Stomach cancer

The symptoms are generally based on the stage of cancer. They include:

1. Early Stage Symptoms

• Indigestion and stomach discomfort
• Bloating
• Mild nausea
• Loss of appetite
• Acidity

2. Advanced Stage Symptoms

• Vomiting
• Weight loss for no known reason
• Trouble swallowing
• Feeling full even after eating small amounts of food
• Stomach pain
• Blood in stools
• Jaundice (yellowing of eyes and skin)
• Ascites (build-up of fluid in the abdomen)
• Anemia
• Enlargement of the liver

Stomach cancer develops when a genetic mutation (inherited or acquired) occurs in the DNA of stomach cells.

DNA is the genetic code that instructs cells on when to grow and when to die.

As a result of the mutation, abnormal cells in the stomach begin to grow and divide uncontrollably.

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Stomach cancer is the 5th most common cancer. It is a multifactorial disease associated with several risk factors, which include:

• Stomach conditions:
  • H. Pylori infection
  • Chronic gastritis (swelling and inflammation of the stomach)
  • Pernicious anemia (decrease in red blood cells when the body can't absorb enough vitamin B12)
  • GERD (stomach acid backing up into the food pipe)
  • Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines)
  • Gastric polyps (growths of noncancerous cells in the stomach)
  • Epstein-Barr virus infection
• Age: Stomach cancer is more common in the elderly. Half of all stomach cancers occur in people aged 75 and above.
• Gender: Men are more likely than women to develop stomach cancer.
• Genetic factors: People who have first-degree relatives with stomach cancer (parents, siblings, or children) are more likely to develop the disease. A family history of genetic syndromes such as Lynch syndrome (an inherited genetic disorder that increases the risk of colorectal cancer, stomach cancer, and other cancers) is likely to increase the risk of stomach cancer.
• Environmental factors:
  • Alcohol and tobacco use
  • Occupation (manual workers and farmers have a higher risk of gastric cancer)
  • Radiation exposure
  • Eating improperly prepared or processed foods in excess
  • Being overweight or obese

To arrive at the diagnosis of any kind of cancer, it is important to understand its staging. The most common way of staging stomach cancer is the TNM staging system, where:

• T stands for Tumor and how many layers of the stomach wall the tumor has penetrated.
• N stands for Lymph Nodes and how many lymph nodes have cancer spread to. It also assesses where the lymph nodes are affected and how close they are to the original tumor.
• M stands for metastasis, i.e., spread to other parts of the body.

Depending on this, the cancer is divided into four stages:

1. Stage 0: Also known as carcinoma in situ. This stage is characterized by abnormal cells in the stomach lining, which can become malignant (cancerous) in the future.
2. Stage 1: Cancer hasn’t spread beyond the thick muscle in the stomach wall.
3. Stage 2: The cancer has spread to deeper layers of the stomach and may have spread to several nearby lymph nodes.
4. Stage 3: Cancerous cells are present in all the layers of the stomach as well as in some adjacent organs like the spleen or colon.
5. Stage 4: Cancer has spread to distant organs in the body, such as the liver, lungs, or brain. This is referred to as advanced, metastatic, or secondary cancer.

The diagnosis consists of the following:

1. Medical history and physical examination: This entails examining the body to check for general signs of health, including looking for signs of disease, such as lumps or anything else that appears unusual. A history of the patient's health habits, previous illnesses, and treatments is taken.
2. Upper endoscopy: Also known as esophagogastroduodenoscopy (EGD). The doctor will insert an endoscope, which is a thin, flexible, lighted tube with a small video camera on the end, down your throat during this test. This allows the doctor to examine the lining of your esophagus, stomach, and the first part of your small intestine.
3. Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. There are two types of ultrasound devices:
   • Transabdominal ultrasound: This is used to see inside the abdomen and check for abnormalities.
   • Endoscopic ultrasound (EUS): This is performed with the help of an endoscope to determine the size of the cancer and whether it has spread. It can be used to help remove very early-stage cancers without the need for more extensive surgery.
4. Biopsy: A biopsy involves the removal of a small amount of tissue for examination under a microscope. It can provide a definitive diagnosis for most cancers.
5. Imaging Tests:
   • X-Ray: A barium meal X-ray or barium swallow involves drinking a chalky liquid containing barium, which makes your stomach visible on an X-ray. It can reveal abnormalities in the shape, position, narrowing, or obstruction of the stomach that may indicate stomach cancer.
   • Chest X-ray: This can also be performed to check if the cancer has spread to the lungs.
   • Computed tomography (CT or CAT) scan: CT scans involve taking pictures of the stomach at specific intervals after the intravenous (IV) injection of contrast medium. It helps diagnose the position of a tumor in relation to nearby organs and blood vessels.
   • Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed images of the body and measure the tumor’s size.
   • Positron emission tomography (PET) scan or PET-CT scan: A PET scan is usually combined with a CT scan or MRI scan to detect and visualize abnormal metabolic activity.
6. Other tests:
   • Laparoscopy: A minor procedure in which a laparoscope (a thin, flexible tube with a small video camera on the end) is inserted through a small incision in the abdomen. It is used by doctors to determine whether stomach cancer has spread.
   • Electrocardiogram (ECG): It may be performed if surgery is planned or if you are taking medications that can affect the heart.
   • HER2 testing: The cancer cells may be tested after biopsy to see if they have excessive levels of a growth-promoting protein called HER2. Cancers with increased levels of HER2 are referred to as HER2-positive.

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Cancer prevention is an action taken to lower the chance of getting cancer. Many factors, including genetics, lifestyle, and environmental influences, can either increase or decrease our risk of developing cancer. Some effective strategies to prevent stomach cancer include:

1. Diet and Nutrition
   • Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
   • Reduce consumption of heavily salted, pickled, and smoked foods.
   • Limit intake of processed meats.
2. Lifestyle Choices
   • Quit smoking.
   • Avoid or limit alcohol consumption.
   • Maintain a healthy weight.
   • Engage in regular physical activity to support overall health.
   • Minimize exposure to carcinogens in the workplace.
   • Protect your skin from excessive sun exposure to prevent skin cancer, which can sometimes metastasize to the stomach.
3. Infections and Medical Interventions
   • Treat and manage Helicobacter pylori infections.
   • Use medications to treat precancerous conditions or to prevent cancer (chemoprevention).
4. Health Monitoring
   • Maintain routine health check-ups for early detection and management of risk factors.

Note: Certain types of cancer can be prevented with vaccines. For example, BCG vaccines help protect the body from viruses that can lead to diseases capable of developing into cancer.

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Treatment for stomach cancer depends on the size, location, and stage of the tumor. It includes:

1. Surgery

Surgery is a common treatment for all stages of gastric cancer. The following types of surgery may be used:

• Endoscopic resection: Surgical tools are passed through the endoscope to remove the tumor and part of the normal stomach wall around it.
• Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD): Minimally invasive procedures where abnormal tissues or early-stage tumors are removed from the stomach lining using an endoscope.
• Subtotal gastrectomy: In this procedure, only a portion of the stomach is removed, sometimes in conjunction with a portion of the food pipe (proximal gastrectomy) or the first part of the small intestine (distal gastrectomy). The remaining stomach section is then reattached.
• Total gastrectomy: This surgery is performed if the cancer has spread throughout the stomach. The entire stomach, as well as nearby lymph nodes and parts of the esophagus, intestines, pancreas, and other nearby organs, are removed.

2. Palliative Surgery for Unresectable Cancer

For people with unresectable stomach cancer, surgery can often still be used to help control cancer or to help prevent or relieve symptoms or complications.

• Gastric bypass (gastrojejunostomy): Connecting a section of the small intestine (the jejunum) to the upper part of the stomach, allowing food to exit the stomach via the new connection.
• Stent placement: Using an endoscope to place a stent (a hollow metal tube) in the opening to keep the passage open and allow food to pass through.
• Feeding tube placement: A feeding tube can be inserted through the skin of the abdomen and into the distal part of the stomach or the small intestine via a minor operation for those unable to eat or drink enough to obtain adequate nutrition.

3. Chemotherapy

Chemotherapy employs anti-cancer drugs that may help shrink the cancer or slow its growth, relieving symptoms and extending lives. Additionally, chemotherapy can enhance the effectiveness of radiation, known as chemoradiation.

• Adjuvant treatment: Chemotherapy is given before surgery for stomach cancer to shrink the tumor and make surgery easier, potentially helping patients live longer by preventing cancer from returning.
• Neoadjuvant treatment: Administered after surgery to remove the cancer, aiming to kill any remaining cancer cells that are too small to see, helping to prevent recurrence.

The most commonly used drugs for stomach cancer include:

• Carboplatin
• Cisplatin
• Capecitabine
• Docetaxel
• Fluorouracil
• Irinotecan
• Oxaliplatin
• Paclitaxel

4. Radiotherapy

Radiation therapy resembles an X-ray procedure, but the radiation used is more potent and can be applied in various ways to aid in the treatment of stomach cancer.

• Before surgery: Radiation can be used in conjunction with chemotherapy before surgery to shrink cancer and make it easier to remove.
• After surgery: Radiation therapy can be used with chemotherapy to kill any cancer cells that were not removed during surgery.
• For cancers that can't be removed by surgery: Radiation therapy may help slow the growth of cancer and alleviate symptoms such as pain, bleeding, or eating difficulties.

5. Targeted Drugs and Immunotherapy

These drugs in stomach cancer treatment focus on specific traits of cancer cells to hinder their growth and enhance the effectiveness of therapy. Some medicines help the body's defense system fight against cancer, known as immunotherapy. Examples of targeted drugs include:

• Ramucirumab
• Entrectinib
• Trastuzumab
• Regorafenib

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The news of stomach cancer can be devastating. Cancer not only affects the body but also has a serious impact on the mind. Some of the things that patients can do at home to help manage the symptoms of treatment include:

• Focus on a balanced diet with small, frequent meals.
• Drink plenty of fluids to stay hydrated.
• Follow prescribed pain medications and communicate any discomfort to your doctor.
• Maintain good personal hygiene to prevent infections.
• Get adequate rest and sleep.
• Seek emotional support from friends, family, or support groups.
• Engage in light physical activity if recommended by your doctor.
• If you've had surgery, follow wound care instructions carefully.

Note: Diagnosis and treatment of stomach cancer can lead to chronic stress. With so much to manage, it is often challenging to cope with situations that are beyond control. Read about effective ways to manage chronic stress.

• Gastrointestinal bleeding
• Gastric perforation (holes in the stomach)
• Small bowel obstruction (partial or full obstruction of the small intestine)
• Loss of appetite and weight loss
• Ascites (fluid build-up in the abdomen)
• Metastases (cancer can spread to distant organs such as the lungs, liver, or bones)

Here are examples of complementary methods that some people have found helpful and safe when used along with standard medical treatment. They include:

Complementary and Integrated Methods

• Acupressure: The application of pressure to or rubbing of specific areas of the body to alleviate symptoms.
• Acupuncture: A technique in which very thin needles are inserted into the body to treat a variety of symptoms, including mild pain and nausea.
• Aromatherapy: The use of fragrant substances distilled from plants, known as essential oils, to alter mood or alleviate symptoms such as stress or nausea.
• Art Therapy: Using creative activities to assist people in expressing their emotions.
• Biofeedback: It can assist in managing symptoms like nausea and pain in stomach cancer patients by teaching them how to control certain bodily functions.
• Labyrinth Walking: A meditative walk through a circular pathway that leads to the center and back out. It can provide relaxation and stress reduction, aiding emotional well-being for individuals dealing with stomach cancer.
• Massage Therapy: Involves manipulating, rubbing, and kneading the muscles and other soft tissues of the body. It reduces stress, anxiety, depression, and pain in individuals dealing with cancer.
• Meditation: A mind-body process in which a person relaxes the body and calms the mind through concentration or reflection.
• Music Therapy: Using music to promote healing and improve one's quality of life.
• Tai Chi: A mind-body system that improves health and well-being through movement, meditation, and breathing. It has been shown to help some people improve their strength and balance, alleviating cancer symptoms.
• Yoga: People with cancer frequently experience a variety of symptoms and side effects, including depression, pain, nausea, fatigue, and others. Yoga can help cancer patients deal with these and other issues.

Living with stomach cancer means different things to different people. Things that the caregiver and the patient should take into consideration include:

1. Managing the emotions

Individuals with cancer may experience a range of emotions such as sadness, anxiety, or anger, and may find it difficult to manage stress levels. Tips that can help include:

• Gathering all necessary information regarding treatment
• Talking to loved ones
• Joining support groups
• Starting palliative care to alleviate other symptoms
• Seeking assistance in coping with practical issues like financial expenses, childcare, and work-related matters

2. Surviving the physical side effects

Changes to physical health depend on various factors including the cancer’s stage, the duration and dosage of treatment, and the patient’s overall health. Important considerations include:

• Keeping a record of any new side effects or changes in existing ones
• Informing your doctor about side effects to prevent worsening
• Tracking side effects to facilitate communication with the healthcare team
• Seeking treatment for long-term side effects and late effects to ensure survival after treatment completion

3. Supervising the costs of cancer care

Cancer treatment can be costly and may cause stress and anxiety for patients and their families. This can be managed by:

• Understanding the costs associated with treatment
• Discussing financial concerns with family members or the healthcare team
• Seeking support from organizations that assist with treatment, housing, travel, and other cancer-related expenses

4. Getting follow-up care

After treatment completion, doctors will continue to monitor the patient closely. It is crucial to attend all follow-up appointments, which include a medical history review and physical exam every 3 to 6 months for 1 to 2 years, every 6 to 12 months for 3 to 5 years, and annually thereafter.

Tips for caregivers

There are numerous resources available for patients and their families battling stomach cancer. Caregivers can support patients during difficult times by:

• Providing encouragement and mental support
• Understanding the course of treatment
• Helping manage symptoms and side effects
• Coordinating medical appointments and administering medications on time
• Assisting with personal care and hygiene
• Communicating with empathy and a positive attitude
• Helping with household chores
• Managing insurance and billing issues