Stomach Cancer

Stomach cancer, also called gastric cancer, is cancer that starts in any part of your stomach or stomach wall. It happens when your stomach cells start to abnormally grow out of control.

Most stomach cancers develop in the lining of the stomach. There are several different forms of stomach cancer.

• Adenocarcinoma – is by far the most common stomach cancer. It starts in the gland cells in your inner stomach lining.
• Gastrointestinal stromal tumours (GIST) - start in the wall of your stomach.
• Non-Hodgkin’s lymphoma – starts in the immune system cells in your stomach.
• Neuroendocrine cancers – start in the hormone cells in your stomach

The cause of stomach cancer is not known. Anyone can get it. There are, however, risk factors that mean you are more likely to get stomach cancer but having one or more risk factors does not mean that you will definitely get it.

Stomach cancer risk factors include:

• Helicobacter pylori (H pylori) infection – is considered one of the main causes of stomach cancer. H. pylori bacteria live in the mucous of your stomach lining. Having an H. pylori infection does not cause problems in many people. If it is a long-term infection, it can cause inflammation and stomach ulcers and lead to atrophic gastritis and other precancerous changes in your inner stomach lining.
• H pylori and your diet - there is also evidence that your diet may interact with H pylori and affect your risk of stomach cancer. H pylori can convert substances in some foods into chemicals that cause DNA changes to your stomach lining cells. Foods such as preserved meats increase your risk of stomach cancer. Fruits and vegetables contain antioxidants that can block substances that damage a cell’s DNA and may lower your stomach cancer risk.
• Age and gender – older people are more likely to get stomach cancer, especially those aged 75 or over. Men are more likely than women to get stomach cancer.
• Smoking tobacco
• Being overweight or obese - increases your risk of getting cancer in the top part of your stomach (the cardia), where your food pipe joins your stomach (the gastro-oesophageal junction).
• Too much alcohol
• Chemical exposure – such as in the rubber industry.
• Previous stomach surgery – such as partial stomach removal to treat ulcers.
• Stomach conditions – including long-term, severe acid reflux, gastritis or pernicious anaemia, which affects your immune system.
• Family history – if you have a brother, sister, or parent who had stomach cancer.

Early-stage stomach cancer rarely causes symptoms. As it progresses, a variety of symptoms can develop.

Signs and symptoms of stomach cancer can include.

• difficulty swallowing (dysphagia)
• feeling full very quickly when eating
• losing weight without trying to
• feeling or being sick
• indigestion pain or discomfort or heartburn
• feeling tired or having no energy
• stomach pain
• a lump at the top of your stomach

Often these symptoms are the cause of something else such as ulcers or a viral infection. However, if you experience stomach cancer symptoms and you are worried or they do not go away or get worse then you should see your GP or a cancer specialist.

Usually, stomach cancer develops slowly over the course of many years.

Stomach cancer is not often diagnosed in the early stages as most people typically don’t show symptoms then. If you have symptoms that might be from stomach cancer, you should see your GP who will examine you and might refer you for tests or to a specialist.

Gastroscopy - is used to diagnose stomach cancer. It uses a long flexible tube (endoscope) with a tiny camera and light on the end to look inside your stomach. The procedure checks your stomach for growths or abnormal-looking areas. A biopsy sample of any abnormal-looking tissue may be collected and sent to a laboratory to check for cancer.

If you are diagnosed with stomach cancer, you will need more tests to help your doctors to find out the size of your cancer and how far it has spread (called the stage).

Tests to determine stomach cancer size and spread include:

• Endoscopic ultrasound scan (EUS) - combines ultrasound and endoscopy to look at your food pipe and stomach. An ultrasound scan uses high-frequency sound waves to create a picture of the inside of your body.
• CT scan - of your stomach, chest, and pelvis. Detailed x-rays from different angles create a series of images.
• PET-CT scan - combines a CT scan and a PET scan. A mildly radioactive drug is used to show areas of your body with more active than normal cells.
• Laparoscopy - a laparoscope is a thin tube with a light and a camera. It is inserted through a small cut in your abdomen to look inside your stomach to find out if stomach cancer has spread. Biopsy samples may be taken.

Your doctors will use the test results to advise on the best treatment for you. They will consider where your cancer is in your stomach, its stage and grade, the cancer type, and your general health.

Treatments for stomach cancer include:

Surgery to remove your stomach cancer – usually used. It can be performed using:

• Endoscopic mucosal resection (EMR) - removes the lining of your stomach for very early, small cancers.
• Subtotal or partial gastrectomy – to remove part of your stomach.
• Total gastrectomy - to remove your whole stomach.
• Oesophagogastrectomy – to remove your stomach and part of your food pipe.

Surgery to relieve symptoms of advanced stomach cancer include:

• Partial gastrectomy - to remove part of your stomach to relieve a blockage when your stomach cancer has grown so that it blocks, or partly blocks, the passage of food through your digestive system and causes symptoms such as feeling full quickly, pain, sickness, and constipation.
• Bypass surgery – to bypass a blockage if cancer cannot be removed. Your small bowel (jejunum) is attached to the part of your stomach above the blockage. You might have surgery with other treatments.

Radiotherapy - uses high-energy rays to destroy cancer cells. Radiotherapy may be combined with chemotherapy (chemoradiotherapy) to help stop cancer from coming back or on its own to help control and improve advanced cancer symptoms.

Chemotherapy - uses anti-cancer drugs in your bloodstream to destroy cancer cells. You may have chemotherapy for stomach cancer:

• before and after surgery to reduce the size of your cancer
• after surgery to help prevent cancer from returning
• at the same time as other treatments to help make them more effective
• to help control and improve advanced cancer symptoms or if cancer cannot be removed by surgery. It is sometimes used alongside targeted medicine treatment.
• Targeted cancer drugs - change the way that cells work to help stop cancer from dividing and growing, encourage your immune system to attack the cancer cells, and stop cancer blood vessels growth.

Stomach cancer can be cured if it is in its early stages. Unfortunately, though, diagnosis often happens in later stages once symptoms begin. The outlook for stomach cancer depends on the stage of cancer.