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Stomach Cancer

Definition

Stomach cancer is a disease in which cancer cells grow in the stomach. Stomach cancer can develop in any part of the stomach and spread to other organs through tumor growth, the bloodstream, or the lymphatic system.

There are five layers of tissue in the stomach. The innermost layer is called the mucosa and is where approximately 90% to 95% of stomach cancer begins. This type of tumor is called an adenocarcinoma.

Less common stomach cancers include lymphoma, a cancer of the immune system sometimes found in the stomach wall; gastric stomal tumors, which are tumors of the stomach wall; and carcinoid tumors, which are tumors of the hormone-producing cells of the stomach.

It is believed that stomach cancer takes several years to develop, and that many precancerous changes that rarely cause symptoms occur before stomach cancer develops. This is why most cases of stomach cancer are undetected until the later stages of the disease.

Causes

The exact cause of stomach cancer is not known. There are, however, several well-known risk factors that contribute to the development of stomach cancer.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The risk factors for stomach cancer include:

  • Age: over 50
  • Gender: twice as common in men
  • Geography: Japan, Korea, parts of Eastern Europe, and Latin America experience higher rates
  • Race: higher rates in Hispanics and African-Americans
  • Helicobacter pylori infection
  • Diet: smoked, salted, pickled food and meat, high starch/low fiber foods
  • Tobacco and alcohol abuse
  • Previous stomach surgery
  • Pernicious anemia
  • Menetriers disease
  • Blood type A
  • Familial cancer syndromes: hereditary nonpolyposis colon cancer and familial adenomatous polyposis
  • Family history of stomach cancer
  • Stomach polyps

Symptoms

There are often no symptoms with stomach cancer, but when they occur, they may include:

  • Indigestion, heartburn
  • Abdominal pain or vague abdominal discomfort
  • Nausea and vomiting
  • Diarrhea or constipation
  • Stomach bloating or sense of fullness after eating
  • Loss of appetite
  • Weakness, fatigue
  • Bleeding in vomit or stool
  • Stool that has turned black or tarry
  • Unintended weight loss
  • Fluid swelling in abdomen

These symptoms may also be caused by other, less serious health conditions. A person experiencing these symptoms should see their doctor to determine the cause of the problem.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Diagnostic tests may include:

  • Blood tests
  • Fecal occult blood test—This test checks for blood in the stool.
  • Upper GI series—X-rays are taken after a barium solution is swallowed.
  • Endoscopy—The stomach is viewed through a thin, lighted tube that is passed through the mouth and into the stomach.
  • Biopsy—Tissue is removed for testing during endoscopy.
  • Ultrasound
  • CT scan

Treatment

Stomach cancer is most often detected in the later stages. Stomach cancer is treated based on the location, size, stage, and extent of disease. Treatment options for stomach cancer include:

Surgery

Surgery is the most common treatment for stomach cancer. The type of surgery depends on the stage of the disease and can vary from removing the tumor and part of the stomach, to removing the entire stomach.

There are three types of stomach surgery that may be performed:

  • Endoscopic mucosal resection—This surgery is generally performed in the early stages where the tumor is removed through an endoscope.
  • Subtotal gastrectomy—This procedure removes the lower part of the stomach, leaving part of the stomach to be reattached to the esophagus and small intestine.
  • Total gastrectomy—This is the removal of the entire stomach and often includes removal of nearby lymph nodes. The esophagus is attached directly to the small intestine.

Radiation Therapy

This is the use of high-energy rays to kill or shrink cancer cells. Radiation therapy may be used after surgery to destroy cancer cells that could not be seen or removed during surgery.

Combined Modality Treatment

A recent study showed that patients with high-risk stomach cancer (positive lymph nodes or spread through the stomach wall by tumor) are best served by surgery followed by both chemotherapy and radiation therapy. This combined modality approach results in best survival and least likelihood of cancer returning.

Prevention

The rate of stomach cancer has declined over the past 60 years due in large part to dietary factors. The change from salting and pickling foods to refrigerating foods for preservation is thought to have played a large role in this decrease.

Prevention includes:

  • Avoid diets high in salted, pickled, and smoked foods.
  • Eat at least five servings of fresh fruits, vegetables, and whole grain foods a day.
  • Limit red meat intake.
  • Limit alcohol intake.
  • Don’t use tobacco.
  • Research is underway to determine if treating Helicobacter pylori infections lessens the risk of stomach cancer.

RESOURCES:

American Cancer Society
http://www.cancer.org

National Cancer Institute
http://www.nci.nih.gov

CANADIAN RESOURCES

BC Cancer Agency
http://www.bccancer.bc.ca/default.htm

Cancer Care Ontario
http://www.cancercare.on.ca/

References:

Gastric cancer prevention. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancerinfo/pdq/prevention/gastric/healthprofessional. Accessed May 7, 2003.

How is stomach cancer diagnosed? American Cancer Society website. Available at: http://www.cancer.org. Accessed May 21, 2003.

What you need to know about stomach cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov. Accessed May 14, 2003.



Last reviewed October 2007 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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