Stomach (gastric) cancer guide
What is stomach cancer?
The stomach is the digestive system organ located in the upper abdomen. Stomach cancer is a condition of abnormal and uncontrolled growth of stomach cells displacing normal cells. Gastric cancer cells can extend to other body parts, such as the liver. This expansion of cancer cells is called metastasis. There are many types of stomach cancer, but the leading and most common types are as follows:
- adenocarcinoma - from 90 to 95% of stomach cancer cases, it begins in the mucous membrane cells (inner membrane of the stomach).
- lymphoma - affects the tissue of the immune system in the stomach, which protects the human body.
- gastrointestinal stromal tumour - occurs in specific stomach cells, which are responsible for contracting the smooth muscles of the digestive tract and pushing food through the oesophagus
- carcinoid tumour - begins in the cells of a particular type of stomach responsible for producing certain hormones.
Stomach cancer is the sixth most common cancer form and the third most mortality. Even though gastric cancer is usually diagnosed at a late stage, there are a large number of treatments.
Stomach cancer is more often diagnosed in men than women. According to the World Health Organization, more than 1 million new stomach cancer cases are recorded every year, and about 750,000 patients die from this diagnosis. In addition, stomach cancer is more often diagnosed in the elderly (50% of patients are over 75).
Signs of stomach cancer can be invisible, such as stomach disorders and difficulty swallowing. As the disease progresses, the number of symptoms increases and may include:
- abdominal pain or discomfort;
- bloody or dark chair;
- constant fatigue;
- fullness or bloating after eating a small amount of food;
- heartburn, nausea and vomiting;
- loss of appetite and uncontrolled weight loss.
Most of the symptoms may signal other digestive system diseases, but the presence of such problems requires seeing a doctor, diagnosis, and further treatment. The gastroenterologist will study the medical history, and the presence of symptoms, conduct a visual examination and possibly prescribe additional tests:
- Blood test - to check general health and measure organ functions. The results may show whether other organs of the body, such as the liver, are affected by cancer.
- Upper endoscopy (EUS) - is the introduction of a thin tube with a tiny chamber down the oesophagus into the stomach, which allows the doctor to examine the inner surface of the stomach visually.
- Endoscopic ultrasound - a special sensor is placed at the end of the endoscope, which is delivered through the throat to the stomach. The sensor emits sound waves and captures echoes from the organ. It is used to obtain an image of stomach wall layers, adjacent lymph nodes and other organs near the stomach.
- X-ray examination (barium swallowing test) - with the help of a contrast solution containing barium, which the patient drinks before the procedure, the inner surface of the stomach and oesophagus is presented. Several X-rays are taken that allow you to see any abnormal changes.
- CT scan (computer tomography scan) - is a particular type of X-ray series that shows in detail the stomach and sections of soft tissues for the presence of cancer.
- MRI scan (magnetic resonance imaging scan) - the study uses magnets and radio waves. The doctor has clear and detailed photos showing stomach cancer or cancer that has already spread.
- PET-CT scan (positron emission tomography scan) - shows the cancer spread in the body. During this test, the patient receives a special type of glucose, which can be seen inside with the help of a camera. In the presence of a disease, this contrast manifests itself in places of cancer formation.
- Biopsy - the material of the pathological area of the stomach is taken during an upper endoscopy. The sample is tested in the laboratory and most accurately confirms the presence or absence of cancer cells.
The diagnosis will determine the presence and type of stomach cancer. Detection of the disease at the initial stage and advanced treatments prolong life and improve the chances of survival.
Treatment of stomach cancer is determined by the stage of the disease, the severity of symptoms, and the general health condition. Options include:
- Systemic chemotherapy - drugs that are injected into the bloodstream. The drugs spread throughout the body and destroy cancer cells. The procedure is performed in cycles intermittently.
- Targeted therapy - is drugs that purposefully affect specific genes or proteins that contribute to cancer development. The increase and further spread of cancer cells are blocked at the molecular level.
- Radiation therapy - high-energy X-rays are used to destroy cancer in the stomach.
- Surgical treatment (removal of the organ) - there are several types of surgery for stomach cancer.
- Endoscopic surgery - used at an early stage, similar to endoscopic examination and performed with tiny surgical instruments;
- Partial gastrectomy - removal of the affected part of the stomach;
- Total (complete) gastrectomy - the entire stomach, lymph nodes and adipose tissue are removed. After removal, the intestine is connected to the oesophagus;
- Palliative surgery of non-respectable cancer - for people with stomach cancer that cannot be removed, surgery is used to control the tumour and prevent or relieve symptoms and complications.
The treatment depends entirely on where the cancer is located, how large it is, whether it has spread to other organs, etc. Then, doctors in the multidisciplinary team select the best treatment and supportive care.
New treatment options
Surgery is the best treatment method for stomach cancer in case of early detection. Surgical treatment is also considered in conjunction with chemotherapy and/or radiation therapy. In the case of advanced gastric cancer, treatment aims to stabilize the disease progression and improve life expectancy. Scientists and researchers worldwide strive to develop new promising treatment options for stomach cancer.
- Immunotherapy - is a class of treatments that use the immune system to destroy cancer cells. Medicines are used to activate the human immune system to kill affected stomach cells. There are various types of immune treatments for stomach cancer, e.g. therapeutic vaccines aimed at specific molecules. Immunotherapy is considered a promising therapeutic method for many types of stomach cancer.
- Transarterial chemoembolization (TACE) - is a minimally invasive proven procedure consisting of the local (through vessels) administration of chemotherapy agents combined with arterial blocking. The blocking (embolization) of the blood arteries that feed the tumour keeps a high concentration of chemotherapy inside.
- Transarterial chemoperfusion (TACP) - is a procedure of local chemotherapy application on a stomach tumour. Chemotherapy drugs are injected through a catheter into the artery that feeds the cancer cells directly. The high concentration of the drug inside the tumour destroys tumour cells.
- Proton therapy - is a new type of radiotherapy when beams (protons) are used for cancer damage. The beam with a given amount of radiation is directed precisely to the gastric tumour leaving nearby (healthy) tissues untouched.
No matter how frightening the diagnosis of stomach cancer is, you need to know that a team of professionals can provide comprehensive treatment options and assistance at each stage. In addition, only experienced specialists can develop an interdisciplinary approach to eliminating the tumour and destroying any residual cancer cells.
Statistics and prognosis
Treatment prospects and survival rate in stomach cancer depend on its stage and spread at diagnosis. While stomach cancer is well treated at the initial stage, the disease is associated with lower survival at advanced stages. The excellent news in diagnosing stomach cancer is that now doctors detect neoplasms in the stomach earlier than ever before. It means that there are more hopes to fight oncology.
The National Cancer Institute differentiates survival rates in stomach cancer into four separate groups, depending on the stage. Below is a five-year prognosis for patients with stomach cancer. When the cancer is localized only in the stomach (stage I), the 5-year survival rate is almost 70%. Cancer diagnosed at stage II shows a survival rate of 35%, stage III - 25%, and IV - survival rate is close to 0%. Unfortunately, there are no statistics on 5-year survival in stage 4 cancer. It is because, unfortunately, most people do not live so long after diagnosis. At the same time, it should be noted that these statistics do not take into account what treatment patients received.
There is no exact way to prevent stomach cancer. Therefore, various research institutes conduct many studies to permanently change the negative stomach cancer statistics, aiming to cure more people and save more lives.
- American Cancer Society: If You Have Stomach Cancer
- Columbia University Irving Medical Center: Gastric Cancer
- Health direct: Stomach cancer
- University of Rochester Medical Center: Stomach Cancer: Newly Diagnosed
- Cancer Research UK: Coping with stomach cancer
- Frontiers in Oncology: Conversion Surgery for Stage IV Gastric Cancer
- Future Medicine: Immunotherapy for gastric cancer: a 2021 update