ABDOMEN CANCER

STOMACH CANCER FACTS


Stomach cancer, also called gastric cancer. While the rates of stomach cancer in general are declining, cancers in the area of the stomach near where it joins the esophagus are increasing.

 It is the second leading cause of cancer death in the world, especially Japan, Eastern Europe, South America and parts of the Middle East. This may be due to differences in diet, the rate of infection with Helicobacter pylori (a type of bacteria) and the environment.

Stomach Cancer Anatomy

Many times, people refer to the abdomen, the area between the hips and chest, as the stomach. But in medical terms, the word stomach refers only to the organ.

The stomach, a J-shaped organ, is in the upper abdomen. After you chew and swallow food, it moves through a hollow tube called the esophagus into the stomach. The stomach mixes the food with gastric juices and begins digestion of the food.

The lining of the stomach has three main layers:

  • Mucosal (inner)
  • Muscularis (middle)
  • Serosal (outer)


Generally, stomach cancer starts when cells in the mucosal layer change. Sometimes these changes develop into cancer, but most times they do not. Stomach cancer usually grows slowly and may not show symptoms for many years.

Stomach Cancer Types

Most stomach cancers are adenocarcinomas, which develop in the cells of the mucosa. However, stomach cancer can develop anywhere in the organ and spread to other parts of the body by growing beyond the stomach wall, entering the bloodstream or reaching the lymphatic system.

The other types of cancer found in the stomach are considered rare. They include:

  • Lymphoma, which affects a body’s immune system
  • Gastrointestinal stromal tumors, often called GIST or gastric sarcomas
  • Carcinoid tumors, which affect the hormone-producing cells of the stomach



Stomach Cancer Risk Factors

Although the exact cause of stomach cancer is not known, certain factors seem to increase your risk of developing the disease. These include:

  • Eating foods preserved through pickling, salting and drying or that contain nitrates
  • Eating foods that have not been stored or prepared correctly
  • Obesity: Men who are obese have a higher risk of cancer in the part of the stomach nearest the esophagus.
  • Infection with Helicobacter pylori: This type of bacteria, or germ, is a common cause of ulcers and may cause                        chronicinflammation in the stomach lining. This sometimes develops into pre-cancerous changes and cancer.
  • Tobacco and alcohol abuse: Smoking and drinking excessive amounts of alcohol appear to increase the likelihood of             cancer in the upper part of the stomach. 


Family history. If close relatives have any of the following conditions, you may be at a higher risk of stomach cancer:

  • Stomach cancer
  • Hereditary non-polyposis colon cancer (HNPCC)
  • Li-Fraumeni syndrome


Having any of the following medical conditions: 

  • Pernicious anemia
  • Chronic stomach inflammation and intestinal polyps
  • Menetrier disease
  • Epstein-Barr virus
  • Acid reflux or chronic indigestion
  • Stomach lymphoma
  • Type A blood
  • Prior stomach surgery


Other factors include:

  • Gender: The majority of stomach cancer patients are male.
  • Age: Most individuals who develop stomach cancer are older than 55.
  • Ethnicity: In the United States, stomach cancer occurs more often in Hispanic Americans and African Americans than in       non-Hispanic whites. It is found most in Asian/Pacific Islanders.
  • Working in the rubber, metal, coal and timber industries, as well as those who have been exposed to asbestos fibers, have    a higher risk for stomach cancer
  • Geography: More people in Japan, China, Southern and Eastern Europe, and Central and South America develop                   stomach cancer than those in Northern and Western Africa, South Central Asia and North America.


Not everyone with risk factors gets stomach cancer. However, if you have risk factors, you should discuss them with your doctor.

Behavioral and lifestyle changes can help prevent stomach cancer. 

In rare cases, stomach cancer can be passed down from one generation to the next. Genetic counseling may be right for you. 



ABDOMEN CANCER SYMPTOMS


Stomach cancer often does not have symptoms in the early stages. When signs do appear, they may be mistaken for less serious problems such as indigestion or heartburn. This means stomach cancer often is not found until it spreads.

Symptoms of stomach cancer may include:

  • Abdominal pain or discomfort
  • Loss of appetite
  • Heartburn, indigestion or ulcer-type symptoms
  • Nausea and vomiting
  • Bloating or swelling in the abdomen
  • Diarrhea or constipation
  • Feeling of fullness after eating small amounts of food
  • Bloody or black stools
  • Fatigue
  • Unintentional weight loss


These symptoms do not always mean you have stomach cancer. However, if you notice any of them for more than two weeks, talk to your doctor. Even if they are not signs of cancer, they may signal other health problems.


ABDOMEN CANCER DIAGNOSIS


​Because stomach cancer often does not have symptoms until it has spread to other parts of the body or has symptoms that are mistaken for other conditions, it can be challenging to diagnose.

However, it is important for stomach cancer to be diagnosed as soon and as accurately as possible. This helps increase your odds for successful treatment and lowers the chance of side effects.

Stomach Cancer Diagnostic Tests

If you have symptoms that may signal stomach cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family medical history.

If stomach cancer is suspected, early tests may include:

  • X-rays of the gastrointestinal tract
  • Testing a stool sample for traces of blood


In addition, one or more of the following tests may be used to find out if you have stomach cancer, if it has spread or if treatment is working.

Biopsy: A biopsy is the removal of tissue to examine under a microscope. Different methods are available to obtain the tissue, depending on where it is located. In stomach cancer, biopsies usually are performed by endoscopy. An endoscope is inserted through the mouth, nose or an incision into the esophagus and stomach. The endoscope has a tool to remove tissue samples for examination.

Imaging tests, which may include:

  • CT or CAT (computed axial tomography) scans
  • PET (positron emission tomography) scans
  • MRI (Magnetic resonance imaging)
  • Chest and dental X-rays


Endoscopic ultrasound: Using specialized equipment, doctors insert an endoscope equipped with a small ultrasound device into the stomach. It produces sound waves that produce an image on a video screen.

Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for stomach cancer.

Blood tests, which may include:

  • Complete blood count (CBC) to look for anemia (low level of red blood cells) that may be caused by internal bleeding
  • β-hCG (beta-human chorionic gonadotropin), CA-125 and CEA(carcinoembryonic antigen) assays that measure certain        chemicals in the blood



ABDOMEN CANCER STAGING


​If you are diagnosed with stomach cancer, your doctor will determine the stage of the disease.

Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.



ABDOMEN CANCER STAGES


​Stage 0: Abnormal cells are found in the inside lining of the mucosal (innermost) layer of the stomach wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I: Stomach cancer has formed. Stage I is divided into stage IA and stage IB, depending on where the cancer has spread.

Stage IA: Cancer has spread completely through the mucosal (innermost) layer of the stomach wall.

Stage IB: Cancer has spread to either:

  • Completely through the mucosal (innermost) layer of the stomach wall and is found in up to six lymph nodes near the             tumor
  • The muscularis (middle) layer of the stomach wall


Stage II: Stomach cancer has spread to one of the following:

  • Through the mucosal (innermost) layer of the stomach wall and to seven to 15 lymph nodes near the tumor
  • The muscularis (middle) layer of the stomach wall and to up to six lymph nodes near the tumor
  • The serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs


Stage III is divided into stage IIIA and stage IIIB depending on where the cancer has spread:

Stage IIIA: Stomach cancer has spread to the:

  • Muscularis (middle) layer of the stomach wall and seven to 15 lymph nodes near the tumor
  • Serosal (outermost) layer of the stomach wall and one to six lymph nodes near the tumor
  • Organs next to the stomach but not to lymph nodes or other parts of the body


Stage IIIB: Stomach cancer has spread to the serosal (outermost) layer of the stomach wall and seven to 15 lymph nodes near the tumor.

Stage IV: Stomach cancer has spread to one of the following:

  • Organs next to the stomach and to at least one lymph node
  • More than 15 lymph nodes
  • Other parts of the body

​


TREATMENT


In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. 

Stomach cancer may be treated with surgery, radiation therapy, chemotherapy, or targeted therapy. 

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. 

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The type of surgery used depends on the stage of the cancer .

For a very early stage (T1a) cancer, some doctors may recommend a non-surgical treatment called endoscopic mucosal resection, which is the removal of the tumor with an endoscope. In early stages (stages 0 or I), when the cancer is still only in the stomach, surgery is used to remove the part of the stomach with cancer, called a subtotal or partial gastrectomy, as well as the nearby lymph nodes. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine.

If the cancer has spread to the outer stomach wall with or without having spread to the lymph nodes, surgery plus chemotherapy or chemotherapy and radiation therapy may be used. The surgeon can perform a subtotal gastrectomy or a total gastrectomy, which is the removal of all of the stomach. During a total gastrectomy, the surgeon attaches the esophagus directly to the small intestine.

Gastrectomy is a major surgery and can have serious side effects. After this surgery, the patient will only be able to eat a small amount of food at a time. One common side effect is a group of symptoms known as dumping syndrome, which includes cramps, nausea, diarrhea, and dizziness after eating. This happens when food enters the small intestine too fast. The symptoms usually lessen or disappear in a few months, but they may be permanent for some people. Patients who have had their entire stomach removed may need regular injections of vitamin B12 because they may no longer be able to absorb this essential vitamin through their stomach.

Regional lymph nodes are often removed during surgery because the cancer may have spread to those lymph nodes. This is called a lymphadenectomy. There is still debate as to how many lymph nodes should be removed. 

When the cancer is diagnosed as Stage IV, surgery is typically not recommended as the main treatment (


Radiation Therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Patients with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.


Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy. Currently, there is no single standard chemotherapy treatment regimen that is used worldwide. However, most chemotherapy treatments are based on the combination of at least two drugs, fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Newer drugs similar to 5-FU, such as capecitabine (Xeloda), and similar to cisplatin, such as oxaliplatin (Eloxatin), appear to work equally well. Other drugs commonly used include docetaxel (Docefrez, Taxotere), epirubicin (Ellence), irinotecan (Camptosar), and paclitaxel (Taxol).

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. 


Targeted Therapy 


Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

A patient with later-stage cancer whose stomach tumor has too much of the protein HER2, called HER2-positive cancer, may benefit from receiving trastuzumab (Herceptin) with chemotherapy.

For patients whose tumor has grown while receiving initial chemotherapy, the drug called ramucirumab (Cyramza) is as an additional treatment. Ramucirumab is a type of targeted therapy called an anti-angiogenic. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.