Cancer Type

Stomach Cancer (Gastric Cancer)

Stomach cancer is an abnormal growth of cells that begins in the stomach. The stomach is a muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach receives and holds the food you eat and then helps to break down and digest it.

Stomach cancer, also known as gastric cancer, can affect any part of the stomach. In most of the world, stomach cancers form in the main part of the stomach (stomach body).

Who gets stomach cancer?

Men are twice as likely to get stomach cancer as women. The disease occurs most often in people over the age of 55. People with Type A blood are also at higher risk of stomach cancer.

The disease is also more common in some parts of the world, including Japan, Korea, parts of Eastern Europe and Latin America And Asian countries. People in these areas eat many foods that are preserved by drying, smoking, oily food, salting or pickling, placing the individuals at increased risk of stomach cancer.

Risk Factor.

Factors that increase the risk of stomach cancer include:

• Gastro esophageal reflux disease
• Obesity
• A diet high in salty and smoked foods
• A diet low in fruits and vegetables
• Family history of stomach cancer
• Infection with Helicobacter pylori
• Long-term stomach inflammation (gastritis)
• Smoking
• Stomach polyps

Symptoms.

Signs and symptoms of stomach cancer may include:

• Difficulty swallowing
• Feeling bloated after eating
• Feeling full after eating small amounts of food
• Heartburn
• Indigestion
• Nausea
• Stomach pain
• Unintentional weight loss
• Vomiting

When to see a doctor

If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more-common causes of these signs and symptoms first.

Causes

It's not clear what causes stomach cancer, though research has identified many factors that can increase the risk.

Doctors know that stomach cancer begins when a cell in the stomach develops changes in its DNA. A cell's DNA contains the instructions that tell the cell what to do. The changes tell the cell to grow quickly and to continue living when healthy cells would die. The accumulating cells form a tumor that can invade and destroy healthy tissue. With time, cells can break off and spread (metastasize) to other areas of the body.

Diagnosis.

The following diagnostic tools and techniques may be used to reach a stomach cancer diagnosis:

• Esophagogastroduodenoscopy (EGD), also called an upper endoscopy, which uses an endoscope to examine the esophagus, stomach and duodenum
• Endoscopic ultrasound (EUS)
• Biopsy
• Advanced genomic testing
• Blood tests, such as a complete blood count (CBC) test
• Liver function tests, to determine whether a cancer has spread
• Nutritional panel
• Computed tomography scan (CT scan)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)/CT scan
• Upper gastrointestinal series (upper GI series), also called a barium swallow X-ray

Treatment.

Treatment options for stomach cancer depend on cancer's location, stage and aggressiveness. Your doctor also considers your overall health and your preferences when creating a treatment plan.

Surgery

The goal of surgery is to remove all of cancer and some of the healthy tissue around it.

Operations used for stomach cancer include:

• Removing early-stage tumors from the stomach lining. Very small cancers limited to the inside lining of the stomach may be removed by passing special tools through an endoscope. Procedures to cut away cancer from the inside lining of the stomach include endoscopic mucosal resection and endoscopic submucosal resection.
• Removing part of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. This operation may be an option if your stomach cancer is located in the part of the stomach nearest the small intestine.
• Removing the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system. Total gastrectomy is used most often for stomach cancers that affect the body of the stomach and those that are located in the gastroesophageal junction.
• Removing lymph nodes to look for cancer. The surgeon may remove lymph nodes in your abdomen to test them for cancer.
• Surgery to relieve signs and symptoms. An operation to remove part of the stomach may relieve signs and symptoms of growing cancer in people with advanced stomach cancer.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach.

Chemotherapy can be given before surgery to help shrink cancer so that it can be more easily removed. Chemotherapy is also used after surgery to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy.

Chemotherapy may be used alone or with targeted drug therapy in people with advanced stomach cancer.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table.

For stomach cancer, radiation therapy can be used before surgery to shrink cancer so that it's more easily removed. Radiation therapy can also be used after surgery to kill any cancer cells that might remain. Radiation therapy is often combined with chemotherapy.

For advanced stomach cancer that can't be removed with surgery, radiation therapy may be used to relieve side effects, such as pain or bleeding, caused by a growing cancer.

Targeted drug therapy

Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. For stomach cancer, targeted drugs are usually combined with chemotherapy for advanced cancers or cancer that comes back after treatment.

Your doctor may test your cancer cells to see which targeted drugs are most likely to work for you.

Immunotherapy

Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make it hard for the immune system cells to recognize the cancer cells as dangerous. Immunotherapy works by interfering with that process.

For stomach cancer, immunotherapy might be used when the cancer is advanced, if it comes back or if it spreads to other parts of the body.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing aggressive 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.

Palliative care is provided by a team of doctors, nurses, and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.