Stomach Cancer

Understanding Stomach Cancer

Stomach cancer, also known as gastric cancer, is a type of cancer that starts in the stomach, a muscular organ in your upper abdomen that helps digest food. It's more common in older adults, with an average age of diagnosis being 68. About 60% of cases happen in people over 65, and men slightly more often get it than women. However, anyone can develop stomach cancer.

The cancer usually develops slowly over many years. Small changes in the stomach cells' DNA cause them to multiply uncontrollably, forming abnormal growths called tumors.

Several factors can increase the risk of stomach cancer, including:

• Smoking: Smoking significantly increases your risk.
• Family history: If someone in your family has had stomach cancer, you may be at higher risk.
• H. pylori infection: This bacterial infection can damage the stomach lining.
• Long-term stomach inflammation: Chronic inflammation can increase the risk.
• Gastroesophageal reflux disease (GERD): This condition, where stomach acid flows back into the esophagus, can also be a risk factor.
• Stomach polyps: These are non-cancerous growths in the stomach, but some can become cancerous.
• Diet: A diet high in salty or smoked foods and low in fruits and vegetables is linked to a higher risk. Being overweight or obese is also a risk factor.

Recognizing the Signs

Stomach cancer can manifest in various ways, including:

• Difficulty swallowing
• Feeling bloated after eating
• Feeling full after eating small amounts
• Heartburn
• Indigestion
• Nausea
• Stomach pain
• Unintentional weight loss
• Vomiting

If you experience any of these symptoms, it's crucial to see a doctor. Your doctor might first investigate other common causes and then refer you to a specialist, such as a gastroenterologist or an oncologist, if needed.

Diagnosis

To diagnose stomach cancer, your doctor might use several methods, including:

• Upper endoscopy: A thin, flexible tube with a camera is used to look inside your esophagus, stomach, and the first part of your small intestine. If something unusual is found, a small tissue sample (biopsy) is taken for laboratory analysis.
• Imaging tests: These might include CT scans, X-rays (like a barium swallow), or other imaging techniques to see the extent of the cancer.
• Further tests: Based on the initial findings, your doctor may order additional tests, such as blood tests, endoscopic ultrasounds, CT scans, or PET scans, to determine the stage of the cancer.
• Laparoscopy: In some cases, a small camera is inserted into the abdomen to get a better view.

Treatment

Treating stomach cancer involves a team of doctors working together to create a personalized treatment plan that considers your overall health and well-being. Treatment options include:

• Surgery: Removing the cancerous tissue, and sometimes some surrounding healthy tissue.
• Chemotherapy: Using drugs to kill cancer cells throughout the body.
• Radiation therapy: Using high-energy beams to target and destroy cancer cells.
• Targeted therapy: Using drugs that target specific weaknesses in cancer cells.
• Immunotherapy: Using drugs to help your immune system fight the cancer cells.

Where the cancer starts in the stomach is a key factor in treatment planning, along with the cancer's stage and type. The location of the cancer, whether it's in the main part of the stomach (stomach body), or near the esophagus (gastroesophageal junction), affects the best treatment approach. Treatment plans often include a combination of these approaches.

Prognosis

The success of stomach cancer treatment depends greatly on how early it's found. Early-stage cancers have a much better chance of being cured. Unfortunately, many stomach cancers are detected when they are more advanced, making a cure less likely. Cancer that has spread beyond the stomach wall or to other parts of the body is more difficult to treat successfully.

Stomach cancer can cause various signs and symptoms. Early on, these might be subtle, such as occasional indigestion or upper belly pain. As the cancer progresses, more noticeable symptoms can appear.

Some common signs and symptoms include:

• Difficulty swallowing: This can be a problem with getting food down.
• Belly pain: This could range from a dull ache to sharp pain.
• Feeling bloated or full: Even after eating small portions, you might feel uncomfortably full.
• Loss of appetite: You might not feel hungry when you normally would.
• Heartburn: A burning sensation in the chest.
• Indigestion: Discomfort or pain after eating.
• Nausea and vomiting: Feeling sick to your stomach and throwing up.
• Unexplained weight loss: Losing weight without trying to diet or exercise.
• Fatigue: Feeling very tired and drained.
• Black stools: Stool that appears dark or tarry.

It's important to understand that not everyone with stomach cancer experiences all these symptoms. Sometimes, the symptoms are so mild or similar to other conditions that they're easily missed.

In more advanced stages, symptoms can become more severe. For example, you might experience:

• Severe fatigue: Feeling extremely tired.
• Significant weight loss: Losing a noticeable amount of weight.
• Vomiting blood: This is a serious symptom needing immediate medical attention.
• Dark, tarry stools: Blood in the stool.

Stomach cancer can spread to other parts of the body (metastasize). When this happens, the symptoms depend on where the cancer spreads. For instance:

• Spread to lymph nodes: You might feel lumps under your skin.
• Spread to the liver: Your skin and the whites of your eyes might turn yellow (jaundice).
• Spread within the abdomen: Your belly might swell with fluid.

If you have any of these symptoms and they worry you, it's crucial to see a doctor. Many other conditions can cause similar symptoms. Your doctor will likely investigate these other possibilities first before considering stomach cancer as a diagnosis. Early detection is key to successful treatment, so don't hesitate to seek medical attention.

If you're experiencing any health concerns that worry you, schedule a visit with your doctor. Many different illnesses can cause symptoms that mimic those of stomach cancer. Your doctor might first investigate other potential causes before testing for stomach cancer.

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Understanding Stomach Cancer

Stomach cancer is a disease where cells in the stomach grow out of control. Doctors don't fully understand what causes it, but they think it often begins when something damages the stomach's inner lining. These damaging factors might include:

• Stomach infections: Certain infections can irritate the stomach lining.
• Long-term acid reflux: Frequent acid reflux can damage the stomach lining over time.
• High salt intake: A diet high in salty foods might contribute to stomach problems.

It's important to understand that not everyone with these factors will get stomach cancer. More research is needed to pinpoint the exact causes.

How Stomach Cancer Develops

Stomach cancer starts when cells lining the stomach develop changes in their DNA. DNA is like a set of instructions for the cell, telling it what to do. These changes cause the cells to multiply rapidly and live longer than healthy cells usually do. This leads to an excess of cells, forming a mass called a tumor.

The Problem with Cancer Cells

Cancer cells in the stomach can invade and damage surrounding healthy tissue. They can grow deeper into the stomach wall and, sometimes, break away and spread to other parts of the body. This spread, called metastasis, is a serious complication.

Different Types of Stomach Cancer

Stomach cancer can be different types, depending on the type of cell where it begins:

• Adenocarcinoma: This is the most common type of stomach cancer. It starts in the cells that produce mucus in the stomach lining.
• Gastrointestinal Stromal Tumors (GIST): These cancers begin in special nerve cells within the stomach and other digestive organs. They're a kind of soft tissue cancer.
• Carcinoid Tumors: These cancers start in neuroendocrine cells, which are found throughout the body and have roles in both nerve function and hormone production. They are a type of neuroendocrine tumor.
• Lymphoma: This type of cancer begins in the immune system cells that fight infections. Sometimes, the immune system sends these cells to the stomach to fight an infection, which can lead to lymphoma in the stomach. Most stomach lymphomas are a type of non-Hodgkin lymphoma.

Understanding these different types is crucial for effective diagnosis and treatment. It's important to remember that while these factors can increase the risk, they don't guarantee that someone will develop stomach cancer. Early detection and treatment are key to improving outcomes.

Several things can raise your chances of getting stomach cancer. Understanding these risk factors can help you take steps to protect your health.

Common Risk Factors:

• Acid Reflux (GERD): If stomach acid regularly flows back into your food pipe (esophagus), it can irritate the lining and increase your risk of stomach problems, including cancer. This condition is called gastroesophageal reflux disease (GERD). Chronic GERD, meaning it happens frequently, is a particular concern.

• Unhealthy Diet: A diet heavy in salty and smoked foods might be a factor. These types of food are often high in preservatives and other substances which can harm the stomach lining over time. Conversely, a diet lacking fruits and vegetables, which are rich in protective vitamins and fiber, may also increase risk.

• Bacterial Infection: A germ called Helicobacter pylori can infect the stomach. If you have this infection, it can lead to inflammation and damage to the stomach lining, and therefore increase your risk of developing stomach cancer.

• Stomach Inflammation (Gastritis): Inflammation of the stomach lining, known as gastritis, can be caused by various factors. Persistent or severe gastritis can damage the stomach lining, making it more vulnerable to cancer.

• Smoking: Smoking is linked to a higher risk of many cancers, including stomach cancer. The chemicals in cigarettes can harm the cells in your body, including those in your stomach.

• Stomach Polyps: Small growths of non-cancerous cells called polyps can sometimes form in the stomach. While most polyps are harmless, some can potentially turn cancerous over time. Regular checkups can help detect and remove these polyps if necessary.

• Family History: If you have a family history of stomach cancer or certain genetic syndromes linked to cancer risk, your chances of developing stomach cancer are higher. These syndromes include hereditary diffuse gastric cancer, Lynch syndrome, juvenile polyposis syndrome, Peutz-Jeghers syndrome, and familial adenomatous polyposis. These conditions can increase your risk for a range of cancers.

It's important to remember that having one or even several of these risk factors doesn't automatically mean you'll get stomach cancer. However, knowing about these factors can help you talk to your doctor about ways to lower your risk and get appropriate screenings. Your doctor can advise on personalized strategies based on your specific circumstances.

Protecting yourself from stomach cancer is possible through lifestyle choices. Here are some simple steps you can take:

1. Boost your fruit and vegetable intake. Eating a variety of colorful fruits and vegetables every day is important. Fruits and vegetables are packed with vitamins, minerals, and fiber that can help your body stay healthy and strong. Aim for a rainbow of colors on your plate – red tomatoes, orange carrots, green leafy greens, and more.

2. Cut back on salty and smoked foods. These foods can potentially irritate your stomach lining. Try to limit how often you eat them. Instead, choose healthier options like fresh meats and vegetables.

3. Quit smoking (if you smoke). Smoking is a major risk factor for stomach cancer, as well as many other serious health problems. If you smoke, quitting is a huge step towards better health. It's not easy, so don't hesitate to ask your doctor or a trusted health professional for support and resources. If you don't smoke, don't start. Protecting your lungs and overall health is important.

4. Talk to your doctor about family history. If stomach cancer is common in your family, you may be a candidate for screening. Screening tests can find stomach cancer early, when it's easier to treat. Early detection can greatly improve outcomes. Your doctor can explain the best screening options for you.

Frequently Asked Questions About Stomach Cancer

Dr. Mohamad (Bassam) Sonbol, an oncologist, answers common questions about stomach cancer.

Is stomach cancer hereditary?

Yes, sometimes. A person can inherit genetic mutations that increase their risk of stomach cancer. Several factors suggest a hereditary link, including: being diagnosed at a young age, having a history of other cancers, or having a family history of multiple cancers.

Can stomach cancer be cured?

A cure for stomach cancer is possible, but it depends on how far the cancer has spread. "Cure" means completely getting rid of the cancer and preventing it from returning. For stomach cancer that hasn't spread to other parts of the body, surgery or an endoscopic procedure can often achieve a cure. Sometimes, chemotherapy is used with surgery to increase the chances of a cure.

If the cancer has spread (metastasized), a cure is less likely. The goal then becomes extending life and improving quality of life. Treatments like chemotherapy and targeted therapies can help control the cancer, alleviate symptoms, and improve the patient's overall well-being. Medical science is constantly advancing, leading to better treatments and outcomes.

How is stomach cancer diagnosed?

Several tests help diagnose and detect stomach cancer. These include:

• Upper endoscopy: A thin, flexible tube with a camera is passed down the throat to look inside the stomach for signs of cancer.

• Biopsy: If something suspicious is found, a small tissue sample (biopsy) can be taken and sent to a lab for testing. This can be done during an upper endoscopy.

• Other tests to determine the stage of cancer: Once stomach cancer is suspected, additional tests help determine how far it has spread. This is called "staging." Staging helps doctors understand the severity of the cancer and predict its likely course. Staging tests include:

  • Blood tests: Blood tests can't diagnose stomach cancer directly, but they can provide information about overall health, such as liver function. A blood test called a circulating tumor DNA test may be used in some cases to detect cancer cells in the blood, particularly if a biopsy isn't possible.
  • Stomach ultrasound: Sound waves create images of the stomach lining to show how far the cancer has grown into the stomach wall. Ultrasound can also be used to examine lymph nodes near the stomach.
  • Imaging tests (CT, PET scans): These tests create detailed images of the body, helping to identify if the cancer has spread to nearby lymph nodes or other organs.
  • Surgery: In some cases, surgery is needed to directly examine the area and look for signs of spread.

Understanding the Stages of Stomach Cancer:

Doctors use the results of these tests to determine the stage of stomach cancer, which ranges from 0 to 4. The stage helps determine the prognosis (likelihood of a cure).

• Stage 0: Cancer is small, only on the stomach's inner surface.
• Stage 1: Cancer has grown into the inner layers of the stomach.
• Stage 2 and 3: Cancer has grown deeper into the stomach wall and may have spread to nearby lymph nodes.
• Stage 4: Cancer has spread beyond the stomach to other organs (metastatic).

What Factors Affect Prognosis?

Several factors can affect the prognosis of stomach cancer, including:

• Cancer type: Different types of stomach cancer have different prognoses.
• Stage: The higher the stage, the lower the chance of a cure.
• Location of the cancer within the stomach:
• Overall health:
• Complete removal with surgery:
• Response to treatment:

Important Considerations:

• Communication: Open communication with your doctor and medical team is vital. Share your concerns and symptoms.
• Second opinion: Getting a second opinion from a specialist in stomach cancer treatment is often recommended, especially since stomach cancer is relatively rare in the United States.
• Screening: Stomach cancer screening is available for high-risk individuals, such as those with a family history of the disease or a genetic syndrome.

This information is for educational purposes only and should not be considered medical advice. Always consult with a healthcare professional for any health concerns.

Choosing the Right Treatment for Stomach Cancer

Stomach cancer, also known as gastric cancer, treatment depends on where the cancer is in the stomach and how advanced it is. Your doctor will also consider your overall health and what you want when creating your treatment plan. Several options are available, including surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and palliative care.

Surgery for Stomach Cancer

The main goal of surgery is to remove all the cancer. For small, early-stage cancers, surgery might be the first treatment. If the cancer has grown deeper into the stomach wall or spread to nearby lymph nodes, other treatments might be used first to shrink the tumor, making surgery easier.

Different types of stomach cancer surgery include:

• Endoscopic Mucosal Resection (EMR): For very small cancers that are only on the inner lining of the stomach, a thin tube with tiny cutting tools is passed down the throat into the stomach. This lets the surgeon remove the cancer. EMR is a good option for stage 1 cancers located on the inner lining. If the cancer has grown into the muscle layer of the stomach, this might not be a suitable option.

• Subtotal Gastrectomy: The surgeon removes the part of the stomach containing the cancer, along with some of the healthy tissue around it. This is often used for cancers located near the small intestine.

• Total Gastrectomy: The entire stomach and some surrounding tissue are removed. The esophagus is then connected directly to the small intestine, so food can still pass through the digestive system. This is usually for cancers closer to the esophagus.

• Lymph Node Removal: The surgeon may remove lymph nodes near the stomach to check for cancer spread.

• Symptom-Reducing Surgery: In advanced cases, surgery might be used to relieve pain or other symptoms caused by the cancer, even if it can't be completely removed. This might be done if other treatments haven't helped.

Other Treatments

• Chemotherapy: This uses powerful drugs to kill cancer cells.

  • Systemic Chemotherapy: Drugs are given throughout the body, either through a vein or as pills. This is the most common type.
  • Hyperthermic Intraperitoneal Chemotherapy (HIPEC): This is a specialized type of chemotherapy used after surgery. The chemotherapy drugs are heated and put directly into the abdomen to kill any remaining cancer cells.

• Radiation Therapy: High-energy beams (like X-rays) are used to target and kill cancer cells. This is often used along with chemotherapy (called chemoradiation).

• Targeted Therapy: These drugs target specific molecules within cancer cells. Tests are done to see if targeted therapy is likely to work for a particular person. It's often used with systemic chemotherapy, especially in advanced cases.

• Immunotherapy: This treatment helps the body's immune system recognize and attack cancer cells. It's sometimes used for advanced cancer or cancer that has come back after treatment.

• Palliative Care: This type of care focuses on improving quality of life for people with serious illnesses like cancer. It helps manage pain, other symptoms, and provides emotional support for patients and their families. Palliative care can be used alongside other treatments.

Treatment Decisions

The best treatment plan depends on the stage of the cancer, the location, and the individual patient's overall health. Doctors often use chemotherapy before surgery (neoadjuvant chemotherapy) to shrink the tumor, making it easier to remove. Sometimes chemotherapy is given after surgery (adjuvant chemotherapy) to kill any remaining cancer cells. Radiation therapy might also be used before or after surgery to improve outcomes. If surgery isn't possible, chemotherapy might be the primary treatment, especially in advanced stages. HIPEC might be an option for stage 4 cancer that can't be fully removed.

Important Considerations

A cancer diagnosis can be overwhelming. It's important to:

• Learn about your treatment options: Talk to your doctor to get clear information about your specific situation, including the type and stage of cancer and the various treatment options. Find reliable resources online and from organizations like the American Cancer Society.

• Connect with others: Support groups, online forums, or conversations with other cancer survivors can be incredibly helpful.

• Stay active: Maintain your usual activities as much as possible, within your physical limits.

Remember, you are not alone. There are resources and support systems available to help you through this challenging time.

Getting a cancer diagnosis can be a really tough and scary experience. It's normal to feel overwhelmed at first. It takes time to adjust to the news. In the meantime, here are some helpful things to do:

Understanding Your Situation: It's important to learn as much as you can about your cancer to make informed decisions about your care. Ask your doctor to write down important details, including the type of cancer, how far it's progressed (the stage), and the different treatment options. This written information will be a great starting point. Use this information to find out more about stomach cancer. Look into the potential good results (benefits) and possible negative effects (risks) of each treatment option.

Connecting with Others: Talking to other people who have been through a similar experience can be incredibly helpful. Ask your doctor about support groups in your area. Online forums, like those offered by the American Cancer Society, can also connect you with others who understand what you're going through. Sharing experiences and getting advice from those who have been there can be a huge source of comfort and strength.

Maintaining Your Well-being: Just because you have cancer doesn't mean you have to stop enjoying life. If you feel up to it, continue doing the activities you enjoy. Staying active, both physically and mentally, can be very beneficial during this time. Physical activity, even light exercise, can help you feel better. Try to maintain a healthy lifestyle by focusing on your overall well-being.