What Is Stomach Cancer

Cancer of the stomach (Gastric Cancer) is a common occurrence; infections or inflammations of the stomach wall are the triggers which lead to the development of  stomach cancer.

  • Infection by the bacteria Helicobacter pylori is found to be the major cause of gastric cancer.
  • The symptoms include discomfort or pain in the stomach, weakness and unexplained weight loss.
  • endoscopic examination is the ideal tool for diagnosis of stomach cancer.
  • When the cancer has already spread to other areas, rate of survival is very low.
  • Cancerous growths in the stomach can be surgically removed to get relief from symptoms.

Adenocarcinomas are the most usual form of stomach cancer, constituting 95 % all of the cancers of the stomach. They develop in the glandular tissue lining the stomach.

The distribution of adenocarcinoma in the general population varies depending on age and race as well as socioeconomic and geographical conditions. American Indians, Hispanics, and blacks and those from lower income groups seem to be predisposed to stomach cancer. More than twenty thousand cases of adenocarcinoma are reported in the US every year though the incidence is on the decline now. It is more prevalent in people in the northern regions and those who are from certain countries such as China, Japan, Iceland and Chile. Stomach cancers commonly appear in people above the age of 50.

Causes and Risk Factors

Adenocarcinoma usually originates from a site of inflammation in the lining of the stomach. Injuries to the stomach lining may have caused the inflammation but the most common reason of stomach cancer has been found to be infections, particularly by the Helicobacter pylori bacteria.

Stomach polyps are usually harmless growths of the stomach wall projecting into the stomach cavity, but sometimes they may become precancerous and eventually develop into stomach cancer, especially when they consist of the glandular cells of the stomach wall. When many polyps exist together or when they are large in size, the chances of them becoming cancerous are higher.

Consuming processed foods and high carbohydrate diet, high salt intake, consuming foods containing preservative agents like nitrates, usually found in smoked items of food like meat, are suspected to increase the chances of developing stomach cancer.  Likewise, diets poor in fruits and vegetables are also said to make people prone to stomach cancer, though there is no conclusive proof for the above assumptions.

Symptoms

The early symptoms of stomach or gastric cancer are not very obvious, and they usually resemble the symptoms of peptic ulcer such as pain and burning in the abdomen. In fact, the possibility of stomach cancer is often considered when symptoms of peptic ulcer do not seem to subside even after treatment. Early satiety, even with small amounts of food, is a usual symptom.

Other symptoms include unexplained weight loss and anemia. They may be a result of inadequate food intake, or malabsorption of nutrients and vitamins from the food. Anemia could be due to different reasons such as:

  • loss of blood by the slow but steady bleeding from the affected region
  • deficiency of Vitamin B12 necessary for the formation of red blood cells due to malabsorption
  • deficiency of iron, which is the main constituent of the oxygen carrying molecule hemoglobin in the red blood cells, due to malabsorption.

People who develop anemia may have weakness, a light headed feeling and fatigue. The internal bleeding causes black stools called melena or it may result in a condition called hematemesis, characterized by bright red blood in the vomit.

.Adenocarcinoma metastasizes early and causes the cancer to spread to different areas elsewhere in the body. When it spreads to the liver, it causes enlargement of the liver and precipitates symptoms of jaundice such as yellowing of the eyes and skin. A condition called ascites, characterized by the accumulation of fluid and consequent bloating of the abdomen, also develops. As the disease progresses, cancerous nodules may appear on the skin and bones may become weak and easily fractured. When adenocarcinoma has grown large, it may be felt as a lump when doctor examines the abdominal region.

Diagnosis

An endoscopic examination of stomach with a flexible viewing tube is the ideal investigative procedure for diagnosing cancer of the stomach. The direct viewing of interiors of the stomach will help the doctor detect Helicobacter pylori infection. The endoscope can retrieve tissue samples for biopsy also. Another diagnostic test is Barium swallow, in which x-rays are taken, after the patient swallows a dose of radio opaque barium solution, which would show abnormal growths in the stomach. This test is not very accurate and not suitable for detecting the cancer in the initial stages.

Once the presence of cancer is confirmed, a CT scan of the abdomen and the chest is done to determine the exact location and size of the cancer. It can also detect the spread of cancer to other organs. Endoscopic ultrasound is another diagnostic procedure in which an ultrasound probe is attached to the endoscope inserted into the stomach. It gives a clearer picture of stomach walls and helps assess the depth and spread of the cancer. The involvement of lymph nodes in the area also can be determined.

Prognosis and Treatment

The prognosis is not bright for the long-term survival of patients, as more than 85% of those having stomach cancer succumb to the disease within a span of five years. This is mainly because of the early spread of cancer to other areas. Adenocarcinoma of the stomach which remains localized may be cured by surgical excision of the tumor. The affected part of the stomach and the lymph nodes in the surrounding area are also removed. In countries like Japan where routine screening for stomach cancer is done due to its high incidence, the prognosis and outcome of surgery are good because of early detection and treatment. In the US, the fatality rate is high because the cancer would have already penetrated deep into the stomach wall or it would have metastasized to other areas by the time it is detected. Treatment for stomach cancer may include radiation and chemotherapy in addition to surgery.

When the cancer has spread to other areas and it cannot be cured by surgery, the aim would be to retard the growth of the cancer as much as possible to prolong life and provide relief from distressing symptoms. Radiation and chemotherapy may help in keeping the growth of cancer under check for a while. If there is obstruction to the passage of food from the stomach into the intestine, the blocked area is bypassed by surgically attaching the intestine to a point before the block. It allows for the smooth passage food in the digestive tract, thus relieving pain and vomiting due to obstruction.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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