Stomach Cancer

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Overview

Stomach cancer, also known as gastric cancer, is the fifth most common cancer worldwide. This disease is a result of the growth of cancerous and malignant cells in the inner lining of the stomach.

Stomach cancer does not grow overnight as this disease usually grows slowly over many years. Some pre-cancerous changes take place before true cancer actually develops. But these early changes rarely result in any symptoms and therefore, often go undetected in the early stage when it is most easy to treat it.

Gastric cancer can grow through the wall of the stomach and invade nearby organs. It can easily spread to the lymph vessels and lymph nodes. In an advanced stage, it can travel through the bloodstream and spread or metastasize to organs such as the liver, lungs, and bones. Usually, people diagnosed with stomach cancer have either experienced metastasis already or eventually develop it.

Types of Stomach Cancer

Stomach cancer should not be confused with other cancers in the abdomen or esophageal cancer. Some other cancer can also occur in the abdomen, including cancer of the large and small intestine, liver or pancreas. These cancers may have different symptoms, outlook, and options for treatment.

Some of the common types of gastric cancer include:

  • Adenocarcinoma: It is the most common form of stomach cancer and about 90 to 95 percent of stomach cancers are This form of cancer develops from the cells that form the innermost lining (mucosa) of the stomach.
  • Lymphoma: This is a rare form of stomach cancer and only about four percent of stomach cancers are lymphomas. These are cancers of the immune system tissue, sometimes found in the wall of the stomach.
  • Gastrointestinal stromal tumor (GIST): It is a rare kind of tumor that starts in very early forms of cells in the wall of the stomach calledinterstitial cells of Cajal. GISTs can be found anywhere in the digestive tract.
  • Carcinoid tumour: It is also a rare form of stomach cancer and about three percent of stomach cancers are carcinoid tumors. Carcinoid tumors start in cells of the stomach that produced hormones.

Some other types of stomach cancers include squamous and small cell carcinoma and leiomyosarcoma. These cancers are very rare.

Stomach Cancer Causes

There is no single, definite cause behind stomach cancer. However, several stomach cancer risk factors have been identified that could potentially lead to the formation to a tumor in the stomach. Some of these stomach cancer causes or risk factors include:

  • Inflammation of the gut called gastritis
  • Infection with common bacteria called Helicobacter pylori
  • Long-lasting anaemia
  • Growth in stomach called polyps
  • Smoking
  • Obesity
  • Excessive consumption of smoked, pickled or salty foods
  • A-type blood group
  • Epstein-Barr virus infection
  • Certain genes (family history of disease)

Stomach Cancer Symptoms

There can be several early stomach cancer symptoms. However, the signs of stomach cancer could be present because of some other underlying condition as well. Unfortunately, this is the main reason why it is difficult to make stomach cancer diagnosis at an early stage.

Some of the early stomach cancer symptoms may include:

  • Heartburn
  • Regular indigestion
  • Slight nausea
  • Loss of appetite
  • Frequent burping
  • Feeling bloated

But just experiencing indigestion or heartburn after a meal does not really mean that you have cancer. Although, if you experience these symptoms a lot, talk to your doctor, who can decide whether to conduct further tests or not.

As advanced gastric cancer grow, you may experience more serious signs of stomach cancer, including the following:

  • Frequent stomach ache or pain in the sternum
  • Frequent heartburns
  • Vomiting containing blood
  • Dysphagia (swallowing difficulties)
  • Loss of appetite, accompanied by sudden weight loss
  • Blood in stools
  • Excessive fatigue
  • Yellowish eyes or skin

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Before the Treatment

It is important to diagnose the type and stage of gastric cancer before performing any procedure to relieve the symptoms. Before the treatment, you must inform your doctor about all the discomfort or symptoms that you are experiencing. It is important to provide complete and detailed information to the doctor because that will help with correct diagnosis and treatment in the future.

Stomach Cancer Diagnosis

Typically, your doctor will ask about the symptoms, family history, eating habits, and medical history before the diagnosis of gastric cancer. After that, a few physical examination can be conducted to check for stomach tenderness or lumpiness.

Usually, stomach cancer is diagnosed by carrying out the following tests:

  • Blood Tests: Stomach cancer diagnosis starts with a series of blood tests to look for signs of cancer in your body.
  • Gastroscopic exam: A fiber optic camera is used to look inside of the patient's stomach to identify any abnormal growth.
  • Ultrasound: The specialist may carry out an ultrasound to diagnose stomach cancer.
  • Laparoscopy: It is a thorough examination of the abdomen. In this test, the patient is placed under a general anesthetic and a laparoscope is inserted through a small incision in the lower part of the stomach.
  • Biopsy: In this test, a small piece of tissue is taken from your stomach to look at under a microscope for signs of cancer cells.
  • CT scans: This test involves taking series of radiographic pictures of the inside of the body. These images help the doctor to determine how advanced the cancer is.  

Stomach Cancer Stages

As soon as the cancer is confirmed, the doctor uses a sample of tissue from the biopsy to confirm stomach cancer stage. It is important to identify the stage of stomach cancer before preparing a treatment plan and its execution.

There are different types of stomach cancer stages, depending on the extent of cancer or its invasiveness. The stages are described as per the TNM system, wherein ‘T’ describes the size of the tumor, ‘N’ represents whether or how many lymph nodes are affected and ‘M’ represents whether or how far the cancer has spread to other parts of the body. The following table highlights the different types of stomach cancer stages and what do they actually mean.

Stage Sub-stage What does it mean?
Stage 0 - It represents a very early stage stomach cancer and that the cancerous cells are restricted within the innermost lining of the stomach.
Stage 1 Stage 1A It represents the stage wherein the cancer is still restricted to the innermost lining and the lymph nodes are not affected (T1N0M0).
  Stage 1B

It represents the stage wherein cancer has:

  • Grown but one or two lymph nodes are affected (T1N1M0)
  • Grown into the muscle layer of the stomach but lymph nodes are not affected (T2N0M0)
Stage 2 Stage 2A

It represents the stage wherein cancer is/has:

  • Restricted to the innermost lining but nearly three to six lymph nodes are affected (T1N2M0)
  • Invaded the muscles layer and one or two lymph nodes are affected (T2N1M0)
  • Reached the outermost layer but no lymph nodes are affected (T3N0M0)
   Stage 2B  

It represents the stage wherein cancer is/has:

  • Restricted to the innermost layer but 7 or more lymph nodes are affected (T1N3M0)
  • Grown into the muscle layer and three to six lymph nodes are affected (T2N2M0)
  • Grown into the outer later and one to two lymph nodes are affected (T3N1M0)
  • Grown outside the outermost lining but there are no cancer cells in the lymph nodes (T4aN0M0)
 Stage 3  Stage 3A  

It represents the stage wherein cancer has:

  • Grown into the muscle layer and seven or more lymph nodes are tested positive (T2N3M0)
  • Grown into the outermost layer and three to six lymph nodes are affected (T3N2M0)
  • Grown into the stomach wall and one to two lymph nodes are affected (T4aN1M0)
   Stage 3B  

It represents the stage wherein the cancer has:

  • Spread to the outermost lining and nearly 7 or more lymph nodes are affected (T3N3M0)
  • Invaded the stomach wall and nearly three to six lymph nodes are affected (T4aN2M0)
  • The cancer has spread to the nearby tissues and organs and cancer cells are either absent in the lymph nodes or one or two nodes are affected (T4bN0/N1M0)
   Stage 3C  

It represents the stage wherein cancer has:

  • Spread to grown through the stomach wall and cancer cells are present in seven or more lymph nodes (T4aN3M0)
  • Spread to the nearby tissues or organs and cancer cells are present in three or six lymph nodes (T4bN2/N3M0)
 Stage 4  -  It means that the cancer is in its advanced stage and has reached to distant organs such as the bones, brain, and lungs.

How it is Performed

There are many options for stomach cancer treatment. Your specialist will choose the most appropriate treatment plan for you, depending on the stage of your cancer.

Most often, a combination of the following stomach cancer treatment options is used to remove tumor:

  • Surgery: It is the most common and preferred option for the treatment of stomach cancer. Your surgeon may remove stomach cancer as well as the margin of healthy tissue. Surgery helps remove the tumor and stops cancer from spreading to other parts of your body by making sure that no cancerous cells are left behind. If the cancer is in a more advanced stage, it may require removal of the entire stomach. Most of the surgeries are conducted with the help of a special device known as an endoscope. Subtotal gastrectomy and proximal gastrectomy are conducted in the case of distal and proximal cancers.
  • Chemotherapy: It involves the use of certain cytotoxic medicines and drugs that help kill cancer cells or stop them from growing. It can be taken as pills or through an IV at a clinic. Chemotherapy usually takes several weeks and it causes some side effects. But these side effects can be subsidized by following your doctor’s advice.
  • Radiation therapy: In this treatment, high-energy rays are used to kill cancerous cells. Radiotherapy is not commonly recommended for the treatment of stomach cancer because of the risk of harming other nearby organs. However, in the advanced case of gastric cancer, radiotherapy is an option.
  • Targeted medicines: Some new types of drugs can fight cancer cells and have fewer side effects than chemotherapy and radiation, which have the tendency to kill healthy cells along with the cancerous ones.

Stage 0 stomach cancer treatment: It is mostly treated with the help of an endoscopic surgery.

Stage 1 stomach cancer treatment: It is mostly treated with the help of an endoscopic surgery, followed up with a few session of chemotherapy. Sometimes, the surgeon may advise you to undergo a few session of chemotherapy before the surgery as well.

Stage 2 stomach cancer treatment: Surgery is the main treatment option followed by chemotherapy. If you decide against the surgery, a combination of chemotherapy and radiotherapy may be used.

Stage 3 stomach cancer treatment: A few cycles of chemotherapy are conducted before the surgery, followed up with a surgery. Following the surgery, a few cycles of chemotherapy are repeated, followed by radiation therapy.

Stage 4 stomach cancer treatment: Chemotherapy is the main treatment option for such patients. A surgery can be conducted to control the symptoms. Radiotherapy could be used if needed to relieve symptoms.

Recovery

Recovery after stomach cancer treatment can take a long time. You may need special palliative care to manage the discomforting symptoms such as extreme pain. With constant support from the doctors, friends, nurses and family members, the health eventually feels better and you are able to experience an improved quality of life.

You may not be able to eat properly or by your own immediately after the surgery. However, you are able to return back to your normal routine in a few days. Planning and managing regular chemotherapy visits after the surgery can be difficult.

Discuss with your doctor about specific side effects that you are likely to face after chemotherapy. The doctor will give you specific medications that will help relieve specific symptoms such as nausea, weakness, vomiting, joint pain, and headache.

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FAQ

Q: Can stomach cancer be prevented?

A: By avoiding smoking, eating a healthy diet and avoiding spicy and salty foods, the risk of getting stomach cancer can be reduced.

Q: Is stomach cancer genetic?

A: A few cases of stomach cancer tend to run in families. However, the association has not been confirmed as yet.

Q: Is Stage 4 stomach cancer curable?

A: Since Stage 4 stomach cancer has spread to the distant organs, it is not always possible to treat it. The symptoms of stomach cancer, at this stage, can only be controlled.

Q: What are the first signs of stomach cancer?

A: A feeling of fullness, heartburn, nausea, and vomiting are some of the earliest signs of stomach cancer.

Q: What is the survival rate for stomach cancer?

A: The 5-year survival rate in the case of Stage 1 and Stage 2 stomach cancer is around 65 percent. The same is around 30 percent for Stage 3 and Stage 4 stomach cancer.

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