Stomach cancer

Stomach cancer, also known as gastric cancer, arises from the cells lining the stomach, the organ responsible for digesting food. This type of cancer tends to develop slowly over many years and can vary significantly in terms of its prognosis and treatment options. Early detection is challenging because symptoms often do not appear until the cancer is advanced. Stomach cancer was once among the most common cancers worldwide, but its incidence has declined significantly in many countries over the past few decades, partly due to better understanding of its risk factors and improvements in diet.

Causes

The exact cause of stomach cancer is not well-understood, but several factors are known to increase the risk:

1. Infection with Helicobacter pylori (H. pylori): This common stomach infection is a significant risk factor for stomach cancer.
2. Diet: A diet high in salty and smoked foods and low in fruits and vegetables can increase the risk of stomach cancer.
3. Smoking: Smokers are at a higher risk than non-smokers.
4. Family History: Having close relatives who have had stomach cancer increases the risk.
5. Chronic Stomach Inflammation: Long-term inflammation of the stomach lining (chronic gastritis) and stomach ulcers can increase the risk.
6. Pernicious Anemia: A condition caused by the failure of the body to absorb vitamin B12 can increase the risk.
7. Stomach Polyps: Certain types of polyps in the stomach can develop into cancer.

Symptoms

Symptoms of stomach cancer can be vague and may mimic other common stomach conditions. Symptoms include:

1. Indigestion or Heartburn: Persistent discomfort in the upper abdomen.
2. Appetite Loss: Particularly a loss of appetite for meat.
3. Abdominal Pain or Discomfort: Especially in the upper or middle part of the abdomen.
4. Nausea and Vomiting: Sometimes vomiting blood.
5. Weight Loss: Unintentional weight loss without trying.
6. Fatigue: Feeling unusually tired.
7. Feeling Full After Eating Small Amounts: Early satiety.
8. Swelling or Fluid Build-up: In the abdomen.
9. Blood in Stool: Or black, tarry stools indicating bleeding in the stomach.

Because these symptoms can be caused by many different conditions, it’s important to consult a healthcare provider for an accurate diagnosis if any of these symptoms are experienced persistently. Early detection through awareness of symptoms and risk factors is key to improving outcomes for individuals with stomach cancer.

Diagnostics

The diagnosis of stomach cancer typically involves a combination of procedures and tests to confirm the presence of cancer and determine its stage. Common diagnostic methods include:

1. Upper Endoscopy (Esophagogastroduodenoscopy or EGD): A thin, flexible tube equipped with a camera (endoscope) is passed down the throat to examine the inside of the stomach. If abnormal areas are found, a biopsy can be performed during the procedure to collect tissue samples for analysis.
2. Imaging Tests: These may include:
   • Barium Swallow X-ray: After swallowing a barium solution, X-rays of the stomach are taken to highlight abnormalities.
   • Computed Tomography (CT) Scan: Provides detailed cross-sectional images of the body to detect tumors and assess the spread of cancer.
   • Magnetic Resonance Imaging (MRI): Offers detailed images of soft tissues in the body, including the stomach.
   • Positron Emission Tomography (PET) Scan: Can help determine if the cancer has spread to lymph nodes or other organs.
3. Biopsy: The definitive way to diagnose stomach cancer; tissue samples taken during an endoscopy are examined under a microscope for cancer cells.
4. Laparoscopy: A surgical procedure that may be used to look inside the abdomen for signs of cancer spread.

Treatment

Treatment options for stomach cancer depend on the cancer’s stage, location, and the patient’s overall health and preferences. Treatment plans often involve a combination of therapies:

1. Surgery: The main treatment for early-stage stomach cancer, aiming to remove the tumor and surrounding tissues. Types of surgery include:
   • Subtotal (Partial) Gastrectomy: Removal of part of the stomach.
   • Total Gastrectomy: Removal of the entire stomach, nearby lymph nodes, and parts of other tissues or organs where cancer has spread.
2. Chemotherapy: Uses drugs to kill cancer cells, which can be administered before surgery (neoadjuvant chemotherapy) to shrink tumors, after surgery (adjuvant chemotherapy) to kill any remaining cancer cells, or as the main treatment for advanced cancer.
3. Radiation Therapy: Uses high-energy rays to target and kill cancer cells. Often used in combination with chemotherapy, either before or after surgery, to enhance the effectiveness of treatment and reduce the risk of recurrence.
4. Targeted Therapy: Focuses on specific genetic mutations or proteins that contribute to cancer growth. Drugs like trastuzumab (Herceptin) may be used for stomach cancer that overexpresses the HER2 protein.
5. Immunotherapy: Utilizes the body’s immune system to fight cancer. Certain immunotherapies target checkpoints that cancer uses to hide from the immune system, and are used for advanced or metastatic stomach cancer.
6. Palliative Care: Aimed at relieving symptoms and improving quality of life, palliative treatments may include medication, nutritional support, and procedures to address issues like pain, blockages, and bleeding.

The choice of treatment is highly personalized and often involves a multidisciplinary team, including oncologists, surgeons, and gastroenterologists. Advances in medical research continue to offer new treatment options and hope for individuals affected by stomach cancer.

Prevention

Preventing stomach cancer involves addressing the known risk factors and making lifestyle changes to reduce the risk. Key preventive measures include:

1. Helicobacter pylori (H. pylori) Infection Management: Seek treatment for H. pylori infection, a major risk factor for stomach cancer, to potentially reduce the risk.
2. Dietary Changes: Consume a diet rich in fruits and vegetables, limit intake of smoked, pickled, and salty foods, and avoid processed meats to reduce stomach cancer risk.
3. Quit Smoking: Smoking is linked to an increased risk of stomach cancer, among other cancers. Quitting smoking can lower the risk.
4. Limit Alcohol Consumption: Excessive alcohol intake may increase stomach cancer risk. Moderation is key.
5. Maintain a Healthy Weight: Being overweight or obese can increase the risk of stomach cancer, particularly in the upper part of the stomach.
6. Regular Screenings: In areas with high rates of stomach cancer or for individuals with a family history or other risk factors, regular screenings may help detect precancerous conditions early.

Complications

Stomach cancer can lead to several complications, especially if not caught early:

1. Metastasis: Cancer can spread to other parts of the body, complicating treatment and reducing the chances of successful management.
2. Obstruction: Tumors can block parts of the stomach, interfering with digestion and causing pain, vomiting, and weight loss.
3. Anemia: Due to chronic bleeding from the tumor, leading to weakness and fatigue.
4. Ascites: Accumulation of fluid in the abdomen, leading to swelling and discomfort.
5. Malnutrition: Difficulty eating and absorbing nutrients can lead to weight loss and malnutrition.

Conclusion

Stomach cancer presents significant challenges due to its often late detection and the complexity of its treatment. However, understanding the risk factors and engaging in preventive measures can help reduce the risk. For those diagnosed, advancements in surgical techniques, chemotherapy, radiation therapy, targeted therapy, and immunotherapy offer hope for effective management and improved outcomes. Early detection through vigilant attention to symptoms and risk factors remains critical. Continued research and patient education are paramount to improving survival rates and quality of life for those affected by stomach cancer.