Stomach Cancer - Types, Symptoms, Diagnosis & Treatment
Stomach cancer is a type of cancer that occurs due to the uncontrolled growth and proliferation of cells lining the surface of the stomach. It can occur at the junction of the esophagus and stomach or in the body of the stomach. It develops more slowly than other cancers.
Types of Stomach Cancer
- Adenocarcinoma (constitutes 90% of cases)
- Gastrointestinal stromal tumor
- Carcinoid tumor (develops from the hormone-secreting cells of the stomach)
- Squamous cell carcinoma
- Small cell carcinoma
Stomach Cancer Risk Factors
Some risk factors that can cause stomach cancer have been identified. Some of these risks are controllable, and some are not. For example, while smoking is a controllable risk factor, genetics cannot.
The leading causes of stomach cancer are:
- Stomach cancer is more common in men than women.
- The risk of stomach cancer increases over the age of 50.
- Stomach cancer is more common in some races.
- Gastric cancer is more common in Japan, China, Southern, Eastern Europe, and South and Central America.
- Helicobacter pylori infection: There is a relationship between this bacterial infection and stomach cancer. However, gastric cancer does not develop in every H. Pylori microbe.
- Diet: Stomach cancer is more common in those who consume smoked and smoked foods and salted fish, meat, and pickled vegetables. There are plenty of nitrates in dried meats. Eating a lot of vegetables and fruits is protective against stomach cancer.
- Smoking: The risk of stomach cancer doubles in smokers. Cancer occurs primarily at the junction of the stomach and esophagus.
- There is an uncertain relationship between being overweight and stomach cancer.
- The risk of developing stomach cancer is higher in those who have had previous gastric surgery.
- People with pernicious anemia due to vitamin B12 deficiency develop gastric cancer more frequently.
- Although the cause is unknown, more stomach cancer has been reported in people with type A blood.
- Having cancer cases in the family
- People who carry mutations of the inherited breast cancer genes BRCA1 or BRCA2 may have a higher incidence of stomach cancer.
- Stomach cancer is more common in patients with polyps in the stomach, intestines, nose, lungs, and bladder.
- Some gastric cancer cases have a history of previous EBV infection.
- Workers in the coal, metal, and rubber industries are at higher risk of developing stomach cancer.
- Patients with chronic atrophic gastritis may develop gastric cancer over time.
Stomach Cancer Symptoms
Gastric cancer symptoms are not seen in all patients at the same time. The symptoms that patients often notice are as follows:
- Stomach ache
- Bloating after eating
- Frequent heartburn
- Recurrent attacks of nausea and vomiting
- Stomach ache
- Unexplained weight loss
- Externally noticeable swelling in the stomach area
- Blood in stool
- Burning sensation in the chest
- Constipation or diarrhea
Stomach Cancer Stages
After the diagnosis of gastric cancer, the physician will stage cancer. Staging determines the severity of cancer and its treatment. Survival rates vary according to the stage of cancer. If stomach cancer is stage 0, there are abnormal cells in the stomach. In stage 1, the muscle layer of the stomach and nearby lymph nodes are involved. In stage 4, the entire stomach is involved, and metastases to distant organs and lymph nodes have occurred. The heaviest stage is stage 4.
Stomach Cancer Diagnosis
The doctor first takes a history from the patient who goes to the doctor with the abovementioned symptoms. Ask about symptoms, duration, lifestyle, and habits. The following tests are then performed for diagnosis:
- Endoscopy: It is the most common application. During endoscopy, a biopsy is taken from the lesion and sent for pathological examination.
- Barium stomach radiography: Used to be more common in the past but is now less needed.
- Computed tomography: The location and size of cancer and, if any, nearby organ metastases are detected.
- Laparoscopy: Laparoscopy is to look at the stomach with a camera under general anesthesia. It is checked whether cancer has spread.
- Endoscopic ultrasound: The physician evaluates the upper part of the stomach and the esophagus with this method. It gives an idea about the lesion.
- Chest X-ray: It gives an idea about whether there is lung involvement.
- MRI: It is used in cancer staging.
- PET: Locates active cancer cells.
- Kidney ultrasound: It gives an idea of whether cancer has spread to the kidney.
- CEA: Cancer antigens are checked in the blood.
Stomach Cancer Treatment
Gastric cancer treatment is done by a gastroenterologist, medical oncologist, cancer surgeon, and radiation oncologist. The stage of the disease is taken into account when planning the treatment.
The main treatment methods for stomach cancer:
Surgery: Stage 0, 1, 2, 3 patients are eligible for surgery. Depending on the stage of cancer, part or all of the stomach can be removed. Nearby lymph nodes are cleaned. Surgery may be considered even if the cancer is at a very advanced stage. This prevents the tumor from bleeding and growing, and blocking the stomach. This is called palliative surgery and is done to improve the patient's quality of life. If the cancer is detected at a very early stage, it can be removed endoscopically. The surgery can be performed as laparoscopic or open surgery. Considering that some patients will have feeding difficulties after the surgery, a tube is placed in the intestine during the operation. Thus, liquid nutrients are given directly to the patient's intestine. Complications such as bleeding, clotting, and damage to nearby organs can occur after stomach surgery. Sometimes there may be leakage from the incisions. After surgery, patients may experience nausea, heartburn, abdominal pain, and diarrhea. Patients are fed little and often. After the operation, vitamin drugs are given against vitamin deficiency.
Chemotherapy: Chemotherapy can be started before or after surgery, depending on the condition of cancer. Chemotherapy before surgery is called Neoadjuvant therapy. It is used to shrink the tumor. Chemotherapy is repeated after surgery. Giving chemotherapy after surgery is called adjuvant therapy. The goal is to kill any cancer cells that are left behind. Concomitant radiotherapy may be given. It is especially preferred in cancers that cannot be entirely removed by surgery. Chemotherapy can be planned as the primary treatment for metastatic gastric cancer. After chemotherapy, patients may experience nausea and vomiting, loss of appetite, hair loss, diarrhea, more frequent infections, rapid skin bruises due to low platelet count, fatigue, and shortness of breath. Cancer drugs can also cause neuropathy, heart damage, hand-foot syndrome.
New generation targeted drug therapy: These drugs directly target cancer cells and aid healing.
Radiotherapy: After surgery, radiotherapy is applied to kill cancer cells that cannot be removed. After radiation therapy, patients may experience skin flushing, nausea, vomiting, diarrhea, fatigue, and low blood cells.
Immunotherapy: This treatment is applied to the person's immune cells to find and destroy cancer cells. Although there are some side effects, there are patients who benefit.
How to Take Precautions Against Stomach Cancer?
- The most important way to prevent stomach cancer is to adopt a healthy diet.
- Avoid foods high in fat and salt, with excess nitrates and preservatives.
- Eat slowly, little, and often.
- Chew your food very well.
- Avoid chocolate and coffee.
- Do not consume cigarettes and alcohol.
- Eat more fish instead of red meat.
- Consume fresh vegetables and fruits.
- Do not lie down or sleep for at least 2 hours after eating.
Questions to Ask Your Doctor
When deciding on a treatment plan:
- Which treatment method is most suitable for me? Why?
- What is the purpose of the treatment to be applied? Will it eliminate cancerous cells or slow their progression?
- Is it possible to get a second opinion? How can I do that?
- How soon do we need to decide on treatment?
- What do I need to do to prepare for treatment?
- How long will the treatment take, where will it be done?
- Are there risks and side effects? If so, what and how long will they last?
- Will the treatment affect my daily life?
- How will we monitor whether the treatment is working?
- Is there anything I can do to minimize the side effects?
- How can I contact you (doctor) and your team if something undesirable happens on weekends, nights, or holidays?
- Do I need to change my nutrition program during the treatment?
- Is there a psychologist I can get support from if I feel stressed or anxious?
- Are there situations in my daily life that I need to pay attention to?
- What symptoms should I monitor after treatment?
- Should I exercise?
- Should I follow a particular nutrition program?
- How do I know if cancer has come back?
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