Stomach cancer is a term used to describe cancer that occurs in the stomach. The most common type of stomach cancer occurs within the mucosa (the inside lining of the stomach) also called adenocarcinoma of the stomach. Stomach cancer may invade deeply into the stomach wall and grow into nearby organs, such as the liver, pancreas, colon, oesophagus and intestine.
Risk Factors for Gastric Cancer
Factors that may increase an individual’s risk of stomach cancer include:
- Smoked food
- Salted and pickled foods
- A diet low in fruits and vegetables
- Family history of stomach cancer
- Infection with Helicobacter pylori
- Chronic inflammation
- Pernicious anemia
- Stomach polyps
Signs and symptoms of stomach cancer:
- Anemia, due to ongoing blood loss that leads to Iron deficiency
- Excessive fatigue
- Weight loss
- Feeling full after eating small amounts of food
- Heartburn or indigestion
- Abdominal pain
- Persistent vomiting
After detailed history and physical examination, a few tests are required to establish the diagnosis. these will include
- Upper GI endoscopy
- CT scan of the abdomen
- PET scan
- Staging laparoscopy
- Endoscopic ultrasound in selected early cancers.
When the extent of the disease is discussed the first thing to look at is how far the cancer has gone through the wall of the stomach. This sometimes needs an endoscopic examination with ultrasound. However, with a CT scan we usually will have an idea. Also, to look at the regional lymph nodes around the stomach to see whether the cancer has spread to them or not and a PET scan can be particularly useful for this purpose. It is also important to see if there are lesions or spread to the liver and the lung.
Stomach cancer, particularly the diffuse type of stomach cancer can spread to the peritoneal cavity and one of the indications that it might have spread is the presence of fluid in the peritoneal cavity on a CT scan. Often your Doctor will recommend for you what we call a staging laparoscopy. With a staging laparoscopy your Doctor will look at the inside of your abdominal cavity or what we call the peritoneal cavity which is the sack where all the gastrointestinal tract lies inside your abdomen. Because gastric cancer, particularly the diffuse type, can spread in a very subtle fashion with small spots in the peritoneum this is unusual to be picked up by even the most sophisticated scans available and a direct look is required. Also, your Doctor will take some samples from the peritoneal cavity, either in the form of fluid washout or a biopsy to ensure there is no spread to the peritoneal cavity.
Once the cancer is diagnosed and staging has been made the next step is going to be a definitive treatment of the cancer. People who present with disease that has spread beyond cure, which means that surgery has been ruled out, can benefit from some palliative chemotherapy. However, if the lesion is treatable and removable an important option these days is to start with chemotherapy which usually is run in the form of three cycles of chemotherapy. For that purpose you might need to have a reservoir or a line inserted in your chest in order to administer the chemotherapy which is a relatively minor procedure to have a central venous access. Once you have finished the chemotherapy, prior to surgery re-staging is often performed with at least a CT scan and at certain times a PET scan is required to ensure there is no progress of the disease. If the disease responds or remains stable then you will get exposed to surgery of the stomach. There are two types of stomach surgery. One of them involves removal of part of the stomach along with all of the lymph nodes and another form is total removal of the stomach. The factors they take into consideration is the site of the cancer, i.e. its location and also the appearance of the cancer under the microscope. Regardless of the type of the operation you would have lymph node dissection which involves removal of all of the lymph nodes that drain the stomach and once you recover from the surgery you will undergo a further three courses of chemotherapy.