Stomach Cancer

Overview:

Gastric cancer, also known as stomach cancer, is a type of cancer that develops in the cells lining the stomach. It is one of the most common types of cancer worldwide, although its incidence varies across different regions. The inside lining of your stomach is often where cancerous cells start to grow. As the malignancy progresses, it then penetrates your stomach walls further. Anywhere in your stomach can develop cancer. Gastric cancer is a cellular tumor that begins in the stomach. Just behind the ribs in the top center of the abdomen is where the stomach is located. Food digestion and breakdown are assisted by the stomach. Any area of the stomach has a chance of developing stomach cancer. The primary portion of the stomach is where stomach cancers occur in the majority of the world. The stomach body is this area.

Types of stomach cancer:

Adenocarcinomas:

About 90% to 95% of stomach malignancies are adenocarcinomas. The mucosa, which is the stomach's innermost lining, contains gland cells that give rise to these malignancies. When you are diagnosed with gastric or stomach cancer, it is nearly invariably an adenocarcinoma.

The two primary types of stomach adenocarcinomas are:

• The prognosis (outlook) is often somewhat better for intestinal types. The likelihood of specific gene alterations in cancer cells increases the possibility that they can be treated with targeted medication therapy.
• The diffuse form typically spreads more rapidly. It is less frequent than the intestinal kind and is typically more difficult to treat.

Gastrointestinal stromal tumors (GISTs):

Interstitial cells of Cajal, which are extremely early kinds of cells in the stomach wall, are where these rare malignancies begin. Some GISTs are far more prone than others to spread to different sections of the body or to develop into new locations. GISTs can begin anywhere throughout the digestive system, although the majority begin in the stomach. See Gastrointestinal Stromal Tumor (GIST) for further details.

Neuroendocrine tumors (including carcinoids):

Cells in the stomach (or other regions of the digestive system) that operate in some ways like nerve cells and in other ways like hormone-producing (endocrine) cells are where neuroendocrine tumors (NETs) originate. The majority of NETs develop gradually and do not spread to other organs, however, some do. Gastrointestinal Neuroendocrine (Carcinoid) Tumors go more in-depth on NETs.

Lymphomas:

A malignancy that begins in immune system cells is lymphoma. The immune system of the body fights pathogens. If the body sends immune system cells to the stomach, lymphoma may occasionally begin there. If the body is attempting to fight off an illness, this might occur. Non-Hodgkin lymphomas are the most common form of lymphomas with gastrointestinal origins.

Causes:

The exact etiology of stomach cancer is unknown. According to experts, the majority of stomach cancers begin when the stomach's inside lining is injured. Examples include consuming a lot of salty meals, having chronic acid reflux, and having an infection in the stomach. However, not everyone who has these risk factors develops stomach cancer. Therefore, additional study is required to determine the specific cause. An injury to the stomach's inner lining cells triggers the development of stomach cancer. DNA alterations occur in the cells as a result. The instructions that inform a cell what to do are stored in its DNA. The adjustments instruct the cells to proliferate fast. When healthy cells would normally expire as a part of their natural lifecycle, the cells can continue to exist. The stomach develops a lot of additional cells as a result. A tumor can develop when the cells group together. Stomach cancer cells have the ability to penetrate and obliterate healthy bodily tissue. They could begin to encroach more into the stomach wall. Cancer cells have the potential to separate over time and invade new organs. The term "metastasis" refers to the spread of cancer cells to another area of the body. Some factors include:

• Helicobacter pylori infection: This bacterium is a major risk factor for gastric cancer. It can cause inflammation of the stomach lining and lead to the development of cancer over time.
• Diet: A diet high in smoked, salted, or pickled foods, as well as processed meats, can increase the risk of gastric cancer. On the other hand, a diet rich in fruits and vegetables may help reduce the risk.
• Tobacco and alcohol use: Smoking and heavy alcohol consumption have been linked to an increased risk of gastric cancer.
• Family history: Having a close relative (such as a parent or sibling) with gastric cancer increases the risk of developing the disease.
• Previous stomach surgeries or certain stomach conditions: Individuals who have had stomach surgery or have certain stomach conditions, such as chronic gastritis or stomach polyps, may have an increased risk.

Signs and symptoms:

• Trouble swallowing
• Belly pain
• Feeling bloated after eating
• Feeling full after eating small amounts of food
• Not feeling hungry when you would expect to be hungry
• Heartburn
• Indigestion
• Nausea
• Vomiting
• Losing weight without trying
• Feeling very tired
• Stools that look black

Generally, there are no symptoms in the early stages (asymptomatic). As the disease progresses, a variety of symptoms can develop. These symptoms include indigestion (dyspepsia), which can be severe and persistent, nausea, vomiting, feeling full after eating a small amount of food (early satiety), feeling bloated after eating, and severe, persistent heartburn. Sometimes, stomach discomfort or pain, difficulty swallowing (dysphagia), fatigue, and unintended weight loss can occur. Pain is mild and vague early in the disease, but becomes more severe and constant as the disease progresses. It is important to note that these symptoms can also be caused by other non-cancerous conditions. However, if any of these symptoms persist or are concerning, it is advisable to consult a healthcare professional for further evaluation.

Diagnosis:

If gastric cancer is suspected, a doctor may perform various tests and procedures to make a diagnosis. These can include:

• Endoscopy: A thin, flexible tube with a camera is inserted through the mouth to examine the stomach lining and take biopsies if necessary.
• Imaging tests: X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans can help determine the extent of the cancer and whether it has spread to other parts of the body.
• Blood tests: Blood tests may be conducted to check for certain markers associated with gastric cancer.

Treatment:

Your cancer care team will go over your treatment choices with you if you have been diagnosed with gastric or stomach cancer. It's critical to balance each treatment option's advantages against any potential drawbacks or adverse effects. The stage and location of the cancer within the stomach determine the available treatments. When developing a treatment plan, your doctor also considers your general health and your preferences. Surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and palliative care are all forms of treatment for stomach cancer.

Surgery:

Surgery for stomach cancer, also known as gastric cancer, aims to completely eradicate the disease. Surgery may be the first course of therapy for minor stomach malignancies. If the stomach cancer progresses to the lymph nodes or invades farther into the stomach wall, other therapies can be tried first.

Operations used to treat stomach cancer include:

• Removing small cancers from the stomach lining. Very small cancers can be cut away from the inside lining of the stomach. To remove the cancer, a tube is passed down the throat and into the stomach. Special cutting tools are passed through the tube to cut out the cancer. This procedure is called an endoscopic mucosal resection. It might be an option for treating stage 1 cancer that's growing on the inner lining of the stomach.
• Removing part of the stomach. This procedure is called a subtotal gastrectomy. The surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. It might be an option if your stomach cancer is located in the part of the stomach nearest the small intestine.
• Removing the entire stomach. This procedure is called a total gastrectomy. It involves removing all of the stomach and some surrounding tissue. The surgeon connects the esophagus to the small intestine to allow food to move through the digestive system. Total gastrectomy is a treatment for cancers in the part of the stomach that is closest to the esophagus.
• Removing lymph nodes to look for cancer. The surgeon may remove lymph nodes in your belly to test them for cancer.
• Surgery to relieve symptoms. An operation to remove part of the stomach may relieve symptoms of growing cancer. This might be an option if the cancer is advanced and other treatments haven't helped.

Small stage 1 stomach cancers often can be cut away from the inner lining of the stomach. But if the cancer grows into the muscle layer of the stomach wall, this might not be an option. Some stage 1 cancers may need surgery to remove all or some of the stomach.

For stage 2 and stage 3 stomach cancers, surgery might not be the first treatment. Chemotherapy and radiation therapy might be used first to shrink the cancer. This might make it easier to remove the cancer completely. Surgery often involves removing some or all of the stomach and also some lymph nodes.

If stage 4 stomach cancer grows through the stomach and into nearby organs, surgery might be an option. To remove all of the cancer, parts of the nearby organs might be removed, too. Other treatments might be used first to shrink the cancer. If stage 4 cancer can't be removed completely, surgery might help control symptoms.

Chemotherapy:

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Types of chemotherapy include:

• Chemotherapy that travels through your whole body. The most common type of chemotherapy involves medicines that travel through your whole body, killing cancer cells. This is called systemic chemotherapy. The medicines can be given through a vein or taken in pill form.
• Chemotherapy only goes in the belly. This type of chemotherapy is called hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is done right after surgery. After the surgeon removes the stomach cancer, the chemotherapy medicines are put directly into the belly. The medicines are heated to make them more effective. The chemotherapy is left in place for a set amount of time and then drained.

Chemotherapy might not be needed for stage 1 stomach cancer. It might not be needed if surgery removed all of the cancer and there's a low risk of cancer coming back.

Chemotherapy is often used before surgery to treat stage 2 and stage 3 stomach cancers. Systemic chemotherapy might help shrink the cancer so that it's easier to remove. Giving chemotherapy before surgery is called neoadjuvant chemotherapy.

Systemic chemotherapy might be used after surgery if there's a risk that some cancer cells are left behind. This risk might be higher if the cancer grows deep into the stomach wall or spreads to the lymph nodes. Giving chemotherapy after surgery is called adjuvant chemotherapy.

Chemotherapy can be used alone or it can be combined with radiation therapy.

If surgery isn't an option, systemic chemotherapy might be recommended instead. It might be used if the cancer is too advanced or if you're not healthy enough to have surgery. Chemotherapy might help control cancer symptoms.

HIPEC might be an option for selective stage 4 stomach cancer. It might be used if the cancer can't be removed completely because it extends through the stomach and into nearby organs. The surgeon might remove as much of the cancer as possible. Then HIPEC helps to kill any cancer cells that are left.

Radiation therapy:

Radiation therapy uses high-powered beams of energy to kill cancer cells. The beams can come from X-rays, protons, or other sources. During radiation therapy, you lie on a table while a machine gives the radiation treatment to precise points on your body.

Radiation therapy is often done at the same time as chemotherapy. Sometimes doctors call this chemoradiation.

Radiation therapy might not be needed for stage 1 stomach cancer. It might not be needed if surgery removed all of the cancer and there's a low risk that the cancer will come back.

Radiation is sometimes used before surgery to treat stage 2 and stage 3 stomach cancers. It can shrink the cancer so that it's easier to remove. Giving radiation before surgery is called neoadjuvant radiation.

Radiation therapy might be used after surgery if the cancer can't be removed completely. Giving radiation after surgery is called adjuvant radiation.

Radiation can help relieve stomach cancer symptoms if the cancer is advanced or surgery isn't possible.

Targeted Therapy:

Targeted treatments use medicines that attack specific chemicals present within cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Your cancer cells are tested to see if targeted therapy is likely to work for you.

For stomach cancer, targeted therapy is often used with systemic chemotherapy. Targeted therapy is typically used for advanced stomach cancer. This might include stage 4 stomach cancer and cancer that comes back after treatment.

Immunotherapy:

Immunotherapy is a treatment with a medicine that helps your body's immune system to kill cancer cells. Your immune system fights off diseases by attacking germs and other cells that shouldn't be in your body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy is sometimes used to treat advanced cancer. This might include stage 4 stomach cancer or cancer that comes back after treatment.

Palliative care:

Palliative care is a special type of health care that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. Palliative care is done by a team of healthcare providers. This can include doctors, nurses, and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family, and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer 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.

As always, it is essential to consult with a healthcare professional for an accurate diagnosis, personalized treatment plan, and up-to-date information regarding gastric cancer.