Stomach cancer is also called gastric cancer.

Stomach cancer

Stomach cancer is also called gastric cancer. After swallowing, food passes through the esophagus (food pipe). The food then enters a pouch-like organ in the upper part of the stomach called the stomach. The stomach (stomach) receives food and begins to digest it by secreting gastric juices. The stomach passes the food mixed with gastric juice into the first part of the small intestine.

How does cancer develop?

Cancer starts when there is an error (mutation) in the DNA of the cell. These cells then divide uncontrollably and continue to grow. These cells combine to form cancer. The abdominal wall is made up of five layers of tissue. Stomach cancer, also called gastric cancer, begins in the mucus-producing cells in the innermost layer of the stomach. It then grows and spreads. It first spreads in the stomach wall and then increases and spreads in the surrounding tissues. Later it spreads to the liver, lungs and peritoneum.

Stomach cancer is the 5th most common cancer in the world. Gastric cancer affects more than 1 million people worldwide every year.

Colon cancer in India

Stomach cancer is the second leading cause of cancer deaths in India. Stomach cancer is less common in India than in developed countries. Stomach cancer is more common in southern and northeastern states of India. It is estimated that approximately 50,000 new cases of gastric cancer occur each year. Stomach cancer is the fourth most common cancer in India.

Types of stomach cancer

Adenocarcinoma (adenocarcinoma); Most common subtype (90-95%)

Gastrointestinal stromal tumor (GIST)

Neuroendocrine tumor (NET)

Lymphoma

Causes and risk factors of breast cancer

Anything that increases someone's risk of developing cancer is called a risk factor. A risk factor does not cause the disease, it only increases the risk. Some people do not get cancer despite having many risk factors, while some people get cancer despite having no risk factors.

Risk factors for colon cancer are:

old age

Men are twice as likely to develop stomach cancer as compared to women

Infection with a bacterium called H. pylori

gastritis

Pernicious anemia

Some types of polyps in the stomach

smoking

obesity

A diet rich in smoked, pickled or salty foods

A diet low in fruits and vegetables

Family history of stomach cancer

Stomach cancer symptoms

Stomach cancer is relatively rare compared to other cancers, but one of the biggest dangers of this disease is not being detected. Like other stomach cancers, gastric cancer usually has no symptoms in its early stages. It is often caught after spreading to other parts of the body. This makes it difficult to treat.

Symptoms of stomach cancer include:

Indigestion, heartburn and flatulence

Constantly feeling weak or tired

Lack of appetite

lose weight

Decrease in hemoglobin (anemia)

Stomach pain or discomfort

Spots of red blood in the stool or black stools

Feeling full after eating a small amount of food

Nausea and vomiting (with or without blood)

Upper abdominal discomfort

Note that many of these symptoms can occur in other diseases besides colon cancer.

Stomach cancer screening and testing (diagnosis)

Health examination

Understanding the symptoms and checking the signs by a doctor is essential to diagnose the disease.

Endoscopy

Colon cancer is confirmed by endoscopy.

An endoscope is a flexible, thin tube that contains a camera. It transmits an image of the inside of your stomach to a monitor. If an abnormality is found, a small sample is also taken from it, which is called a biopsy.

Biopsy

Biopsy means taking a small sample of a tumor and examining it under a microscope. This is done by a pathologist. Gene testing can also be done on biopsy samples if needed.

Staging

The severity or stage of stomach cancer is estimated by looking at where the tumor is in the stomach, how far it has spread into the stomach tissues, and if it has spread outside the stomach to other internal organs of the body. .

Cancer cells come out of the tumor and spread in the body in three ways;

through the blood

through the lymphatic

directly in the surrounding tissues

Cancer can spread locally, to the stomach, surrounding tissues and lymph nodes. Or it can be distant, in the liver, lungs and the lining of the abdomen (peritoneum). When cancer spreads to distant organs, it is called metastasis.

Staging is determining the spread of the disease. After colon cancer is diagnosed, we do tests to find out how far the tumor has spread. For this we do some of the following tests.

Blood test: Different types of elements are checked in the blood. Some patients have anemia (low hemoglobin). Apart from this, liver and kidney tests are also done.

Computed Tomography (CT) Scan: In this test, the patient is placed in a CT scanner. X-rays then take images of the internal organs from all sides. Computers develop these images and give us precise information about the internal situation. By injecting contrast we get a better image.

Positron emission tomography (PET) scan: Cancer cells take up too much glucose. In this test, radioactive glucose (18F-fluorodeoxy; FDG) is injected. This radioactive glucose goes into the tumor which we can see with the scanner.

Endoscopic ultrasound (EUS): This is an ultrasound of the abdomen from the inside. It is useful in small tumors. It looks at how far the cancer has spread to the lining of the stomach and nearby lymph nodes.

Laparoscopy: CT and PET scans cannot detect small tumors. In laparoscopy, a thin camera is inserted through a small hole in your abdomen and small tumors can be detected on the liver and peritoneal surface (membrane inside the abdomen).

These tests help us provide a stage of the cancer. Broadly we classify cancer into three categories:

Localized - The cancer is confined to the organ in which it started.

Local spread - the cancer has spread to nearby lymph nodes or has spread beyond the walls of the organ in which it started.

Distant spread - Cancer has spread to distant organs, away from the organ of origin of the tumor. This is called metastasis.

TNM (Tumor, Node and Metastasis) classification

This classification was developed by the American Joint Committee on Cancer (AJCC). It is used to accurately classify the stage of cancer. It is based on the following three main elements and ranges from Stage I to IV.

Tumor size (T): How far has the cancer spread into the layers of the stomach? Has the cancer spread to nearby structures or organs?

Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? And how many lymph nodes?

Metastasis (M): Has the cancer spread to distant lymph nodes or distant organs such as the liver or lungs?

T, N and M are followed by numbers and letters that give more details. The higher the number, the more advanced the cancer. By combining information from T, N and M we provide a stage of cancer. Colorectal cancer ranges from stages I to IV.

Stages I to III are localized disease and stage IV is cancer that has spread (metastatic disease).

The chances of recovering from cancer depend on the stage of the cancer at the time of treatment. The fewer the steps the better the chances.

Stomach cancer treatment

Colon cancer treatment depends on the stage of the tumor. The primary treatment for early stage colon cancer is surgery.

To achieve the best results in advanced cancer (local spread), chemotherapy and/or radiotherapy and surgery are combined, which is called multimodal treatment. Depending on the spread of the tumor, chemotherapy or chemoradiation may be given before surgery or after surgery.

Surgery for localized stomach cancer - gastrectomy

Surgery is the primary treatment for early stage cancer. In this, the cancerous part of the intestine is removed along with the surrounding lymph nodes and omentum. Then the cut parts of the intestine are joined together to re-establish the continuity of the intestine (anastomosis).

There are two ways to perform a gastrectomy;

Open, etc

laparoscopic or robotic

In open surgery, a single long incision is made to perform the surgery on the abdomen.

Laparoscopic surgery is a special technique of operating, also known as key-hole surgery, minimally invasive surgery or minimal access surgery. In this, instead of a large incision, the operation is performed by inserting special instruments and a camera through small holes on your abdomen. These devices are made thin and long with special construction. The camera projects high-resolution images of the inside of your abdomen onto a large screen, which allows the surgeon to operate inside the abdomen. This technique is one of the most important innovations in the surgical field in the last few decades which has revolutionized the field of abdominal surgery. This surgical technique is now available and valid for most abdominal operations. The use of this technique is also beneficial in the operation of stomach cancer.

Benefits of laparoscopic surgery

Open abdominal surgery requires a large incision and due to this, it takes time to recover and a long stay in the hospital. Minimally invasive surgery means "less pain", "minimum scars" and "quick recovery". Shorter stays in ICU and hospital. Because of the larger view of the inside of the abdomen on a large monitor, blood loss during surgery is reduced. You can quickly start walking and feeding by mouth. Compared to open surgery, the risk of infection and hernia is also less.

Treatment of advanced (spread) stomach cancer

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Many medicines are given together for better results. These are given in a specific order on specific days as a cycle.

Adjuvant chemo - In patients with localized colon cancer, chemotherapy is usually given after surgery. It destroys those cells that remain in the body even after the operation. The decision to give chemotherapy depends on the surgical stage. In this way, chemotherapy helps reduce the risk of cancer recurrence and death from cancer.

Neoadjuvant chemo - If the tumor has grown excessively, chemotherapy is given before surgery. This will shrink the cancer and give better results from the subsequent operation.

Palliative chemo - Chemotherapy in metastatic (spread) cancer prolongs life and improves its quality.

Targeted therapy

Substances that identify and target cancer cells without harming normal cells. Targeted therapy for colon cancer includes HER2-targeted therapy and anti-angiogenesis therapy.

Immunotherapy

It uses the patient's immune system to fight cancer. Immune checkpoint inhibitor therapy is a type of immunotherapy.

radiation therapy

Radiation therapy uses high-energy X-rays to destroy cancer cells. People with stomach cancer usually receive external beam radiation therapy, which is radiation delivered from a machine outside the body. Radiation therapy may be used before or after surgery to shrink the size of the tumor or destroy any remaining cancer cells.

Palliative treatment

Palliative treatment relieves symptoms and improves quality of life. It is given when the tumor is very advanced or disseminated. Patients unfit for major surgery are also treated with palliative intent. Blockages can be opened by inserting a stent (a hollow metal tube) into the stomach. Chemotherapy prolongs life and improves its quality. Sometimes surgery like gastrojejunostomy or gastrectomy is also required for this.

Prognosis

Survival rates

According to the American Cancer Society, the percentage of people who survive at least five years after being diagnosed with colon cancer is 68-82% for stage II and 18-54% for stage III cancer.

How to reduce the risk of stomach cancer?

We can classify the risk factors of colon cancer into modifiable and non-modifiable. Age and genetic factors are non-changeable and we cannot do anything about it. But we can reduce the risk by avoiding those risk factors that we can control.

We can reduce our risk by taking the following steps:

Keep your weight under control

Do regular physical activity and exercise

Eat a healthy diet that is especially rich in fibrous fruits, vegetables, and whole grains, while avoiding processed foods.

Reduce intake of salty and smoked foods

Avoid smoking and tobacco

Do not consume alcohol

Get treatment for H pylori infection