Stomach cancer: Causes, Symptoms, Treatment and Survival Rates

Stomach cancer (0r Gastric Cancer) is abnormal growth and uncontrolled division of cells involving the inner lining of the stomach.Stomach is a part of the upper digestive tract which helps in digestion of food. Stomach is divided into different parts which include fundus, body and Antrum region. Cancer can occur in any part of the stomach.In this article, we will understand about the various aspects of the stomach cancer which can help in early detection and better management.

Stomach cancer Causes

A number of risk factors are associated with causation of stomach cancer. These are described as followsHelicobacter pylori Infection: Infection with the bacterium Helicobacter pylori (H. pylori) is a major risk factor for stomach cancer. This bacterium can cause chronic inflammation of the stomach lining (gastritis) and increase the risk of developing stomach cancer over time.Dietary Factors: Consuming a diet high in salted, smoked, or pickled foods, as well as processed meats, can elevate the risk of stomach cancer. Conversely, diets rich in fruits, vegetables, and whole grains are associated with a lower risk of developing stomach cancer.Tobacco and Alcohol Use: Smoking tobacco and excessive alcohol consumption are linked to an increased risk of various cancers, including stomach cancer. These habits can damage the stomach lining and contribute to the development of cancerous cells.Family History and Genetics: A family history of stomach cancer or certain genetic mutations, such as mutations in the CDH1 gene (associated with hereditary diffuse gastric cancer), can predispose individuals to a higher risk of developing stomach cancer.Chronic Gastric Conditions: Long-term inflammation of the stomach lining due to conditions such as chronic gastritis, gastric polyps, or pernicious anemia can increase the likelihood of stomach cancer development.Age and Gender: Stomach cancer is more common in older adults, with the risk increasing with age. Men tend to have a higher incidence of stomach cancer compared to women.Obesity: Being overweight or obese is associated with an increased risk of various cancers, including stomach cancer. Obesity-related factors such as insulin resistance and chronic inflammation may contribute to cancer development.Previous Stomach Surgery: Individuals who have undergone stomach surgery, such as partial gastrectomy for benign conditions like ulcers, may have an increased risk of stomach cancer in the remaining stomach tissue.understanding the above risk factors is very essential for both general population and healthcare workers for risk stratification of a person.

Stomach cancer Symptoms

In early stages, the disease is often symptomless. Understanding about the symptoms is essential for early detection of cancer.Here’s a list of symptoms associated with stomach cancer:Symptoms associated with digestive problems include –Indigestion and Heartburn: Chronic indigestion, heartburn, or discomfort after eating may be early signs of stomach cancer,Loss of Appetite and Weight Loss: Unexplained weight loss, loss of appetite, or feeling full even after eating small amounts can be indicative of stomach cancer.Difficulty Swallowing: Dysphagia or difficulty swallowing may develop as the tumor obstructs the passage of food through the esophagus or affects the stomach’s ability to empty properly.Nausea and Vomiting: Persistent nausea, vomiting (which may contain blood), and bloating may occur as the tumor grows and affects normal digestive function.Other symptoms associated with stomach cancer are –Abdominal Discomfort: Persistent abdominal pain or discomfort, especially in the upper abdomen, may occur. This pain can be vague or dull initially but may worsen over time.Fatigue and Weakness: Generalized weakness, fatigue, and a decline in overall energy levels may be experienced, often due to the body’s response to cancer and related metabolic changes.Bloody Stools or Vomit: In advanced stages, stomach cancer may cause bleeding in the digestive tract, leading to bloody stools (black, tarry stools) or vomiting blood (hematemesis).Jaundice: Yellowing of the skin and whites of the eyes (jaundice) may occur if the cancer spreads to the liver or blocks the bile ducts, causing a buildup of bilirubin in the bloodstream.

Stomach cancer Diagnosis

How to diagnose stomach cancer is important in finding about the cancer in its early stages. Based on the above symptoms and thorough medical examination, a provisional diagnosis can be made and further tests are ordered to investigate the disease further.Various diagnostic tests include:

1. Upper Endoscopy (Esophagogastroduodenoscopy or EGD): A flexible tube with a camera (endoscope) is inserted through the mouth into the esophagus, stomach, and duodenum. This allows visualization of the stomach lining, and tissue samples (biopsies) can be taken for examination under a microscope to look for cancer cells.
2. Imaging Studies: Various imaging tests help assess the extent of cancer and detect metastasis. These include:
   • CT Scan  and MRI: Detailed cross-sectional images of the abdomen and chest can identify tumor size, location, and spread to nearby lymph nodes or organs.
   • PET Scan (Positron Emission Tomography): PET scans detect areas of increased metabolic activity, aiding in identifying cancer spread beyond the stomach.
3. Endoscopic Ultrasound (EUS): This combines endoscopy with ultrasound to obtain detailed images of the stomach wall layers and nearby lymph nodes. EUS helps assess tumor depth and involvement of adjacent structures.
4. Biopsy and Pathological Analysis: Tissue samples obtained during endoscopy or surgery are examined by a pathologist to confirm the presence of cancer, determine cancer type (e.g., adenocarcinoma), grade (degree of abnormality), and stage (extent of spread).
5. Laparoscopy: In some cases, minimally invasive surgery (laparoscopy) may be used for staging purposes. A camera is inserted into the abdomen to visualize organs and detect cancer spread.

Stomach Cancer Treatment

Treatment depends on the stage of the cancer at the time of diagnosis and condition of the patient to tolerate the treatment. Various treatment modalities include Surgery, Chemotherapy, Radiation therapy, immunotherapy and Targeted therapy.Surgery include removal of part of stomach (partial gastrectomy) or whole of stomach (total gastrectomy) with adjacent lymph node removal (D1 and D2 lymphadenectomy). Surgery can be done by Traditional open technique or by Minimally invasive techniques including laparoscopic and Robotic assisted surgery. These approaches use small incisions and specialized instruments to perform surgery, resulting in shorter recovery times and reduced post-operative complications.In cases where stomach cancer is advanced and cannot be completely removed, palliative surgery may be performed to alleviate symptoms such as pain, obstruction, or bleeding. This may involve procedures like bypass surgery to create alternate pathways for food or stent placement to keep the digestive tract open.Chemotherapy uses powerful drugs to kill cancer cells or slow their growth. It may be used before surgery (neoadjuvant chemotherapy) to shrink tumors, after surgery (adjuvant chemotherapy) to destroy any remaining cancer cells, or as palliative treatment for advanced-stage cancer to relieve symptoms and improve quality of life.Radiation therapy uses high-energy beams to target and destroy cancer cells. It may be used alongside surgery and chemotherapy (chemoradiation) or as palliative treatment to shrink tumors and alleviate symptoms such as pain or obstruction.Targeted therapy drugs specifically target cancer cells’ unique features, minimizing damage to healthy cells. These drugs may be used in combination with chemotherapy or as standalone treatments, especially for advanced-stage stomach cancer with specific genetic mutations.Immunotherapy drugs boost the immune system’s ability to recognize and attack cancer cells. While still under investigation for stomach cancer, immunotherapy shows promise in certain cases, particularly for advanced or recurrent cancers.During the treatment, regular follow up with your treating doctor is important to detect any treatment related side effects or any recurrence of disease early.

Stomach Cancer Survival Rates

Survival depends on the stage at which cancer is diagnosed.Five year survival ranges for 65-90% in localized stage when the tumor is still confined to the stomach. when the cancer spreads to adjacent lymph nodes and tissues (Locoregional), five-year survival rate decreases to around 30% to 70%. Stomach cancer that has metastasized (spread) to distant organs or tissues (distant stage) has a lower five-year survival rate, averaging around 5% to 20%.Survival rates for stomach cancer have improved over the years due to advancements in early detection, surgical techniques, chemotherapy drugs, and supportive care measures.Understanding about disease, its symptoms and treatment is essential for early detection and to achieve maximum benefits with the treatment. Consult your doctor if you experience any of the above symptoms or have above risk factors for risk assessment.