Stomach Cancer

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Definition

Stomach cancer is a disease in which cancer cells grow in the stomach. There are five layers of tissue in the stomach. Types of cancer include:

  • Adenocarcinoma—tumors of the mucosa (the innermost layer), which make up over 90% of stomach cancers
  • Lymphoma—a cancer of the immune system, which is sometimes found in the stomach wall
  • Gastric stomal tumors—tumors of the stomach wall
  • Carcinoid tumors—tumors of the hormone-producing cells of the stomach

Stomach Cancer
Stomach cancer
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Causes

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues including the lymph nodes. Cancer that has invaded the lymph nodes can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors

Stomach cancer is more common in men, and in people aged 50 years and older. Other factors that may increase your chance of stomach cancer include:

  • Ethnicity and geography, more common in:
    • Hispanics and African-Americans than Caucasians
    • People from Japan, Korea, parts of Eastern Europe, and Latin America
  • Helicobacter pylori infection
  • Diet
    • High intake of smoked, salted, pickled food and meat, high starch/low fiber foods
    • Low intake of certain vegetables, such as garlic scallions, onions, chives, leeks
  • Smoking
  • Alcohol abuse
  • Previous stomach surgery
  • Pernicious anemia
  • Ménétrier disease (a disease that causes large folds in the stomach lining)
  • Barrett's esophagus
  • Blood type A
  • Familial cancer syndromes: hereditary nonpolyposis colon cancer and familial adenomatous polyposis
  • Family history of stomach cancer
  • Stomach polyps

Symptoms

In some people, stomach cancer may have no symptoms. In those that have them, stomach cancer may cause:

  • 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

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

Imaging tests to evaluate the stomach and surrounding structures may include:

The physical exam, combined with all of your test results, will help to determine the type and stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, stomach cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

Cancer treatment varies depending on the stage and type of cancer. Stomach cancer is most often detected in the later stages. A combination of therapies may be more effective. For example, surgery may be used in conjunction with chemo- or radiation therapy.

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. There are three types of stomach surgery that may be done:

  • Endoscopic mucosal resection—This surgery is generally done in the early stages where the tumor is removed through an endoscope.
  • Subtotal gastrectomy—This is the removal of the lower part of the stomach, leaving part of the stomach to reattached to the esophagus and small intestine.
  • Total gastrectomy—This is the removal of the entire stomach. It 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 Treatment

In cases where stomach cancer has spread, chemotherapy combined with radiation therapy may increase the risk of survival and reduce the risk of cancer returning. Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including: pill, injection, or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Prevention

To help reduce your chance of stomach cancer:

  • Avoid diets high in salted, pickled, and smoked foods.
  • Eat at least 5 servings of fresh fruits, vegetables, and whole grain foods a day.
  • Limit red meat intake.
  • If you smoke, talk to your doctor about how to quit.
  • Avoid or drink alcohol only in moderation. This means 2 drinks per day for men and 1 drink per day for women.

Revision Information

  • American Cancer Society

    http://www.cancer.org

  • National Cancer Institute

    http://www.nci.nih.gov

  • BC Cancer Agency

    http://www.cancer.ca

  • Cancer Care Ontario

    http://www.cancercare.on.ca

  • Cashen AF, Wildes TM. The Washington Manual; Hematology and Oncology Subspeciality Consult. 2nd ed. New York, NY: Wolter Kluwers; 2008.

  • Gastric carcinoma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 19, 2014. Accessed September 30, 2014.

  • Ménétrier disease. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/menetrier. Updated March 12, 2014. Accessed September 30, 2014.

  • Stomach cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003141-pdf.pdf. Accessed September 30, 2014.

  • Stomach cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/stomach. Accessed September 30, 2014.

  • 4/29/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Zhou Y, Zhuang W, Hu W, Liu GJ, Wu TX, Wu XT. Consumption of large amounts of allium vegetables reduces risk for gastric cancer in a meta-analysis. Gastroenterology. 2011;141(1):80-89.