Stomach cancer is a type of cancer that emanates from the mucus-producing cells that line the stomach. It is also known as adenocarcinoma. The rate of cancer in the main part of the stomach has been falling worldwide for the past 10 years.
Also, during this same period cancer on the top part of the stomach called cardia gets in contact with the lower end of the swallowing tube called esophagus has become much more rampant. This particular area of the stomach is known as the gastroesophageal junction.
Furthermore, stomach cancer is rampant among men than women. The stomach cancer rate is high among people over age 50. Most people diagnosed with this type of cancer are between late 60s-80s. In the U.S., stomach cancer is predominant among Hispanic Americans, Native Americans, African Americans, and Asian/Pacific Islanders than the non-Hispanic whites.
Also, in the world, this disease is less common in Western and Northern Africa, North and South Central Asia but more common in Japan, Southern, and Eastern Europe, China, and South and Central America.
Infection associated with Helicobacter pylori
A Helicobacter pylori bacterium is known to be the main cause of stomach cancer, especially cancers around the distal (lower) part of the stomach. Being infected with this germ for long inside your stomach may bring about inflammation known as chronic atrophic gastritis and pre-cancerous altering of the inner lining of the stomach.
Consequently, it is known that people with stomach cancer stand a higher chance of being infected with Helicobacter pylori than people without this cancer. Also, some people may still have this germ in their stomach but never develop cancer.
People with a certain type of lymphoma of the stomach called MALT lymphoma (mucosa-associated lymphoid tissue) stand a higher chance of having adenocarcinoma of the stomach. This occurs because mucosa-associated lymphoid tissue lymphoma of the stomach is caused by being infected with Helicobacter pylori bacteria.
What are the symptoms of stomach cancer?
The following are the signs and symptoms of stomach cancer and gastroesophageal junction cancer:
- Feeling bloated after eating
- Chronic heartburn
- Having anemia
- Consistent nauseating feeling
- Incessant vomiting with little or no blood
- Feeling of fatigue
- Swelling around the abdomen
- Loss of appetite
- Feeling full after consuming small amounts of food
- Having severe indigestion
- Presence of blood in the stool
- Stomach ache
- Unknown weight loss
When can I see a doctor?
If you experience the above signs and symptoms, quickly visit your doctor. Your doctor will then check for the more likely causes of these signs and symptoms first before requesting you to undergo some test.
What are the causes of stomach cancer?
There are many known risk factors for stomach cancer, but how these factors cause cells within the stomach lining to become cancerous is not well known. This is an important subject in ongoing researches today.
Also, there are some changes perceived to be pre-cancerous can occur in the lining of the stomach.
In the aspect of chronic atrophic gastritis, the normal glands of the stomach can either be decreased or absent. Some degree of inflammation can also occur like the stomach cells being destroyed by cells of the immune system. Atrophic gastritis is usually caused by Helicobacter pylori infection. The autoimmune reaction can also bring about stomach cancer. Some individuals with this medical condition go on to have pernicious anemia or other related stomach problems, including cancer. But how this condition might lead to cancer is not actually known.
Furthermore, intestinal metaplasia can also bring about pre-cancerous change. Here, the normal stomach lining is replaced with cells that closely resemble the cells that mostly line the intestine. Usually, people with this condition do have chronic atrophic gastritis as well. The process of how and why this change occurs and leads to stomach cancer is not well known. It might also be similar to Helicobacter pylori infection.
When an error (mutation) occurs in a cell’s DNA it brings about the development of cancer. The mutation makes the cell to grow and replicate at a rapid rate which the normal cell would have died but continue living. Its cancerous cells accumulated gives rise to a tumor that can penetrate nearby structures and can also break away from the tumor to spread to other parts of the body.
The good news today is that scientists have made a lot of progress in understanding how particular changes in DNA can cause normal stomach cells to develop abnormally and become cancers. DNA which is the chemical in cells that contains our genes also controls how our cells function.
There are certain genes that control when cells grow and replicate into new cells:
Oncogenes: These are genes that help cells to grow and divide.
Tumor suppressor genes: Genes that help maintain cell division under control or cause cells to die at the appointed time.
Consequently, DNA changes that turn on oncogenes or turn off tumor suppressor genes can bring about cancers.
Gastroesophageal junction cancer is simply having GERD (gastrointestinal reflux disease), less strongly with obesity and smoking. Gastrointestinal reflux disease is a medical condition that arises from the consistent backflow of acid in the stomach into the esophagus.
A diet rich in smoked/salted foods and stomach cancer found in the main part of the stomach both have a strong correlation. The rates of stomach cancer have been limited recently due to the rapid use of refrigeration for the preservation of foods.
Risk factors of stomach cancer
The major risk factors for gastroesophageal junction cancer are having a previous history of GERD and being overweight.
The following are the factors that may increase your chance of having stomach cancer:
- A diet not rich in fruits and vegetables
- Having type A blood
- Being infected with Helicobacter pylori
- Having pernicious anemia
- Stomach polyps
- A diet rich in salty and smoked foods
- Having a family history of stomach cancer
- A person’s age
- Incessant inflammation of the stomach for long
- Having Menetrier disease (hypertrophic gastropathy)
- Having EBV (Epstein-Barr virus) infection
- People with common variable immune deficiency (CVID)
- Some occupations like people working in the metal, coal, and rubber industries
- Inherited cancer syndromes like hereditary diffuse gastric cancer, FAP (Familial adenomatous polyposis), Lynch syndrome/hereditary non-polyposis colorectal cancer (HNPCC), Li-Fraumeni syndrome, BRCA1 and BRCA2, and PJS (Peutz-Jeghers syndrome).
How to diagnose stomach cancer
Use of endoscopy
The following are the tests and procedures that are employed in diagnosing stomach cancer and gastroesophageal junction cancer:
Use of upper endoscopy (a tiny camera to view inside your stomach): Usually a thin tube with a tiny camera is inserted into your throat to reach your stomach. Its signs can be checked by your doctor and if any suspicious areas are noticed, a piece of tissue will then be collected for biopsy.
Imaging tests: Computerized tomography (CT) scans and a particular type of X-ray exam sometimes known as barium swallow are the major imaging tests used to identify stomach cancer in the body.
Determining the stages of the stomach and gastroesophageal cancer
Basically, the stage of your stomach cancer aids your doctor to determine the optimal treatments for you. The following are the tests and procedures used to identify the stage of cancer:
Use of imaging tests: These include Computerized tomography (CT scan) and Positron emission tomography (PET).
Surgery: Your medical doctor may recommend surgery to ascertain the signs that your cancer has spread beyond your esophagus or stomach, within your chest/abdomen. Exploratory surgery may be done laparoscopically. Here the surgeon makes several small incisions in your abdomen and introduces a special camera into it to help transmit visuals to the monitor in the theatre room.
Other several staging tests may also be used depending on your condition.
How can I determine the stomach cancer stage?
The main staging system used for stomach cancer is the AJCC (American Joint Committee on Cancer) TNM system, which depends on 3 main pieces of information:
The size or extent of the tumor (T): This is simply how far cancer has developed into the 5 layers of the stomach wall. It helps ascertain if cancer has reached nearby organs or structures.
Mucosa which is the innermost layer has 3 parts namely: Here, the epithelial cells lie on top of a layer of connective tissue called the lamina propria, which is on top of a thin layer of muscle called the muscularis mucosa. Beneath the mucosa is a supporting layer known as the submucosa. Under the submucosa is the muscularis propria, a thick layer of muscle that moves and mixes contents in the stomach. The next two (2) layers, the subserosa, and the outermost serosa serve as wrapping layers for the stomach.
Being able to spread to the nearby lymph nodes (N): It helps determine if cancer has spread to the nearby lymph nodes?
Metastasis to extreme areas (M): Has cancer spread to distant organs like the lungs/liver or distant lymph nodes?
What are the stages of stomach cancer?
The following are the stages of adenocarcinoma of the stomach/esophagus:
Stage I: In this stage, the tumor is restricted to the top layer of tissue that lines the inside of the stomach or esophagus. Sometimes cancerous cells may have spread to some limited number of nearby lymph nodes in the body.
Stage II: At this stage, cancer has spread deeper, developing into a deeper muscle layer of the esophagus or wall of the stomach. Cancer may also have spread to more of the lymph nodes in the body.
Stage III: This stage shows that cancer may have developed through all the layers of the esophagus or stomach and spread to nearby structures in the body. Sometimes it may be small cancer that has spread more widely to the lymph nodes.
Stage IV: In this stage, cancer has spread to distant places of the human body.
There is no way you can prevent this medical condition since it is not clear what causes stomach or gastroesophageal junction cancer. However, they are little steps you can take that can help lower your chance of having stomach and gastroesophageal junction cancer. They include:
Exercising regularly: Try to indulge in physical exercise at least thrice a week as it helps lower your chance of having stomach cancer.
Reduce your intake of salty/smoked foods: When you lower the consumption of salty and smoked foods, your chance of having stomach and gastroesophageal junction cancer is negligible.
Inquire from your doctor about your risk of stomach/gastroesophageal junction cancer: Discussing with your medical doctor if you have an increased risk of stomach or gastroesophageal junction cancer. This will aid your doctor to consider periodic endoscopy to check for signs/symptoms of stomach cancer in your body.
Try consuming enough fruits/vegetables: Consumption of more fruits and vegetables into your diet daily helps lower your risk of having this disease.
Avoid smoking: If you were smoking before, immediately put a stop to it as smoking increases your chance of having stomach cancer and many other types of cancer. Here is a little guide that can help you stop smoking.
Use of aspirin: Taking aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) like naproxen or ibuprofen, helps lower the risk of stomach cancer. These medications can also help lower the risk of having colon cancer and colon polyps. But they can also bring about severe and even life-threatening internal bleeding and other possible health risks in some individuals.
Can stomach cancer be detected early?
Yes, it can especially in countries like Japan where stomach cancer is very rampant, mass screening of the population has greatly helped discover many cases at early, a curable stage with ease. This may have reduced the number of people who die of this medical condition, but it has not been proven. Screening helps in testing for a disease like cancer, in people without noticeable symptoms.
Although studies in the U.S., have not deduced that regular screening in people at average risk for stomach cancer is important, because this medical condition is not that common. Notwithstanding, people with particular stomach cancer risk factors may benefit from screening. You are advised to ask your doctor any questions about your stomach cancer risk or about the benefits of screening to be well enlightened.
What are the treatments for stomach cancer?
Your optimal treatment for gastroesophageal junction/stomach cancer depends on the stage of your cancer, your preferences, and your overall health.
Gastroesophageal junction cancer that has not spread may require surgery to remove some part of the esophagus or stomach where the tumor is being found. Surgery helps remove all cancer and a margin of healthy tissue when possible. Also, nearby lymph nodes may be removed from the body. Its options include:
Removing early-stage tumors from the lining of the stomach: An endoscope may be needed to help remove a small tumor found inside the lining of the stomach using a procedure known as endoscopic mucosal resection. The endoscope which is a thin tube with a camera is passed down your throat into your stomach and its visuals are sent to the monitor for proper treatment. Most doctors use special instruments to remove cancer and a margin of healthy tissue from the lining of the stomach.
Removal of a portion of the stomach called subtotal gastrectomy: Here, your medical doctor removes only the part of the stomach that is being affected with cancer.
Complete removal of the entire stomach (total gastrectomy): In this method, your surgeon will remove the entire stomach and some surrounding tissue. To enable food to reach your digestive system, your esophagus will then be connected directly to your small intestine.
Removal of some lymph nodes: Your medical doctor will examine and remove lymph nodes around your abdomen in search of cancerous cells.
Inculcating surgery to relieve signs/symptoms: When a part of the stomach is being removed, it helps relieve signs and symptoms of a developing tumor in people with advanced stomach cancer. Never expect to have complete cure from advanced stomach cancer through surgery but it can make you feel comfortable. Have in mind that surgery is being accompanied by a risk of bleeding and infection. You may experience digestive issues if part or all of your stomach is being removed.
Use of radiation therapy
Radiation therapy involves the use of high-powered rays of energy, like X-rays and protons, to destroy cancer cells. You’ll be asked to lie on a table and the energy beams from the machine will then move around you.
Furthermore, radiation therapy can be used before surgery (neoadjuvant radiation) to make the tumor appear small so that it can be removed very easily in gastroesophageal junction cancer and stomach cancer. Radiation therapy can also be used after surgery called adjuvant radiation to destroy cancerous cells that might be left in the area around your esophagus/stomach.
In gastroesophageal junction cancer, chemoradiotherapy enables chemotherapy and radiation to be administered at the same time, most at times before surgery.
Radiation therapy has some side effects like around your stomach you may experience indigestion, diarrhea, vomiting, and nausea. Side effects associated with radiation therapy to your esophagus may bring about difficulty in swallowing and induce pain on swallowing.
To avoid experiencing this side effect, you may be advised to have a feeding tube placed in your stomach through a small opening in your abdomen until your esophagus heals. If it’s advanced cancer, radiation therapy may be employed to alleviate the side effects caused by a large tumor.
It involves the usage of chemicals to destroy cancerous cells. These chemotherapy drugs move around your body, destroying cancer cells that may have spread beyond the stomach.
Neoadjuvant chemotherapy is a type of chemotherapy administered before surgery to help reduce the size of a tumor so that it can be easily removed from the body. Adjuvant chemotherapy is a type of chemotherapy administered after surgery to kill any cancerous cells that may be left in the body. Chemotherapy may be combined with radiation therapy and can also be used alone in people with advanced stomach cancer to help alleviate signs and symptoms.
Its side effects depend on the type of chemotherapy drugs being administered.
Use of targeted drugs
These drugs are used to attack particular abnormalities within cancer cells or direct your immune system to destroy cancer cells called immunotherapy. The following are some targeted drugs used to treat stomach cancer effectively:
Cyramza (Ramucirumab): Used in advanced stomach cancer that has not responded to other treatments.
Sutent (Sunitinib): Suitable for gastrointestinal stromal tumors.
Herceptin (Trastuzumab): Used for stomach cancer cells that produce excessive HER2.
Gleevec (Imatinib): It is suitable for a rare form of stomach cancer known as a gastrointestinal stromal tumor.
Stivarga (Regorafenib): Used for gastrointestinal stromal tumors.
Although several targeted drugs are being researched for the treatment of gastroesophageal junction cancer, only trastuzumab and ramucirumab have been approved for this function.
Targeted drugs can also be used together with standard chemotherapy drugs for effective treatment. But your doctor will have to perform some tests of your cancer cells to know if these treatments are likely to work for you.
Palliative care is specialized medical care that deals with providing relief from pain and other symptoms that arise from a severe illness. Most palliative care specialists work closely with you, your other doctors and your family to provide extra support that complements your ongoing care in the hospital. Also, while undergoing aggressive treatments like chemotherapy, surgery or radiation therapy, palliative care services can be employed.
Furthermore, palliative care is performed by a team of doctors, nurses, and other specially trained professionals for optimal care. Palliative care teams help improve the life of the patient with cancer and their family. This type of care is often accompanied with curative or other treatments you may be receiving.
Are there any potential future treatments for stomach cancer?
Yes, they are as scientists around the world are studying a number of new medications that harness the power of the immune system to completely inhibit cancer; an approach known as immunotherapy. Its medications work in distinctive ways to enable the immune system to respond to cancer cells as if they were foreign bodies like bacteria.
Clinical trials for this disease
Clinical trials are ongoing to test new treatments and tests as a means to prevent, detect, and treat this disease. You can explore Mayo Clinic Studies as they are reliable and knowledgeable.
Coping with stomach cancer
After being diagnosed with cancer, it could be frightening but once you start to recover from your diagnosis, you may have to stay focused on things that help you cope effectively well. You can try doing the following:
Try to connect with other cancer survivors: You can inquire about any support group around your area from your doctor. Why not check the American Cancer Society that can help you connect with cancer survivors on message boards online?
Learn in details about your cancer: Asking your doctor to write down the details of your cancer like its type, stage, your treatment options enable you to find more information about stomach cancer and the benefits/risks of each treatment option selected.
Enjoy your normal life: This doesn’t mean you have to stop doing the things you normally do or enjoy just because you were diagnosed with cancer. It excludes an unhealthy lifestyle like smoking/drinking of alcohol but if you feel well enough to indulge in your favorite hobbies and hiking, go ahead and have fun.
How to prepare for your appointment
You can begin by visiting your family doctor if you suspect the above signs and symptoms of this disease. If your family doctor suspects you may have a stomach problem, you may be referred to a gastroenterologist a doctor who specializes in gastrointestinal diseases. After you must have been diagnosed with gastroesophageal junction cancer or stomach cancer, you may be asked to see an oncologist a cancer specialist or a surgeon who’s an expert in operating on the digestive tract.
It is always advisable to be well prepared since appointments can be brief due to many things on the ground to cover. We have detailed information to aid you to get ready, and what to expect from your medical doctor.
What you can do on your own
Try to know any pre-appointment restrictions: Always ask if there’s anything you need to do in advance like restrict your diet, at the time you make the appointment.
Write down important personal information, involving any major stresses or recent life changes experienced.
Try writing down any symptoms you are experiencing, not excluding any that may seem unrelated to the reason for your scheduled appointment.
Make a detailed list of all medications, supplements or vitamins that you are taking.
Consider going with a family member or friend: Sometimes it can be difficult to absorb all the information given to you during an appointment because you might be passing through the trauma of this disease. Your family member or friend who accompanies you may remember something that you forgot or missed.
Write down what seems to worsen or improve your signs and symptoms: Note which foods, medications or other factors that may influence your signs and symptoms.
Make a detailed list of questions to ask your doctor as your time with your doctor is always limited. The following are some basic questions to ask your doctor on stomach cancer:
- What kind of stomach cancer do I have?
- How severe is my stomach cancer?
- What other types of tests do I need?
- Are they any treatment options for me?
- How effective are the treatments?
- Are there risks and benefits of each treatment option?
- Is there any option you feel is best for me?
- Will the treatment affect my normal life?
- Can I move on with my work?
- Should I request a second opinion? How much will it cost, and will my insurance cover it?
- Are there any printed material or brochures I can take with me?
- What websites have rich information about my condition?
You are advised to also ask questions as they occur to you during your appointment not just the questions you have written down from home.