Table Of Content

Introduction

The stomach is a muscular organ that is found in the upper abdomen. After being ingested, food passes from the esophagus to the stomach. When food reaches the stomach, it is mixed with gastric juices, which aid in the digestion of the food. From this, the food is digested further in the small intestine.

Stomach cancer occurs when healthy cells of the stomach become abnormal and grow rapidly. It is otherwise known as gastric cancer. It may happen anywhere in the stomach and spread to surrounding lymph nodes and other body parts.

Types Of Stomach Cancer

The type of stomach cancer is based on the type of cell where your cancer began. It includes:

Adenocarcinoma is the most prevalent type of stomach cancer, which occurs anywhere in the body and begins in the glands that line inside the organs. It develops in glandular epithelial cells, which secrete mucus, digestive juices, or other fluids.

Gastrointestinal stromal tumors (GIST) occur when cells become abnormal and proliferate uncontrollably. It can begin anywhere in the digestive tract but most commonly happens in the stomach and small intestine. This tumor develops from a special type of nerve cells known as interstitial cells of Cajal (ICCs).

Carcinoid tumor is slow-growing cancer that can start anywhere in the body but most commonly begins in the digestive system (stomach, appendix, small intestine, colon, rectum) or the lungs. This type of tumor is otherwise known as a neuroendocrine tumor. There are three types of carcinoid tumors:

  • Slow-growing tumors are the most common type, which usually remains small and do not spread to other body parts or grow quickly.
  • Faster-growing tumors are large tumors that may develop and spread more quickly.
  • Hormone-secreting tumors may release hormones like serotonin. The symptoms of carcinoid syndrome are brought on by the effects of serotonin and other hormones.

Lymphoma is an immune system cancer that begins anywhere in the lymph tissues, including the stomach. Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of non-Hodgkin lymphoma that typically starts in lymph tissue that lines the stomach.

Stages Of Stomach Cancer

The TNM staging tool is the common tool used in determining the stages of stomach cancer.

Stage 0: There is a high degree of dysplasia ( abnormal cells) in the stomach lining or cancer cells in the top layer of mucosal cells (innermost layer of the stomach). This stage is otherwise known as early cancer or carcinoma in situ.

Stage I A: The tumor has grown into the inner layer of the stomach wall, and it has not spread to other organs or lymph nodes.

Stage I B: It occurs in two stages;

  • The tumor has grown into the stomach wall's outer layer and has not spread to lymph nodes or other organs.
  • The tumor has grown into the stomach wall's inner layer, spreading to one to two lymph nodes.

Stage II A: The tumor has spread to nearby lymph nodes and grown into an inner, supporting, or muscular layer of the stomach, and it has not spread to other organs or distant body parts.

Stage II B: The tumor has grown into or through the outer lining of your stomach, which has not spread to other body parts or any lymph nodes.

Stage III A: The tumor may have grown into the muscle layer, serosa (outermost layer), and subserosa (layer of connective tissue) of the stomach wall, and it has spread to surrounding organs or tissues. However, it does not spread to lymph nodes or other distant body parts.

Stage III B: The tumor may have grown into or through the outer, supportive, muscle, or inner layer of the stomach, or it has spread to nearby organs or tissues. It may or may not spread to nearby lymph nodes, but it has not spread to distant body parts.

Stage III C: A tumor has grown through the stomach's outer layer or spread through the stomach wall and into nearby tissues or organs. Although there is cancer in the lymph nodes, it has not spread to other body parts.

Stage IV: The tumor is of any size, and it may have spread to other parts of the body and distant lymph nodes in addition to the area around the stoma

Causes & Risk Factors of Stomach Cancer

Stomach cancer develops due to genetic mutations in the DNA of the stomach cells. These changes or mutations in the DNA cells lead to their abnormal proliferation. These cancer cells overtake healthy cells and metastasize to other body parts. It is not exactly known what causes stomach cancer. However, certain factors might increase a person's risk of developing stomach cancer. These risk factors are:

Gender: The risk of developing stomach cancer is high in men when compared to women.

Age: People over 55 are most likely to develop stomach cancer. Most stomach cancer cases affect persons in their 60s and 70s.

Family history: The risk of developing stomach cancer is higher in people with a family history of this disease.

Obesity: The chance of acquiring stomach cancer increases by being overweight or having an excess body weight.

Helicobacter Pylori infection: Helicobacter pylori (H. pylori) bacterium causes ulcers and gastrointestinal inflammation, increasing the risk of stomach cancer.

Occupational exposure: Exposure to dust and fumes may raise the risk of developing stomach cancer.

Unhealthy Diet: Regular eating of salty and smoked foods increases the risk of stomach cancer.

Previous surgery or health conditions: People who had stomach surgery, pernicious anemia, or achlorhydria have a higher risk of stomach cancer.

Tobacco and alcohol: Tobacco use and excessive drinking of alcohol may increase the risk of getting stomach cancer.

Stomach polyps: Polyps are non-cancerous growths that develop on the stomach lining. Most polyp forms, including hyperplastic and inflammatory polyps, do not raise a person's risk of stomach cancer. However, adenomatous polyps can turn into cancer.

Epstein-Barr virus: Epstein-Barr virus infection develops due to clonal growth of Epstein-Barr virus on the gastric mucosal epithelial cells. It increases the risk of stomach cancer.

Gastritis and GERD: Gastritis and Gastroesophageal Reflux Disease (GERD) increase the risk of developing stomach cancer.

Genetic disorders: Some inherited genetic conditions may raise the risk of stomach cancer. Those includes:

  • Lynch syndrome is caused by changes in mismatch repair (MMR) genes such as MLH1 or MSH2, which raises the risk of colorectal cancer, stomach cancer, and other cancers.
  • Familial adenomatous polyposis (FAP) is caused by the APC gene mutation, which increases the risk of stomach and colorectal cancer.
  • Hereditary diffuse gastric cancer (HDGC) is mostly caused by mutations in the CDH1 gene, raising the risk of stomach cancer.
  • Gastric adenoma and proximal polyposis of the stomach (GAPPS) is a rare condition caused by a mutation (changes) in a specific part of the APC gene. It raises the risk of stomach cancer.
  • Li-Fraumeni syndrome is caused by a Tp53 gene mutation which develops the risk of stomach cancer.

Symptoms of Stomach Cancer

  • Heartburn or indigestion
  • Loss of appetite
  • Feeling bloated
  • Early satiety (feeling full after eating only a small meal)
  • Fatigue or weakness
  • Nausea and vomiting
  • Abdominal pain
  • Unexplained weight loss.
  • Trouble swallowing
  • Yellowing of the skin and eyes (Jaundice)
  • Black stools

Stomach Cancer Screening

There are no standard or regular screening tests for stomach cancer, and some screening tests have been studied to detect stomach cancer at an early stage. The following are some of the screening tests for stomach cancer:

Barium-meal gastric photofluorography: It is a procedure where the esophagus, stomach, and duodenum are photographed using x-rays. These images are taken after the patient consumes a barium-containing liquid (a silver-white metallic compound). The photos are processed to make the organs more visible before being turned into a film.

Upper endoscopy: It is a procedure to look inside the esophagus, stomach, and duodenum to examine for any abnormalities. An endoscope is a tiny, tube-shaped device containing a light and lens inserted through the mouth, throat, and esophagus. It might also be used for removing tissue so it can be detected under a microscope for disease indications.

Serum pepsinogen levels: A test that measures blood levels of pepsinogen. Low pepsinogen levels indicate chronic gastric atrophy, which can cause stomach cancer.

Stomach Cancer Diagnosis

Various tests and procedures can be performed to diagnose stomach cancer. These diagnostic procedures and tests for stomach cancer include

A Physical examination and medical history: A physical exam of the body is performed to determine the patient's health problems. It involves examining any abnormalities or tumors in your abdomen. A history of the patient's health, diseases, treatment, signs, and symptoms is also examined.

Blood tests: It is performed to assess the details of your organ health. For example, tests to measure your liver health may reveal problems caused by stomach cancer that has spread to the liver.

Biomarker testing: Your physician could perform laboratory testing on a tumor sample to find particular proteins, genes, and other factors unique to the tumor. This procedure is also known as molecular testing of the tumor.

Biopsy: In this procedure, a medical professional removes a small amount of tissue and examines it for cancer indications. A biopsy is an accurate method of diagnosing stomach cancer.

Laparoscopy: The doctor inserts a thin, lighted, flexible tube called a laparoscope into the abdominal cavity, which is performed to check if cancer has spread to the lining of the abdominal cavity.

Imaging tests: Various imaging tests can be done to check for stomach cancer which include:

  • Computed tomography (CT) scan: It uses X-ray machines and computers to create more detailed images of your abdomen. It helps the physician to detect cancer and its location and check if it has spread to other abdominal organs.
  • Magnetic resonance imaging (MRI): It uses a powerful magnet and radio waves to produce extremely clear images of the inside of your body. MRI can show you whether the tumor has spread to other organs.
  • Positron emission tomography (PET): These scans help to detect stomach cancer, as well as determine the stage of the disease and whether it is spread.
  • Upper gastrointestinal (GI) series: It is a procedure in which a physician views your upper GI tract using x-rays, fluoroscopy, and a chalky liquid called barium. The barium will make your upper GI tract more visible on an x-ray.

Stomach Cancer Treatment

Depending on the type of stomach cancer, stage of cancer, size and location of the tumor, general and overall health, and how far it has spread, the doctor may
recommend treatment options. Major stomach cancer treatment includes surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy.

Surgery removes the tumor, part or all of the stomach, nearby lymph nodes, and tissues. It is the common treatment for all gastric cancer stages. There are two types of surgery includes:

  • Subtotal gastrectomy: Removal of the cancerous part of the stomach, nearby lymph nodes, and parts of other tissues and organs.
  • Total gastrectomy: Removal of the whole stomach, nearby lymph nodes, and parts of the esophagus, small intestine, and other tissues near the tumor.

Chemotherapy uses medications to kill cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It is used alone or in combination with radiation therapy. Cisplatin, Oxaliplatin, and Fluorouracil are chemotherapy drugs for treating stomach cancer. There are two types of chemotherapy includes:

  • Systemic chemotherapy uses medications that pass through your whole body and kill cancer cells. It is the most common type of chemotherapy.
  • Hyperthermic intraperitoneal chemotherapy (HIPEC) involves the removal of a tumor where the warm chemotherapy is sent directly into the peritoneal cavity.

Radiation therapy is a better option if other treatments are not feasible. It uses high-energy X-rays and protons to damage the DNA of cancer cells and shrink tumors, and this damage inhibits cancerous cells from proliferating. For people with advanced stomach cancer, radiation therapy may be used to control the symptoms.

Targeted therapy can identify and target the genes or proteins involved in cancer cell proliferation and multiplication by preventing cancer growth. Targeted therapy is used for advanced stomach cancer patients, which include stage 4 stomach cancer and cancer that comes back after treatment.

Immunotherapy uses our disease-fighting immune system to identify and destroy abnormal cells and prevent cancerous growth. Advanced stomach cancer patients can benefit from immunotherapy treatments.

Supportive (palliative) care is specialized medical care that relieves pain and other symptoms associated with serious conditions. Palliative care is used while receiving other types of treatment, including surgery, chemotherapy, or radiation therapy.

Stomach Cancer Prognosis:

The Stomach cancer prognosis depends upon various factors such as:

  • Age
  • Types of stomach cancer
  • Size of cancer
  • Grade of cancer
  • Stage of cancer
  • Overall patient health and response to the treatment

The stomach cancer survival rate is five years in patients diagnosed and treated early. If cancer has spread to nearby tissues, lymph nodes, or organs, the five-year survival rate is 32%.

Prevention of Stomach Cancer

Regular screening: Regular screening is essential for lowering the chance of getting stomach cancer since it assists in the early detection and treatment of cancer.

Family history: Knowing your family medical history is important to reducing the risk of getting cancer because it will assist in regular screenings.

Healthy diet: Consuming a diet rich in fruits and vegetables is essential for preventing stomach cancer. Beta-carotene and vitamin-rich foods lower the incidence of stomach cancer. Low-sodium diet and dietary supplements can also lower the risk. Avoid eating smoked food is also crucial.

Maintain a healthy weight: Retaining a healthy weight and regular exercise will help you stay fit, reducing your risk of developing stomach cancer.

Avoid alcohol intake: Avoid drinking too much alcohol since it raises your risk of stomach cancer. Limiting or avoiding alcohol intake can help to reduce the chance of acquiring stomach cancer.

Quit smoking: Smoking may cause stomach cancer, head and neck, esophagus, larynx, lung, kidney, and pancreatic cancer. Quitting smoking will reduce the risk of getting stomach cancer and other cancers.

Reducing chemical exposure: Minimize exposure to chemicals by taking appropriate safety precautions, as it reduces the chance of developing stomach cancer.

Aspirin Use: The risk of stomach cancer is reduced by using aspirin or other non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen or naproxen. These medications can reduce the chance of acquiring colon polyps and colon cancer.

Stomach polyps: Stomach polyps are clusters of cells that grow on the linings of the stomach. Sometimes these polyps can turn into cancerous cells, and early detection and treatment of these polyps can aid in preventing stomach cancer.

Epstein-Barr virus infection: Treatment of Epstein-Barr virus infection can lower the risk of developing stomach cancer.

H. Pylori infection: Treating an H. Pylori infection is important because it can damage the stomach lining and result in ulcers. This H. Pylori infections raise the risk of stomach cancer as they influence the cells lining the stomach, which may develop into abnormal cells leading to stomach cancer. Antibiotic treatment for the H. Pylori infection will help reduce the chance of getting stomach cancer.

Gastroesophageal Reflux Disease (GERD): Proper treatment for Gastroesophageal Reflux Disease (GERD) and gastritis can help reduce stomach cancer risk.

Stomach Cancer FAQs

1. What symptoms might I observe if I have stomach cancer?

Heartburn or indigestion, loss of appetite, feeling bloated, early satiety (feeling full after eating only a small meal), fatigue or weakness, nausea, vomiting, abdominal pain, weight loss, swallowing problems, jaundice (yellowing of the skin and eyes) and black stools are the symptoms of stomach cancer.

2. Who is most at risk of stomach cancer?

Stomach cancer most commonly occurs in older people. People over the age of 60 and above are more likely to get stomach cancer.

3. What should I do if I am diagnosed with stomach cancer?

If I am diagnosed with stomach cancer, the essential step is to learn about my treatment options. Surgery, chemotherapy, radiation therapy, or a combination of treatments may be used to treat stomach cancer. The treatment plan depends on various factors, including general health, the size and location of the tumors, and any prior treatments received.

4. What are the risk factors for developing stomach cancer?

Risk factors for developing stomach cancer include:

  • Age and Gender
  • H. pylori infection
  • Unhealthy diet
  • Smoking
  • Excessive alcohol consumption
  • Being overweight or obese

5. Which bacteria are commonly associated with stomach cancer?

Helicobacter pylori (H. pylori) bacteria are commonly related to stomach cancer. This bacteria causes chronic inflammation and gastric ulcers, leading to stomach cancer.

6. Which blood type has the highest risk for stomach cancer?

People with type A blood have an increased risk of developing stomach cancer because they are more prone to be infected by H.pylori infection.

7. Does stomach cancer spread rapidly?

No, stomach cancer begins in the lining of the stomach and spreads slowly to the nearby organs. It is otherwise known as slow-growing cancer.

8. Is stomach cancer silent cancer?

Yes, the early stage of stomach cancer may be silent because it causes very few or no symptoms.

References:

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