What is Stomach Cancer?
Stomach cancer is characterized by a growth of cancerous cells within the lining of the stomach. Also called gastric cancer, this type of cancer is difficult to diagnose because most people typically don’t show symptoms in the earlier stages.
While stomach cancer is relatively rare compared to other types of cancer, one of the biggest dangers of this disease is the difficulty of diagnosing it. Since stomach cancer usually doesn’t cause any early symptoms, it often goes undiagnosed until after it spreads to other parts of the body. This makes it more difficult to treat.
Before Stomach Cancer Treatment
Symptoms of stomach cancer
There are typically no early signs or symptoms of stomach cancer. Unfortunately, this means that people often don’t know anything is wrong until the cancer has reached an advanced stage.
Some of the most common symptoms of advanced stomach cancer are:
. Nausea and vomiting
. Frequent heartburn
. Loss of appetite, sometimes accompanied by sudden weight loss
. Constant bloating
. Early satiety (feeling full after eating only a small amount)
. Bloody stools
. Jaundice
. Excessive fatigue
. Stomach pain, which may be worse after meals
When to see a doctor
If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more-common causes of these signs and symptoms first.
Causes
Your stomach (along with the esophagus) is just one part of the upper section of your digestive tract. Your stomach is responsible for digesting food and then moving the nutrients along to the rest of your digestive organs, namely the small and large intestines.
It’s not clear what causes stomach cancer, though research has identified many factors that can increase the risk.
Doctors know that stomach cancer begins when a cell in the stomach develops changes in its DNA. A cell’s DNA contains the instructions that tell the cell what to do. The changes tell the cell to grow quickly and to continue living when healthy cells would die. The accumulating cells form a tumor that can invade and destroy healthy tissue. With time, cells can break off and spread (metastasize) to other areas of the body.
Risk factors of stomach cancer
Stomach cancer is directly linked to tumors in the stomach. However, there are some factors that might increase your risk of developing these cancerous cells. These risk factors include certain diseases and conditions, such as:
. Lymphoma (a group of blood cancers)
. H. pylori bacterial infections (a common stomach infection that can sometimes lead to ulcers).
. Tumors in other parts of the digestive system
. Stomach polyps (abnormal growths of tissue that form on the lining of the stomach)
Stomach cancer is also more common among:
. Older adults, usually people 50 years and older
. Men
. Smokers
. People with a family history of the disease
. People who are of Asian (especially Korean or Japanese), South American, or Belarusian descent.
While your personal medical history can impact your risk of developing stomach cancer, certain lifestyle factors can also play a role. You may be more likely to get stomach cancer if you:
. Eat a lot of salty or processed foods
. Eat too much meat
. Have a history of alcohol abuse
. Don’t exercise
. Don’t store or cook food properly
You may want to consider getting a screening test if you believe you’re at risk for developing stomach cancer. Screening tests are performed when people are at risk for certain diseases but don’t show symptoms yet.
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Diagnosis
Tests and procedures used to diagnose stomach cancer include:
. A tiny camera to see inside your stomach (upper endoscopy). A thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can use it to look for signs of cancer.
. Removing a sample of tissue for testing (biopsy). If any suspicious areas are found during the upper endoscopy, special tools can be used to remove a sample of tissue for testing. The sample is sent to a lab for analysis.
. Imaging tests. Imaging tests used to look for stomach cancer include CT scans and a special type of X-ray exam called a barium swallow.
Determining the extent (stage) of stomach cancer
The stage of your stomach cancer helps your doctor decide which treatments may be best for you. Tests and procedures used to determine the stage of cancer include:
. Blood tests. Blood tests to measure organ function may indicate whether other organs in your body, such as your liver, may be affected by cancer.
. Endoscopic ultrasound. During an endoscopic ultrasound, a thin tube with a camera on the tip is passed down your throat and into your stomach. A special ultrasound tool is used to create pictures of your stomach. Endoscopic ultrasound helps doctors determine how deeply a cancer penetrates the stomach wall.
. Imaging tests. Tests may include CT and positron emission tomography (PET).
. Exploratory surgery. Your doctor may recommend surgery to look for signs that your cancer has spread beyond your stomach, within your chest or abdomen. Exploratory surgery is usually done laparoscopically. This means the surgeon makes several small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room.
Other staging tests may be used, depending on your situation.
Your doctor uses the information from these procedures to assign a stage to your cancer. The stages of stomach cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating that the cancer is small and affects only the inner layers of your stomach. By stage IV, the cancer is considered advanced and may have spread to other areas of the body.
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Prevention
To reduce the risk of stomach cancer, you can:
. Maintain a healthy weight. If you’re overweight or obese, talk to your doctor about strategies to help you lose weight. Aim for a slow and steady weight loss of 1 or 2 pounds a week.
. Choose a diet full of fruits and vegetables. Try to incorporate more fruits and vegetables into your diet each day. Choose a wide variety of colorful fruits and vegetables.
. Reduce the amount of salty and smoked foods you eat. Protect your stomach by limiting these foods.
. Stop smoking. If you smoke, quit. If you don’t smoke, don’t start. Smoking increases your risk of stomach cancer, as well as many other types of cancer. Quitting smoking can be very difficult, so ask your doctor for help.
. Ask your doctor about your risk of stomach cancer. Talk with your doctor if you have an increased risk of stomach cancer. People with a strong family history of stomach cancer might consider tests, such as endoscopy, to look for signs of stomach cancer.
During Stomach Cancer Treatment
Treatment
Treatment options for stomach cancer depend on the cancer’s location, stage and aggressiveness. Your doctor also considers your overall health and your preferences when creating a treatment plan.
Surgery
The goal of surgery is to remove all of the cancer and some of the healthy tissue around it.
Operations used for stomach cancer include:
. Removing early-stage tumors from the stomach lining. Very small cancers limited to the inside lining of the stomach may be removed by passing special tools through an endoscope. Procedures to cut away cancer from the inside lining of the stomach include endoscopic mucosal resection and endoscopic submucosal resection.
. Removing part of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. This operation may be an option if your stomach cancer is located in the part of the stomach nearest the small intestine.
. Removing the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system. Total gastrectomy is used most often for stomach cancers that affect the body of the stomach and those that are located in the gastroesophageal junction.
. Removing lymph nodes to look for cancer. The surgeon may remove lymph nodes in your abdomen to test them for cancer.
. Surgery to relieve signs and symptoms. An operation to remove part of the stomach may relieve signs and symptoms of a growing cancer in people with advanced stomach cancer.
Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach.
Chemotherapy can be given before surgery to help shrink the cancer so that it can be more easily removed. Chemotherapy is also used after surgery to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy.
Chemotherapy may be used alone or with targeted drug therapy in people with advanced stomach cancer.
Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table.
For stomach cancer, radiation therapy can be used before surgery to shrink the cancer so that it’s more easily removed. Radiation therapy can also be used after surgery to kill any cancer cells that might remain. Radiation therapy is often combined with chemotherapy.
For advanced stomach cancer that can’t be removed with surgery, radiation therapy may be used to relieve side effects, such as pain or bleeding, caused by a growing cancer.
Targeted drug therapy
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. For stomach cancer, targeted drugs are usually combined with chemotherapy for advanced cancers or cancer that comes back after treatment.
Your doctor may test your cancer cells to see which targeted drugs are most likely to work for you.
Immunotherapy
Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body’s disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make it hard for the immune system cells to recognize the cancer cells as dangerous. Immunotherapy works by interfering with that process.
For stomach cancer, immunotherapy might be used when the cancer is advanced, if it comes back or if it spreads to other parts of the body.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
Treatment by Type and Stage of Stomach Cancer
Treatment of stomach cancer depends to a large degree on where the cancer started in the stomach and how far it has spread.
Stomach cancers can grow and spread in different ways. They can grow through the wall of the stomach and invade nearby organs. They can also spread to the lymph vessels and nearby lymph nodes (bean-sized structures that help fight infections). The stomach has a very rich network of lymph vessels and nodes. As the stomach cancer becomes more advanced, it can travel through the bloodstream and spread (metastasize) to organs such as the liver, lungs, and bones, which can make it harder to treat.
Stage 0
Because stage 0 cancers are limited to the inner lining layer of the stomach and have not grown into deeper layers, they can be treated by surgery alone. No chemotherapy or radiation therapy is needed.
Surgery with either subtotal gastrectomy (removal of part of the stomach) or total gastrectomy (removal of the entire stomach) is often the main treatment for these cancers. Nearby lymph nodes are removed as well.
Some small stage 0 cancers can be treated by endoscopic resection. In this procedure the cancer is removed through an endoscope passed down the throat. This is done more often in Japan, where stomach cancer is often detected early during screening. It is rare to find stomach cancer so early in the United States, so this treatment has not been used as much here. If it is done, it should be at a cancer center that has a great deal of experience with this technique.
Stage I
. Stage IA: People with stage IA stomach cancer typically have their cancer removed by total or subtotal gastrectomy. The nearby lymph nodes are also removed. Endoscopic resection may rarely be an option for some small T1a cancers. No further treatment is usually needed after surgery.
. Stage IB: The main treatment for this stage of stomach cancer is surgery (total or subtotal gastrectomy). Chemotherapy (chemo) or chemoradiation (chemo plus radiation therapy) may be given before surgery to try to shrink the cancer and make it easier to remove.
After surgery, patients whose lymph nodes (removed at surgery) show no signs of cancer spread are sometimes observed without further treatment, but often doctors will recommend treatment with either chemoradiation or chemo alone after surgery (especially if the patient didn’t get one of these before surgery). Patients who were treated with chemo before surgery may get the same chemo (without radiation) after surgery.
If cancer is found in the lymph nodes, treatment with either chemoradiation, chemo alone, or a combination of the two is often recommended.
If a person is too sick (from other illnesses) to have surgery, they may be treated with chemoradiation if they can tolerate it. Other options include radiation therapy or chemo alone.
Stage II
The main treatment for stage II stomach cancer is surgery to remove all or part of the stomach, the omentum, and nearby lymph nodes. Many patients are treated with chemo or chemoradiation before surgery to try to shrink the cancer and make it easier to remove. Treatment after surgery may include chemo alone or chemoradiation.
If a person is too sick (from other illnesses) to have surgery, they may be treated with chemoradiation if they can tolerate it. Other options include radiation therapy or chemo alone.
Stage III
Surgery is the main treatment for patients with this stage disease (unless they have other medical conditions that make them too ill for it). Some patients may be cured by surgery (along with other treatments), while for others the surgery may be able to help control the cancer or help relieve symptoms.
Some people may get chemo or chemoradiation before surgery to try to shrink the cancer and make it easier to remove. Patients who get chemo before surgery will probably get chemo after, as well. For patients who don’t get chemo before surgery and for those who have surgery but have some cancer left behind, treatment after surgery is usually chemoradiation.
If a person is too sick (from other illnesses) to have surgery, they may be treated with chemoradiation if they can tolerate it. Other options include radiation therapy or chemo alone.
Stage IV
Because stage IV stomach cancer has spread to distant organs, a cure is usually not possible. But treatment can often help keep the cancer under control and help relieve symptoms. This might include surgery, such as a gastric bypass or even a subtotal gastrectomy in some cases, to keep the stomach and/or intestines from becoming blocked (obstructed) or to control bleeding.
In some cases, a laser beam directed through an endoscope (a long, flexible tube passed down the throat) can destroy most of the tumor and relieve obstruction without surgery. If needed, a stent (a hollow metal tube) may be placed where the esophagus and stomach meet to help keep it open and allow food to pass through it. This can also be done at the junction of the stomach and the small intestine.
Chemo and/or radiation therapy can often help shrink the cancer and relieve some symptoms as well as help patients live longer, but is usually not expected to cure the cancer. Combinations of chemo drugs are most commonly used, but which combination is best is not clear.
Targeted therapy can also be helpful in treating advanced stomach cancers. Trastuzumab (Herceptin) can be added to chemotherapy for patients whose tumors are HER2-positive. Ramucirumab (Cyramza) may also be an option at some point. It can be given by itself or added to chemo. The immunotherapy drug pembrolizumab (Keytruda) might also be an option at some point.
Because these cancers can be hard to treat, new treatments being tested in clinical trials may benefit some patients.
Even if treatments do not destroy or shrink the cancer, there are ways to relieve pain and symptoms from the disease. Patients should tell their cancer care team about any symptoms or pain they have right way, so they can be managed effectively.
Nutrition is another concern for many patients with stomach cancer. Help is available ranging from nutritional counseling to placement of a tube into the small intestine to help provide nutrition for those who have trouble eating, if needed.
After Stomach Cancer Treatment
Long-term outlook
Your chances of recovery are better if the diagnosis is made in the early stages. In fact, around 30 percent of all people with stomach cancer survive at least five years after being diagnosed.
The majority of these survivors have a localized diagnosis. This means that the stomach was the original source of the cancer. When the origin is unknown, it can be difficult to diagnose and stage the cancer. This makes the cancer harder to treat.
It’s also more difficult to treat stomach cancer once it reaches the later stages. If your cancer is more advanced, you may want to consider participating in a clinical trial.
Clinical trials help determine whether a new medical procedure, device, or other treatment is effective for treating certain diseases and conditions.
Recurrent cancer
Cancer that comes back after initial treatment is known as recurrent cancer. Treatment options for recurrent disease are generally the same as they are for stage IV cancers. But they also depend on where the cancer recurs, what treatments a person has already had, and the person’s general health.
Clinical trials or newer treatments may be an option and should always be considered.
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Sources:
https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/stomach-cancer
https://www.cancer.org/cancer/stomach-cancer/treating.html
https://www.cancer.net/cancer-types/stomach-cancer/types-treatment