Stomach Cancer

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Stomach Cancer Facts

  • The stomach is a muscular, sac-like organ with a capacity of about 1 liter or quart. It lies along the upper digestive tract between the esophagus and the small intestine.
    • It is normally found in the upper left portion of the abdominal cavity.
    • The stomach serves as a reservoir for food eaten during meals and begins the process of digestion.
    • Its inner lining contains glands that secrete acid and digestive enzymes.
  • The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach.
    • Gastric cancer tends to spread through the wall of the stomach and from there into the adjoining organs (pancreas and spleen) and lymph nodes.
    • It can spread through the bloodstream and lymph system (metastasize) to distant organs such as the liver, bones, and lungs.
  • The incidence and death rates for stomach cancer have decreased markedly during the past 60 years in the USA.
    • In 1930, stomach cancer was the leading cause of cancer-related deaths among American men.
    • Since then, the death rate in men from stomach cancer in the United States has dropped markedly for reasons which are still being debated.

Stomach Cancer Risk Factors

  • Stomach cancer remains the second most frequent cause of cancer-related death worldwide, with particularly high frequencies in Japan, China, Korea, parts of Eastern Europe, and Latin America. Established risk factors for stomach cancer include the following:
    • Low socioeconomic status
    • Male sex
    • Cigarette smoking
    • Advanced age
    • A prior diagnosis of pernicious anemia (a chronic progressive disease caused by the failure of the body to absorb vitamin B-12)
    • A diet deficient in fresh fruits and vegetables and rich in salted or smoked fish or meats and poorly preserved foods
  • Treating benign stomach or duodenal ulcer disease by removing part of your stomach is associated with an increased risk of cancer developing in the remaining stomach, especially at least 15 years after the surgery.
  • Recent studies have demonstrated a higher frequency of stomach cancer in people chronically infected with Helicobacter pylori, a common cause of chronic gastritis and peptic ulcer disease.
  • A family history of stomach cancer is a further risk factor in the disease.
  • People with blood type A also have an increased risk.

Stomach Cancer Symptoms

  • Early symptoms of stomach cancer tend to be vague and nonspecific. Seek medical attention if you have any of the following symptoms:
    • Mild upper abdominal discomfort associated with nausea and loss of appetite
    • Difficulty swallowing because of a tumor involving the upper part of your stomach, near the esophagus
    • Feeling of fullness after taking only a small amount of food
  • The following symptoms may indicate advanced disease:
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Stomach Cancer Diagnosis and Staging

Several procedures are used in the diagnosis and staging of stomach cancer. A diagnostic test establishes the presence of the disease, while staging determines its extent and helps to guide treatment decisions.

  • Gastrointestinal (GI) endoscopy allows a direct view of the area of concern. The doctorcan alsotake a sample of tissue (biopsy) to confirm the diagnosis.
  • Once doctors establish the diagnosis, further tests are performed, including the following:
    • Upper gastrointestinal endoscopy with ultrasound umaging (EUS)
    • A PET scan and CT of the chest, abdomen, and pelvis in all but the earliest or lowest-stage cancers of the stomach.
    • Laboratory testing including analysis of the cancer for specific mutations and genetic amplifications in advanced cases.

Stomach Cancer Treatment

The treatment of stomach cancer depends on the results of tests and your overall health.

  • People with advanced heart and lung disease may not tolerate aggressive therapy.
  • In many cases, the stomach cancer may have advanced too far for any available treatment to be curative.
  • You will require surgery to be cured.Your stomach is removed entirely, and your esophagus is attached to your small intestine.
  • Surgery may relieve symptoms of obstruction. The upper end of your stomach is connected to your small bowel, bypassing the area of obstruction.
  • Companion treatment with either chemotherapy or radiation may improve your survival following surgery.
  • After your stomach has been removed, your doctor willmonitor your disease with repeat CT scans of your abdomen and gastrointestinal endoscopy to make sure the cancer does not return.

Prognosis

  • Early stomach cancer may be amenable to even local removal through the endoscope in centers with experience with that technique.
  • Patients with cancers found to have an operable or resectable stage of stomach cancer and who are well enough for major surgery should undergo an adequate removal of as much of the stomach as necessary to ensure adequate clear margins. In some people this will involve removal of a portion of the stomach, while in others the entire stomach must be removed. Lymph nodes next to the stomach as removed during these operations as well.
  • In the stomach cancers found at an early stage, treatment can result in half of patients living cancer free for more than 5 years.
  • The more advanced or higher the cancer stage, the greater the likelihood of the cancer recurring elsewhere after surgery, and the greater the likelihood that treatments involving chemotherapy and radiation will be recommended.
  • Stage 4, or metastatic stomach cancer patients are usually only offered surgery to relieve symptoms of obstruction- or blockage. Chemotherapy and radiation may prolong survival but are not curative in stage IV disease.
  • Targeted therapies include the use of monoclonal antibody therapy may be given alone or in combination with chemotherapy in cases of advanced stomach cancer.
  • After your stomach cancer has been removed, and if necessary other treatments given and completed, and you are felt to be free of disease, your doctor will monitor your disease with repeat scans, laboratory testing, and gastrointestinal endoscopy to make sure the cancer does not return.

Stomach Cancer Prevention

  • It is felt today the number of stomach cancers has decreased because of the following:
    • Improved socioeconomic standards
    • Widespread use of refrigeration for food preservation
    • Adoption of diets rich in fruits and vegetables
  • In areas where frequency of stomach cancer remains high, such as Japan, screening programs that include upper GI barium studies and, more recently, gastrointestinal endoscopy have improved survival rates. Evidence does not support mass screening of populations with lower rates of stomach cancer.
  • Eliminating Helicobacter pylori infection in people with peptic ulcer disease also may decrease rates of stomach cancer.
  • It has been suggested that people who had portions of their stomachs removed 20 years ago or longer should receive yearly endoscopies. This is because of the increased risk of stomach cancer following such surgery.

Stomach Cancer Pictures

The stomach lies between the esophagus and small intestine in the upper abdomen.
The stomach lies between the esophagus and small intestine in the upper abdomen. Click to view larger image.

This photograph of an adenocarcinoma of the lower part of the stomach was taken through a gastroscope and demonstrates the typical appearance of a gastric tumor with a central area of ulceration.
This photograph of an adenocarcinoma of the lower part of the stomach was taken through a gastroscope and demonstrates the typical appearance of a gastric tumor with a central area of ulceration. Click to view larger image.

Reviewed on 11/20/2017
Sources: References

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