What is Gastric Cancer?
Stomach cancer, also called gastric cancer, is much more common in other areas of the world, particularly Japan, than it is in the United States, where the number of people diagnosed with the disease each year is declining.
Risk factors for stomach cancer include age gender, race and diet. Most people who develop stomach cancer are age 72 or older. Men are more likely than women to get stomach cancer, and it is more common in Asians, Pacific Islanders, Hispanics and African Americans than in non-Hispanic white Americans.
Studies suggest that diets high in smoked, salted and pickled foods may increase chances of stomach cancer. The bacteria helicobacter pylori, commonly found in the stomach, can cause infections which may increase risk of stomach cancer.
Signs & Symptoms
Research is increasing regarding what we know about gastric cancer. Scientists are learning more about its causes. Following are common risk factors for the disease:
- Family History - Patients who have parents, brothers, sisters, or children with a history of stomach cancer are somewhat more likely to develop the disease themselves.
- Helicobacter Pylori Infection - H. pylori is a bacterium that commonly infects the inner lining (the mucosa) of the stomach. Infection with H. pylori can cause stomach inflammation and peptic ulcers.
- Long Term Inflammation of the Stomach - People who have conditions associated with long-term stomach inflammation (such as the blood disease pernicious anemia) are at increased risk of stomach cancer.
- Poor Diet/Overweight - Studies suggest that people who eat a diet high in foods that are smoked, salted, or pickled have an increased risk for stomach cancer. Also, patients who are obese and lack physical activity may increase the risk of stomach cancer.
- Smoking - Smokers are more likely than nonsmokers to develop Stomach Cancer.
Signs and Symptoms
Early stomach cancer often does not cause symptoms. As the cancer grows, the most common symptoms are:
- Difficulty swallowing
- Discomfort or pain in the stomach area
- Feeling full or bloated after a small meal
- Nausea and vomiting
- Vomiting blood or having blood in the stool
- Weight loss
Diagnosis & Staging
Early stomach cancer often doesn’t cause diagnosable symptoms. As the cancer grows, common symptoms include: discomfort in the stomach area, bloating or a feeling of fullness after a small meal, nausea, vomiting, and weight loss. These symptoms are most often not caused by cancer, but by ulcers or infections.
If a patient has these symptoms, a doctor may refer the patient to a gastroenterologist, a doctor who specializes in digestive problems. The doctor may perform one or more of the following procedures to determine if cancer is present:
- Physical Exam - The doctor feels the abdomen to check for fluid, swelling, or other changes. The doctor checks for swollen lymph nodes and checks the skin and eyes for signs of jaundice.
- Upper GI Series - The patient drinks a solution made of barrier, which makes the stomach show up more clearly on x-rays. The doctor then x-rays the stomach and esophagus.
- Endoscopy - The doctor uses a thin, lit tube called an endoscope to look into the stomach. The patient’s throat is numbed with an anesthetic spray, and the doctor passes the endoscope through the mouth and esophagus into the stomach.
- Biopsy - A doctor removes samples of tissue from the stomach with the use of an endoscope. A pathologist looks at the tissue sample under a microscope to check for cancer cells. This is the only sure way to tell if stomach cancer is present.
Stages of Gastric Cancer
If gastric cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.
Stage 0 (Carcinoma in Situ)
The cancer is found only in the inner layer of the stomach. It is carcinoma in situ.
- The tumor has invaded only the submucosa. (The picture in section 2 shows the layers of the stomach.) Cancer cells may be found in up to 6 lymph nodes, or
- The tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.
- The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes, or
- The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes, or
- The tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other organs.
- The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes, or
- The tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes, or
- The tumor has invaded nearby organs, such as the liver or spleen. Cancer cells have not spread to lymph nodes or to distant organs.
- Cancer cells have spread to more than 15 lymph nodes, or,
- The tumor has invaded nearby organs and at least 1 lymph node, or
- Cancer cells have spread to distant organs.
Treatment & Side Effects
Treatment Options for Stomach Cancer
There are several treatment options for stomach cancer, depending on the cancer stage and the patient’s age and general health. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs. Many patients have one or more of the following:
Surgery - This is the most common treatment for stomach cancer. There are two main types of surgery for stomach cancer:
- Partial (subtotal) Gastrectomy: The surgeon removes part of the stomach and may also remove part of the esophagus or small intestine, nearby lymph nodes, and other tissues.
- Total Gastrectomy: The surgeon removes the entire stomach, nearby lymph nodes, parts of the small intestine and esophagus, and other tissues. The spleen may also be removed in this surgery. The surgeon connects the esophagus to the small intestine and makes a new “stomach” from intestinal tissue.
Radiation Therapy - A large machine directs radiation at the abdomen and uses high-energy rays to kill cancer cells. Radiation can be given alone or with chemotherapy, surgery, or both. It is used to destroy cancer cells that remain after surgery and to relieve pain caused by cancer.
Chemotherapy - This treatment uses drugs to kill cancer cells. In patients with stomach cancer, chemotherapy is given alone, with surgery, radiation, or both. Most often, drugs are injected into the veins.
Follow-up care after treatment for stomach cancer is an important part of the overall treatment plan. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment
Side Effects From Treatment
It helps to learn more about the side effects from your treatment(s) before you begin, so you will know what to expect and talk with your health care team to manage your quality of life during and after treatment.
Talk to your doctor about effective and readily available medications to address traditional side effects from cancer treatment (such as nausea, diarrhea, constipation and mouth sores.) Keep in mind that everyone reacts differently to treatment and experiences side effects differently. There are coping mechanisms and strategies that can help.
Surgery - Many people who have stomach surgery feel tired or weak for a while. The surgery can cause constipation or diarrhea, and a feeding tube may be used during recovery.
Radiation Therapy - Side effects of radiation to the abdomen depend on dose and may include nausea, vomiting, diarrhea, or other problems with digestion.
Chemotherapy - Side effects depend on the specific drugs and the dose and include hair loss, loss of appetite, nausea and vomiting, diarrhea, fatigue, and mouth sores.