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Stomach (Gastric) Cancer

cancer stomach


Stomach cancer is sometimes called gastric cancer. Worldwide it is one of the most common cancers. It is common in Japan and China .Stomach cancer is more common in men than in women.

What is the stomach?

The stomach lies in the upper part of the abdomen, just below the ribs. When we eat, food passes down the food pipe into the stomach. The stomach makes acid and some enzymes (chemicals) which help to digest food.From stomach food passes into the duodenum (the first part of the small intestine).

Type of stomach cancer

Adenocarcinoma of the stomach

In most cases, stomach cancer begins from a cell which is on the inside lining of the stomach. This type is called adenocarcinoma of the stomach. As the cancer cells multiply:
The tumour may invade deeper into the wall of the stomach and later may pass through the wall of the stomach and invade nearby organs such as the pancreas or liver.
The tumour may spread up or down the stomach into the oesophagus (gullet) or small intestine.
Some cells may break off into the lymph channels or bloodstream. The cancer may then spread to nearby lymph nodes or spread to other areas of the body (metastasise).

Other types of stomach cancer

There are some less common and rare types of stomach cancer which include:

Lymphomas. These are cancers which arise from the lymphatic tissue within the wall of the stomach.
Sarcomas. These are cancers which arise from the muscle or connective tissue within the wall of the stomach.
Carcinoid cancers. These are cancers which arise from cells in the stomach lining which make hormones.

What causes stomach cancer (adenocarcinoma of the stomach)?

A cancerous tumour starts from one abnormal cell. Many people develop stomach cancer for no apparent reason. However, certain risk factors increase the chance that stomach cancer may develop. These include:

Ageing. Stomach cancer is more common in older people. Most cases are in people over the age of 55.
Having a type of anaemia called pernicious anaemia, which causes a lack of vitamin B12, can very slightly increase your risk of stomach cancer.
Diet is probably a factor:Countries such as Japan, where people eat a lot of salt, pickled and smoked foods, have a high rate of stomach cancer.
Eating a lot of fruit and green vegetables can reduce the risk.
Smokers have a higher rate of stomach cancer compared with people who do not smoke.
Long-term infection of the stomach lining with a bacterium called Helicobacter pylori seems to lead to a slightly higher risk of stomach cancer
Gender. Stomach cancer is twice as common in men as in women.
Family history. For some cases, stomach cancer may run in the family. However, most cases of stomach cancer do not run in families and are not inherited.
Blood group A. People who have this blood group have a slightly higher risk.

What are the symptoms of stomach cancer?

When a stomach cancer first develops and is small, it usually causes no symptoms. Some do not cause symptoms until they are quite advanced. Initial symptoms may include:

Pain or discomfort in the upper abdomen, especially after eating.
Indigestion. (Note: most people who have indigestion do not have stomach cancer.)
Feeling sick, off food. Some people have a sense of fullness after eating.
Weight loss and/or loss of appetite.You may pass blood out with your stools.You may not notice bleeding if small amounts of blood pass out with your stool. A lot of bleeding from the stomach can turn stool black.

As the cancer grows in the stomach, symptoms may become worse and may include:

The same symptoms as above, but more severe.
Feeling generally unwell and more tired than usual.
Becoming anaemic if the tumour regularly bleeds.
The cancer growing very large and causing a blockage to food and drink.
If the cancer spreads to other parts of the body, various other symptoms can develop.

Note: all the above symptoms can be due to other conditions, so tests are needed to confirm stomach cancer.

How is stomach cancer diagnosed and assessed?

Initial assessment and gastroscopy

If a doctor suspects that you may have stomach cancer, he or she may examine you. The gastroscopy (endoscopy) is usually done. A gastroscope (endoscope) is a thin, flexible, telescope. It is passed through the mouth, into the food pipe and down towards the stomach and duodenum. The endoscope contains fibre-optic channels so the doctor can see inside your stomach and duodenum.

Biopsy - to confirm the diagnosis

A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. When you have a gastroscopy, if anything abnormal is seen then the doctor can take a biopsy. It can take two weeks for the biopsy results.

Assessing the extent and spread

If you are confirmed to have stomach cancer, further tests may be done to assess if it has spread. For example, a barium meal X-ray, a CT scan, an MRI scan, an ultrasound scan, laparoscopy or other tests. This assessment is called staging of the cancer.

The aim of staging is to find out:

How much the tumour has grown, and whether it has grown partially or fully through the wall of the stomach.
Whether the cancer has spread to local lymph nodes.
Whether the cancer has spread to other areas of the body (metastasised).

By finding out the stage of the cancer it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for stomach cancer?

Treatment options which may be considered include surgery, chemotherapy (and sometimes radiotherapy). The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.

It is important to make sure you get enough nutrition from your food and you will probably be asked to see a dietician to make sure you are on the best possible diet.

Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.

Surgery

Removing the tumour may be curative if the cancer is in an early stage. The common operation is to cut out the affected part of the stomach. Sometimes the whole of the stomach is removed.Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, a blockage may be eased by removing part of the stomach, or by using laser surgery or by a bypass operation.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells or stop them from multiplying. When chemotherapy is used in addition to surgery it is known as adjuvant chemotherapy. Adjuvant chemotherapy can be given before surgery  or after the surgery, depending on stage of tumour.

Radiotherapy

Radiotherapy is a treatment which uses high energy beams of radiation to kills cancer cells, or stops cancer cells from multiplying. Radiotherapy is not commonly used to treat stomach cancer. It is sometimes used to reduce the size of a particular part of the cancer which is causing symptoms.

Chemoradiotherapy

In some cases a combination of chemotherapy and radiotherapy - shortened to chemoradiotherapy - is offered, often as an addition to surgery.

What is the prognosis (outlook)?

 If diagnosed and treated at an early stage (before growing through the wall of the stomach or spreading to lymph nodes or other areas of the body) then there is a good chance of a cure with surgery. If the cancer is diagnosed when it has grown through the wall of the stomach, or spread to other parts of the body, a cure is less likely. However, treatment can often slow down the progression of the cancer using chemotherapy medicines.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.


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