells that form the mucosa (the innermost lining of the stomach).

• Lymphoma

These are cancers of the immune system tissue. They are sometimes found in the walls of the stomach. The treatment and outlook depend on the type of lymphoma.

• Carcinoid tumor

These tumors begin in the cells of the stomach that make hormones. Most of these tumors do not spread to other organs.

• Other cancers

There are other types of cancer, such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma that can also start in the stomach but these types are quite rare.

CAUSES

Generally, cancer begins when an error occurs in a cell's DNA. The error (mutation) causes the cell to grow and divide at a rapid rate and to continue living when a normal cell would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancerous cells can break off from the tumor to spread throughout the body.

Gastro esophageal junction cancer is strongly associated with having gastrointestinal reflux disease (GERD), which is a condition caused by frequent backflow of stomach acid into the esophagus.

Studies have established a strong correlation between a diet high in smoked and salted foods and stomach cancer, which is located in the main part of the stomach. The increased use of refrigeration for preserving foods around the world has caused a decline in the rates of stomach cancer.

SYMPTOMS

Stomach cancer can cause several symptoms. Except that these symptoms may not appear for many years as stomach cancers tend to grow very slowly.

For this reason, many people with stomach cancer may not receive a diagnosis until the disease is already advanced.

Early stage symptoms of stomach cancer include:

• Feeling very full during meals
• Indigestion that seems untreatable
• Difficulty when swallowing
• Stomach ache
• Feeling bloated after meals
• Belching frequently
• Persistent heartburn
• Pain in the breastbone
• Nausea and vomiting which may contain blood

However, many of these symptoms are very similar to those of other, less serious conditions.

As the stomach cancer becomes more advanced, some people might experience the following symptoms:

• Fatigue
• Loss of appetite
• Anemia
• A buildup of fluid in the stomach (this may cause the stomach to feel lumpy to the touch)
• Black stools that contain blood
• weight loss

Risk factors

Certain factors increase the risk of cancer, these will include:

• Diet

Eating salted, pickled, or smoked foods regularly will place people at a higher risk of developing gastric cancer. Same with high intakes of red meat and refined grains as they also increase the risk of stomach cancer.

Some foods contain substances that are suspected to have links to cancer. For example, crude vegetable oils, cocoa beans, tree nuts, groundnuts, figs, and other dried foods and spices contain aflatoxins.

• Medical conditions

Conditions linked to stomach cancer include:

• Peptic stomach ulcers - Painful sores in the lining of the stomach
• pylori infection in the stomach
• Stomach polyps - Masses of cells that form on the lining inside the stomach
• Intestinal metaplasia, in which cells that would usually line the intestine line the stomach lining
• Chronic atrophic gastritis, or long term stomach inflammation that makes the stomach lining thinner
• Pernicious anemia, which might develop due to a deficiency of vitamin B12

Certain genetic conditions add to the risk of stomach cancer, including:

• Li-Fraumeni syndrome - A rare, hereditary disorder that predisposes carriers to development of cancer
• Familial adenomatous polyposis (FAP) - An inherited disorder characterized by cancer of the large intestine (colon) and rectum
• Lynch syndrome - An inherited disorder that increases the risk of many types of cancer, particularly cancers of the colon (large intestine) and rectum,
• Type A blood - Has A antigens on the red blood cells with anti-B antibodies in the plasma
• Smoking - Causes cancer, lung disease, and heart disease · can shorten one's life by 10 years or more. Regular, long-term smokers have an increased risk of stomach cancer when compared to non-smokers.
• Family history - Family history includes health information about one's family and his/her close relatives. Having a close relative who has or has had stomach cancer can increase the risk.
• Sex

Men are more likely to get stomach cancer than women.

• Age

The risk of developing stomach cancer increases significantly after the age of 50 years.

• Certain surgical procedures

Surgery to the stomach or any part of the body that affects the stomach, such as ulcer treatment, can increase the risk of stomach cancer in later years.

DIAGNOSIS

Tests and procedures used to diagnose stomach cancer include

• Upper endoscopy

A thin tube containing a tiny camera is passed down the throat and into the stomach. The doctor can look for signs of cancer. If any suspicious areas are found, a biopsy will be conducted (a piece of tissue can be collected for analysis).

• Imaging tests.

Imaging tests used to look for stomach cancer include computerized tomography (CT) scans and a special type of X-ray exam sometimes called a barium swallow. Tests may also positron emission tomography (PET).

• Determining the extent (stage) of gastro esophageal or stomach cancer

The stage of the stomach cancer will help the doctor to decide which treatment regimen may be best. Tests and procedures used to determine the stage of cancer include:

• Exploratory surgery - The doctor may recommend surgery to look for signs that the cancer has spread beyond the esophagus or stomach, within the chest or abdomen. Exploratory surgery is usually done by laparoscopy. The surgeon makes several small incisions on the abdomen and inserts a special camera that transmits images to a monitor in the operating room.

STAGES OF STOMACH CANCER

The stages of adenocarcinoma of the stomach or esophagus include:

Stage 1. The tumor is limited at this stage to the top layer of tissue that lines the inside of the esophagus or stomach. The cancer cells also may have spread to a limited number of nearby lymph nodes.

Stage 2. At this stage, the cancer has spread a bit deeper, growing into a deeper muscle layer of the esophagus or stomach wall. The cancer may also have spread to more of the lymph nodes.

Stage 3. At this stage, the cancer may have grown through all the layers of the esophagus or stomach and possibly spread to nearby structures. It may also be a smaller cancer that has spread more extensively to the lymph nodes.

Stage 4. This stage indicates the spread of the cancer to distant areas of the body

TREATMENT FOR STOMACH CANCER

Stomach cancer is often treatable, but it could also be difficult to treat.

Treatment will depend on:

• Where the cancer is located
• Whether or not it has spread
• The type and size of the stomach cancer
• Patient's general health

Treatment usually includes surgery and chemotherapy. It may also include radiotherapy, and treatment with targeted medicines.

The specialist care team will:

• Help and offer support during recovery period
• Explain the treatments and side effects
• Collaborate with patient to create the best treatment plan
• Help manage any side effects, including changes to diet

There will be regular check-ups during and after treatments. Patients may also undergo tests and scans.

• Surgery

Treatment will depend on whether the cancer can be removed or not.

In case the cancer cannot be removed, surgery may be done to help control some of the symptoms.

• Surgery to remove stomach cancer

Surgery may be performed to remove the cancer if it is found early, if it has not spread or has not spread far. Surgery may remove part or all of the stomach. They may possibly, also need to remove parts of other organs around the stomach. Recovery periods from surgeries to treat stomach cancer can take a long time.

• Surgery to help control the symptoms of stomach cancer

One may need surgery to relieve a blockage in the stomach. This will facilitate easy passage of food through the stomach.

The aim of this surgery is to help improve the symptoms and not to cure the cancer,

• CHEMOTHERAPY

Chemotherapy uses medicines to kill cancer cells.

A doctor may use chemotherapy:

• In combination with other treatments to help make treatment more effective
• Before and after surgery to help make the cancer smaller
• After surgery to help stop the cancer from re-occurring
• To help control and improve the symptoms of advanced cancer or if the cancer cannot be removed by surgery, chemotherapy is given alongside treatment with targeted medicines

• RADIOTHERAPY

Radiotherapy uses high-energy rays of radiation to kill cancer cells.

A doctor may use radiotherapy:

• In combination with chemotherapy to help stop the cancer from recurring
• To control and improve the symptoms for advanced cancer.

• TREATMENT WITH TARGETED MEDICINES

Targeted cancer medicines aim at stopping the cancer from growing.

These may be used together with chemotherapy to treat advanced stomach cancer.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with the individual, his/her family and other doctors to provide an extra layer of support that complements the ongoing care. Palliative care can be used even as the patient is undergoing aggressive treatments, such as surgery, chemotherapy or radiation therapy.

Palliative care, if it is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

WHO IS LIKELY TO GET STOMACH CANCER

Anyone can get stomach cancer. Up until now, it is not clear what causes it.

However, one might be more likely to get it if he/she is:

• Over the age of 50
• Is a man
• Has a long-term infection with Helicobacter pylori (H. pylori)
• Has certain stomach conditions, such as long-term, severe acid reflux, gastritis or a condition called pernicious anemia, which affects the immune system
• Has a brother, sister or parent who had stomach cancer

Many stomach cancers are also linked to lifestyle.

REDUCING THE RISK OF STOMACH CANCER

Stomach cancer cannot always be prevented. Making healthy changes however, can lower the risks of getting it.

• Quit smoking
• Lose weight if they are overweight
• Use protective clothes and masks if exposed to harmful chemicals.
• Cut down on salt intake
• Cut down on alcohol consumption
• Eat at least 5 portions of a variety of fruit and vegetables in a day
• As much as possible, do not eat red and processed meat Information
• It is important to get any symptoms of stomach cancer checked by a GP

Even if one does not fit into any of the groups with a higher chance of getting it. Anyone can get stomach cancer.

PREVENTION

There is no way anyone can prevent stomach cancer entirely.

However, a person can take steps to reduce the risk of developing the disease. These include the following.

Diet

Several dietary measures can help reduce the risk of stomach cancer.

It is suggested that eating at least two and a half cups of fruits and vegetables every day can help limit the risk.

The recommendation is to reduce the quantity of pickled, salted, and smoked foods in the diet. Cutting out refined grains and opting instead for whole grain cereals, bread, and pasta. Lastly replacing red or processed meat with beans, fish, and poultry. All of these if adhered to, can also reduce a person's chance of developing stomach cancer.

Smoking

• Smoking tobacco actually increase the risk of cancer developing in the part of the stomach near the esophagus. People who smoke must seek advice and quit. Those people who do not smoke should avoid exposure to tobacco smoke.
• Taking non-steroidal anti-inflammatory drugs. Using NSAIDs, such as aspirin, naproxen, or ibuprofen, may reduce the risk of stomach cancer. However, they carry additional risks, such as life threatening internal bleeding.

Only take NSAIDs to treat other conditions, such as arthritis. Do not take them solely to reduce the risk of stomach cancer.