Stomach Cancer

What is stomach cancer?

While the stomach is often referred to as the area between the chest and pelvic area, medically it is only one organ in this general region.  The stomach is divided into five sections and has five layers.  Cancer of the stomach mostly occurs in the mucosa layer, the inner most layer.  Approximately 90 to 95 percent of stomach cancers are adenocarcinomas, which develop from the epithelial cells that form the inner most layer of the stomach, the mucosa layer.  The symptoms and outcomes are different depending on the section of the stomach involved. 

What are risk factors for stomach cancer?

Risk factors increase the chance of getting stomach cancer, but not everyone with a risk factor gets stomach cancer. 

• Helicobacter pylori – This bacterial infection of the stomach, which is a common cause of ulcers, significantly increases the risk for stomach cancer.
• Other medical conditions – Chronic gastritis, intestinal metaplasia, pernicious anemica, gastric polyps increase the risk for stomach cancer.
• Family history – Having a first degree relative who has had stomach cancer, increases the risk of stomach cancer.
• Age – Most stomach cancers occur in persons over the age of 50.
• Diet – A diet high in salted, smoked foods and foods that are not-well preserved increases the risk of stomach cancer. 
• Tobacco – Smoking increases the risk of stomach cancer.
  

What are prevention strategies for stomach cancers?

While the exact cause of stomach cancer is not known, there are ways to reduce the risk of stomach cancer.

• Diet – Eat a diet high in fruits and vegetables and limit intake of salted, smoked and pickled foods.
• Tobacco – Avoid smoking and quit smoking (link to tobacco document under prevention)if you currently smoke.
• Medical conditions – If you suffer from long-standing reflux disease or helicobacter pylori, discuss this with your health care provider.
  

Is screening available?

There are no established national screening guidelines for stomach cancer.  If a person is experiencing symptoms that may indicate stomach cancer or high risk for stomach cancer, they should discuss this with their doctor.

What are the symptoms of stomach cancer?

In the early stages of stomach cancer, there are often no symptoms.  Symptoms of stomach cancer often are symptoms of other medical conditions, including 

• Unintentional weight loss
• Loss of appetite
• Heartburn, indigestion, bloating after meals
• Diarrhea or constipation
• Nausea, vomiting
• Discomfort or pain in the abdomen
• Weakness or fatigue
• Bleeding in vomit or stools

It is important to see a healthcare professional if you experience any of these symptoms.

How is stomach cancer diagnosed?

If stomach cancer is suspected, your doctor may conduct several test to make a diagnosis.  Following are tests that may be performed.

• Medical history and physical exam
• Fecal occult blood test – This test checks for blood in the stool
• Upper GI series – x-rays of the esophagus and stomach
• Endoscopy – A thin lighted is inserted through the mouth to view the esophagus and stomach. 
• Biopsy – This removes tissue for a pathologist to check for cancer cells.  This is usually done through the endoscopy.
• Imaging test- Computed tomography (CT) scan, Magnetic resonance imaging (MRI), Position emission tomography (PET), chest x-ray
  

What is staging?

Staging describes the extent of the cancer.  It determines if the cancer has spread and if so, what parts of the body are affected.  Staging a cancer is important to assist the doctor to determine the appropriate course of treatment and assess an accurate prognosis.  Staging head and neck cancers can be difficult.

The most common staging system is the TNM.

• T – size of the tumor
• N – degree to which regional lymph nodes are involved
• M – the absence or presence of distant metastases

Once the TNM has been determined, then a stage of I, II, III or IV is assigned.

• Stage I – cancers are small and local and usually curable
• Stage II & III – typically these are locally advanced and could involve the lymph nodes
• Stage IV – cancer has metastasized and can be inoperable
  

What are treatment options?

There are several treatment options for stomach cancer.  Which treatment is needed is dependent upon factors such as stage and location of cancer.  Your doctor will discuss these options with you.

• Surgery – This is the most common treatment for stomach cancer. 
• Chemotherapy – This systemic drug is administered through the veins to kill cancer cells.
• Radiation therapy-  This uses high energy rays to kill cancer cells.  It is used mainly to treat advanced stomach cancer.
• Biological therapy – This form of treatment helps the body’s immune system attack and destroy cancer cells and may help the body recover from some of the side effects of treatment.
  

What clinical trials are available?

Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer.  Clinical trials test new approaches to treatment, such as new drugs, new approaches to surgery or radiation therapy, or a combination of treatments.

Learn more about clinical trials.

What questions should I ask my doctor?

It is often helpful to make a list of questions before an appointment.  This will help you to remember what the doctor says.  Patients and care givers can write notes or ask if they may use a tape recorder.  Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen.  Below are a few suggested questions a patient may ask their doctor.

Will you please write down the type of cancer that I have?

What stage is my cancer and what does that mean?

What are my treatment options?

What treatment do you recommend and why?

What are the risks and benefits of each treatment?

What are possible side effects of treatment?

How will you help manage my side effects?

How will treatment affect my normal activities?

Are there specific things I must do to get ready for treatment?

Are there other things I can be doing to help with my treatment, such as diet and exercise?

What resources can I use to learn more about my cancer and help me deal with it?

Make an appointment

Resources

American Cancer Society – www.cancer.org, 1-800-ACS-2345

National Cancer Institute – www.cancer.gov, 1-800-4CANCER