All about gastric cancer: causes, symptoms, diagnosis, treatment and FAQs

What is stomach cancer?

Stomach cancer or gastric cancer is the growth of malignant cells mainly in the innermost layer of the stomach which is the mucosa. The most common cancer type of the stomach is gastric adenocarcinoma.

The stomach is formed by different layers such as mucosa, submucosa, muscle, subserosa, and serosa. These all layers are arranged from inner to outer. This cancer first starts from mucosa which is the innermost layer and if not treated on time it gradually spread to outer layers and other surrounding parts of the body.

What are the causes of gastric cancer?

In causes, let’s discuss gastric cancer risk factors that can lead to it and these are…

• The most common risk factor is H pylori infection especially when it is associated with hypochlorhydria or achlorhydria. In hypochlorhydria, there is a low level of hydrochloric acid. While achlorhydria is a severe form of hypochlorhydria where there is very little or no hydrochloric acid secretion in the stomach.
• Diet rich in salt, pickles, smoked foods, and low in fruits and vegetables.
• Excessive is smoking and alcohol consumption.
• Autoimmune gastritis as in Pernicious anemia.
• History of gastric cancer in the family.
• Adenomatous gastric polyps.
• Past history of peptic ulcer surgery.
• Hypertrophic gastritis.
• A male with older age is at higher risk.

Symptoms of gastric cancer

• Epigastric discomfort especially postprandially. Fullness or burning in epigastric or behind sternal religion after heavy meals or indiscretion in diet.
• Belching or eructation.
• There may be a disturbance of appetite or lack of appetite. Sometimes there is a distaste for some heavy foods, especially meat.
• Recurrent bouts of nausea and vomiting.
• Many times affected patients notice haematemesis or melena as a first symptom.
• When the lesion is at the lower esophageal region, there may be substernal oppression, slight dysphagia after solid food, cough triggered by swallowing and regurgitation.

• Diarrhea due to associated achlorhydria or rapid emptying of the stomach. There may also be constipation and lower abdominal discomfort or pain.
• Anemia and pallor
• Loss of weight and generalized weakness
• Due to metastasis, there may be ascites, jaundice, pathological fracture

• Acute abdominal symptoms appears rarely when there is perforation of gastric carcinoma
• dyspnea with unexplained right heart failure due to lymphangitic carcinomatosis in cases of subacute cor pulmonale
• Physical examination:

Physically examine for any stomach cancer lump or mass in the epigastric region, jaundice, left supraclavicular node, ascites, etc. These types of sign mostly signifies incurable disease in case of gastric cancer except pyloric stenosis which may be caused by an early stage of the cancer.

Diagnosis of gastric cancer

One or more investigation methods may be needed for the diagnosis of stomach cancer as mentioned below…

Radiology

• Barium swallow: In this patient is given a liquid containing barium. When swallowed this liquid coats the esophagus and stomach. After that multiple X-rays are taken to investigate different conditions of the esophagus and stomach.
• CT scan and MRI: These are more efficient methods for diagnosis and also helpful for the evaluation of metastasis in the surrounding organs. Normal and contrast CT Scan is also done whenever necessary.

• PET scan: The full form of is Positron Emission Tomography scan and is also done to find out metastasis of the stomach cancer. In this, radioactive glucose is injected intravenously, and then a scan is performed. CT scan and PET scan can also be done simultaneously.

Endoscopy and Biopsy

• Endoscopy: It is the most efficient technique to diagnose the disease. A tube containing a camera is introduced from the mouth and the whole upper GI tract is visualized live by camera. Endoscopy is more helpful as it has also the facility to take biopsy whenever any suspicious lesion is found in the GI tract.

• Biopsy: Biopsy tissue taken during endoscopy is sent to a pathologist for microscopic examination and diagnosis is made accordingly after studying that issue

Treatment of gastric cancer

Treatment depends on different stages of gastric cancer and the condition of the patient. Various treatment options are surgical removal of cancerous part, chemotherapy, radiotherapy, targeted therapy, and immunotherapy.

Surgery:

• When the tumor is in a very early stage that is from stage 0 to 1 a surgery is performed called local gastric endoscopic mucosal resection.

• When cancer is more advanced where it has spread to lymph nodes surgery with subtotal or total gastrectomy is performed. In subtotal gastrectomy, some part of the stomach is removed. While in total gastrectomy whole stomach is removed.

• When a tumor is in a much-advanced stage like stage IV, surgery is usually not advised. Other treatment options like radiotherapy or chemotherapy is recommended.

Radiotherapy:

In this high energy X-rays or other substances are used to kill the cancer cells. In gastric cancer external-beam radiation therapy means radiation is given from a machine outside the body. Tumor size will shrink after radiation therapy and afterward surgical removal of the tumor may also be planned.

Chemotherapy:

• To prevent growth, dividing, and to kill cancer cells one or a combination of more drugs are used as chemotherapy for gastric cancer. It is also used after surgical removal of the tumor to destroy the cancerous cell that remained after surgery.

• The most commonly used medicines are Cisplatin, Oxaliplatin (Eloxatin), fluorouracil (Efudex, Adrucil), Capecitabine (Xeloda), Docetaxel (Taxotere), epirubicin (Ellence), irinotecan (Camptosar), paclitaxel (Taxol), etc.

• The common side effect of chemotherapy includes generalized weakness, higher chance of getting infection, nausea, vomiting, loss of appetite, hair loss, diarrhea, etc. Different patient have different side effects and also depends on the dose of the medicine used.

Targeted Therapy:

• In this, specific genes, proteins, or the tissue environment is targeted to limit the growth and spread of the cancer cells and to prevent the healthy cells.

• Different cancer have different targets and some tests may also be done to detect the gene, protein, and other factors that help to grow the tumor.

• Targeted therapy for gastric cancer includes:

HER2 – targeted therapy: Full form of HER2 is Human Epidermal growth factor Receptor 2. In this drugs like trastuzumab (Herceptin, Ogivri, Ontruzant) in association with chemotherapy medicines are used.

Anti-angiogenesis therapy: To starve the cancer cells the process of developing new blood vessels is curbed by medicine like Ramucirumab (Cyramza) in addition to chemotherapy.

Immunotherapy:

This is also known as biologic therapy in which the immunity system of the patient is made stronger to fight against cancer. Pembrolizumab (Keytruda) is one of the medicines used in immunotherapy which is one kind of immune checkpoint inhibitor.

Supportive care:

Supportive or palliative care is much helpful in cases of cancer as the patient is broken not physically but also mentally. Individual diagnosed with cancer is much affected emotionally, socially, and many time financially also including their family members.

Supportive care experts focus on the improvement of the life quality of affected patients and their family members during the treatment of cancer. It may include medication, changes in lifestyle with nutritional changes, mental support, relaxation, and other therapies. It may support much to the patient and have a good improvement in the quality of life.

Prognosis of gastric cancer

Prognosis, outlook, or survival rate depends on many factors like early diagnosis, spread or stage of cancer, age, and general condition of the patient.

If the cancer is in the initial stage that is not spread means carcinoma in situ the outlook is good and the survival rate is more than 69%.

Cancer with stage II or more where it has started to spread in surrounding tissue or organ and nearby lymph nodes 5-year survival rate is 31%.

But survival rate is only 5% for 5 years when it has spread to a distal part of the body. Unfortunately, most gastric cancer cases are diagnosed at a later stage. Therefore the prognosis is very poor for them.

For all gastric cancer patients after diagnosis 42% of patients have a 1-year survival rate, 19% have 5 year survival rate and 15% have a 10-year survival rate.

Stages of gastric cancer

After diagnosis doctor tries to stage out from stage 0 to IV. TNM system introduced by American Joint Committee on Cancer (AJCC) is used to differentiate in the stages. In this

T stands for tumor: means size or growth of the cancer into the different layers of the stomach and surrounding organs.

N stands for lymph nodes: means spread of the tumor to localized lymph nodes.

M stands for metastasis: means spread of cancer to distal lymph nodes and/or distal organs like liver, lungs, etc.

According to this system, gastric cancer is categorized into stages like…

Stage 0 or Carcinoma in situ

Stage IA & IB

Stage IIA & IIB

Stage IIIA, IIIB & IIIC

Stage IV

Stage IV cancer can be of any size and spread to the distal organs of the body including the nearby area of the stomach.

Gastric Cancer FAQs

Note: This article is meant for educational purposes only. Please consult your doctor before taking any action. Thank you.