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Stomach Cancer

Introduction

In India, the incidence rate of stomach cancer is very low compared to that in western countries, and the number of new gastric cancer cases is approximately 34,000, with a male predominance (male-to-female ratio, 2:1). It is estimated that by the year 2020, approximately 50,000 new gastric cancer cases will be reported annually in India.
Stomach cancer is an abnormal growth of cells that begins in stomach. Stomach cancer, also known as gastric cancer, can affect any part of the stomach. Gastric cancer is more likely to affect the area where the long tube (the esophagus) that carries the food you swallow meets the stomach. This area is called as gastroesophageal junction. This type of cancer is difficult to diagnose because most people typically don’t show symptoms in the earlier stages. The biggest danger of this disease is delay in diagnosis.

Types of Stomach Cancer:

Most cancers of the stomach (about 90% to 95%) are adenocarcinomas. These cancers develop from the gland cells (mucus secreting cells) in the innermost lining (mucosa) of the stomach.

There are 2 main types of stomach adenocarcinomas:

1. The intestinaltype tends to have a slightly better prognosis (outcome). The cancer cells are more likely to have certain gene changes that might allow for treatment with targeted drug therapy.
2. The diffusetype tends to grow spread more quickly. It is less common than the intestinal type, and it has poor prognosis.

Causes and Risk Factors

The exact cause for stomach cancer is still not known but few things that can raise the risk for the disease. One of the major risk factors is – H. pylori bacterial infections (a common stomach infection that can sometimes lead to ulcers).

Other things that play a role in raising the risk include:

• Age
• Tobacco
• Gastroesophageal reflux disease
• Obesity
• A diet high in salty and smoked foods
• A diet low in fruits and vegetables
• Family history of stomach cancer
• Long-term stomach inflammation (gastritis)
• Smoking
• Stomach polyps

Signs and Symptoms

Sometimes cancer can grow in the stomach for a long time before it causes symptoms. Signs and symptoms of stomach cancer may include:

• Discomfort or pain in the stomach area or upper abdomen
• Vomiting
• Heartburn
• Nausea
• Feeling bloated after eating
• Difficulty swallowing
• Indigestion
• Unintentional weight loss or weakness
• Feeling full after eating small amounts of food
• Blood in vomiting or black stools

Diagnosis

Cancer in the stomach is detected by an assessment from the doctor and undergoing tests or procedures that will guide doctors in stomach cancer diagnosis and staging. To make a diagnosis, your doctor will first perform an examination to find any abnormalities. These tests consist of:

• History and physical assessment: the physician will ask about stomach cancer symptoms that you have experienced and obtain data if you have stomach cancer risk factors. The physician will perform a physical examination such as palpation of the abdomen to determine if you have stomach cancer signs.
• Upper GI Endoscopy: the leading test for stomach cancer diagnosis. Through upper GI endoscopy, the doctor can visualize the linings of the esophagus, stomach, and part of the small intestines.
• Biopsy: If any unusual growth, ulceration, or abnormal areas is seen during endoscopy, the doctor can take a small sample of tissues that will be sent to check for the presence of cancer cells.
• Laboratory tests:
  • Complete blood count (CBC):to check for decreased hemoglobin levels, it could be due to bleeding in stomach.
  • Fecal occult blood test:to determine the presence of blood in the stool that cannot be seen by the naked eyes
• Imaging tests:to determine the suspected organ is cancerous, to evaluate extent of cancer or response to treatment. Imaging tests include – Chest X-ray, Positron Emission Tomography (PET) Scan, Contrast CT-scan.

Management

The decision of treatment for patients with stomach cancer relies upon a few elements including their age, general condition of wellbeing, and their capacity to withstand the treatment. The level of cancer spread is another critical factor. The distinctive types of treatment that might be managed incorporate the accompanying:

• Surgery –Surgery is the primary treatment for earlier-stage stomach cancer. It entails the removal of the diseased stomach with a margin of healthy tissue, omentum, and adjacent lymph nodes.
• Chemotherapy –Chemotherapy uses drugs to destroy cancer cells. Several drugs are combined and given in a specific order on specific days as cycles to downstage.
• Radiation treatment – Radiation therapy uses high-energy X-rays to destroy cancer cells. People with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body.
• Targeted treatment – Substances that identify and attack cancer cells without harming normal cells. Targeted therapy for stomach cancer includes HER2neu targeted therapy and Anti-angiogenesis therapy.

Follow-Up

After treatment follow-up visits every 3 to 6 months for the first few years, then less often afterwards. These visits usually include a physical exam and review of any symptoms.