Stomach (Gastric) Cancer
What is stomach cancer?
Stomach cancer, or gastric cancer, refers to cancer arising from any part of the stomach. It occurs when healthy cells in your stomach become “autonomous” and start to grow out of control, forming a tumour. Stomach cancer is thankfully relatively rare, and the incidence is currently decreasing due to the widespread use of PPI’s (acid reducing medication). Stomach cancer can be difficult to diagnose due to the paucity of symptoms, especially early in the disease.
What are stomach cancer symptoms?
Stomach cancer is often either asymptomatic (producing no noticeable symptoms) or it may cause only nonspecific symptoms (symptoms which are not specific to just stomach cancer, but also to other related or unrelated disorders) in its early stages. By the time symptoms occur, cancer has often reached an advanced stage (see below) and may have also metastasized (spread to other, perhaps distant, parts of the body), which is one of the main reasons for its relatively poor cancer prognosis. Stomach cancer can cause the following signs and symptoms:
- Indigestion or heartburn
- Loss of appetite
- Abdominal discomfort
- Weakness and fatigue
- Bloating of the stomach
- Abdominal pain
- Nausea and vomiting
- Diarrhoea or constipation
- Loss of weight
- Bleeding: haematemesis (vomiting of blood) or melena stools (black, tarry, offensive stool).
The following risk factors for gastric cancer have been identified:
- Helicobacter pylori infection:
H. pylori is an organism that commonly infects the inner lining (the mucosa) of the stomach. Infection can cause stomach inflammation and peptic ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer. - Long-term inflammation of the stomach:
People with underlying conditions associated with long-term inflammation of the stomach (such as the blood disease pernicious anaemia) are at increased risk of stomach cancer. Also, people who have had surgery to remove a part of their stomach may have long-term stomach inflammation and an increased risk of developing stomach cancer. - Smoking:
Smokers are more likely than non-smokers to develop stomach cancer. Heavy smokers are most at risk. - Family history:
Close relatives (parents, brothers, sisters, or children) of a person with a history of stomach cancer are somewhat more likely to develop the disease themselves. If many close relatives have a history of stomach cancer, the risk is even greater. - Poor diet, lack of physical activity and obesity may increase the risk of stomach cancer.
- There is evidence to suggest that people who eat a diet high in foods that are smoked, salted, or pickled have an increased risk for stomach cancer. However, people who eat a diet high in fresh fruits and vegetables may have a lower risk of stomach cancer.
- A lack of physical activity may increase the risk of stomach cancer.
- People who are obese may have an increased risk of stomach cancer developing in the upper part of the stomach.
The suspicion of gastric cancer will be raised by the patient’s history and physical findings. The diagnosis will be confirmed by performing a gastroscopy with biopsies of the tumour. Contrast studies (with barium) can also be useful to plan surgery and staging will be done by performing a computerized tomogram (CT) to assess local resectability and exclude metastatic spread (distant disease).
What are the treatment options for stomach cancer?
Dr Cooper will determine a treatment strategy depending on the stage of cancer:
In the early stages, cancer surgery is the mainstay of treatment. Surgery can be curative and can be performed in a minimally invasive (laparoscopic) manner or performed using an upper midline incision. If the cancer is small and located in the distal stomach, a partial (distal) gastrectomy will be done with the remaining stomach anastomosed (joined) to the small bowel. If the tumour is bigger or located more proximally, the whole stomach will be removed, and the gullet (food pipe) joined to the small bowel. The surrounding lymph nodes (glands) will also be removed with the stomach.
For more advanced stomach cancer, neoadjuvant (pre-operative) chemotherapy will be given. The response will be assessed, and the patient evaluated for surgery. Where surgery is not indicated or possible, a self-expanding metallic stent can be placed if the lumen (opening) of the stomach is compromised. Radio- and/or chemotherapy can also be given to palliate symptoms of pain and/or bleeding. The prognosis of stomach cancer is generally poor. Due to the lack of symptoms in the early stages of stomach cancer, patients often present with a tumour that has already metastasised by the time of discovery. Most people with stomach cancer are also elderly (median age is between 70 and 75 years) at presentation, often with significant co-morbidities.