Stomach Cancer

What is stomach cancer?

Stomach cancer usually begins in the cells that line the stomach and produce mucus. This type of cancer is called adenocarcinoma.

In the last decades, the cancer rate in the main part of the stomach (body part of the stomach) has shown a decrease worldwide. In the meantime, cancer became much more common in the area where the upper part of the stomach (cardia) and lower end of esophagus meet. This part of the stomach is named gastroesophageal junction.

What are the signs of stomach cancer? 

The signs and indications of gastroesophageal junction cancer and stomach cancer include the following:

  • Fatigue
  • Feeling distension after eatingmide kanseri
  • Feeling full after eating a small serving of food
  • Serious, insistent heartburn
  • Constant severe indigestion
  • Inexplicable and insistent nausea
  • Stomachache
  • Insistent vomiting
  • Inexplicable weight loss

If you are experiencing concerning signs and indications, schedule an appointment with your physician. Most probably, your physician will investigate the more common reasons of these signs and indications, at first.

What are the reasons of stomach cancer?

Generally, cancer starts when a fault (mutation) occurs in the cell DNA. This mutation causes these cells to grow in size and increase in number and allows a cell to sustain its life even after the time when it has to die. Accumulated cancer cells can create a tumor which can invade the nearby structures. Afterwards, cancer cells can separate from the tumor in order to spread to the rest of the body.

Gastroesophageal junction cancer is related to the disease of gastrointestinal reflux (GERD) and to obesity and smoking, less frequently. GERD is a condition which occurs with sending the gastric acid back to esophagus, frequently.

There is a strong correlation between the main part of stomach and stomach cancer with the nutrition types, which are rich in smoked and pickled foods. As the use of refrigerator has increased all around the world in order to protect nutrition, the stomach ache rates have decreased.

What are the risk factors of stomach cancer?

The main risk factors for gastroesophageal junction cancer is the history of GERD and obesity .

The factors which will increase your risk of having inner-stomach cancer include the following:

  • The nutrition type which is rich in salt and smoked products
  • The nutrition type which is poor of fruit and vegetables
  • Eating foods which are contaminated with a fungus, called aflatoxin
  • Having a history of stomach cancer in family
  • Helicobacter pylori infection
  • Long-term gastroenteritis
  • Pernicious anemia
  • Smoking
  • Stomach polyps

What can be done to prevent stomach cancer?

It is not certain what causes gastroesophageal junction or stomach cancer, so there is not a way to prevent it. By making changes in your daily life, you can take the necessary steps in order to reduce the risk of gastroesophageal junction and stomach cancer. For example, try to do the following:

  • Exercise. Regular exercise has been associated with the reduction of stomach cancer. In most of the days of the week, try to add physical activity into your daily routine in a way.
  • Eat more fruit and vegetables. Try to add more fruit and vegetables into your daily nutrition. Choose various and colorful fruit and vegetables.
  • Reduce the amount of salty and smoked food that you eat. Protect your stomach by limiting these foods.
  • Do not smoke. If you are smoking, stop. If you are not smoking, do not start. Smoking increases the risk of stomach cancer as well as many others. Quitting smoking can be difficult, for this reason, ask your physician’s help.
  • Consult your physician about your risk of gastroesophageal junction and stomach cancers. Consult your physician if you have a high risk of gastroesophageal junction and stomach cancers. Together with your physician, you can consider periodical endoscopy to seek for the signs of stomach cancer.

How is stomach cancer diagnosed?

The tests and processes, used in order to diagnose gastroesophageal junction and stomach cancers, are as follows:

  • The small camera, used to see inside your stomach, (upper endoscopy). A thin hose, carrying a small camera, is pushed down to your stomach. Your physician looks for the signs of cancer. If a suspicious field is found, a small piece of tissue can be taken in order to examine (biopsy).
  • Imaging tests. Computerized tomography (CT) and sometimes a special X-Ray test, named fluoroscopy, are among the imaging tests, which are used in order to examine stomach cancer.

How is the spread of stomach cancer (its stage) determined?

The phase of your stomach cancer will help your physician decide on the best treatments for you. The tests and processes, used in order to determine the stage of cancer, include the following:

  • Imaging tests. Among these tests, CT and positron emission tomography (PET) can be included.
  • Exploratory surgery. Your physician can recommend surgery in order to look for the signs that your cancer spread into your abdominal cavity by exceeding through your esophagus or stomach. The exploratory surgery is mostly made with the laparoscopic method. This means the sturgeon will cut a small part from the wall of your stomach and put a special small camera into your stomach, which will transfer the images to a screen in the operating room.

Depending on your situation, other staging tests can be used.

What are the stages of stomach cancer?

The stages of stomach or esophagus adenocarcinoma include the following:

  • Stage I. In this stage, the tumor is limited with the tissue layer which covers the inner surface of esophagus or stomach. The cancer cells might have spread to the nearby lymph nodes in small numbers.
  • Stage II. In this stage, the cancer has spread into deeper areas by growing into a deeper muscle layer of esophagus or stomach wall. The cancer might have spread to higher number of lymph nodes.
  • Stage III. In this stage, the cancer might have grown in all layers of esophagus or stomach and spread to nearby structures. Or it can be a smaller cancer which widely involves the lymph nodes.
  • Stage IV. This phase shows that the cancer spread to the distant areas of body.

What are the treatment methods of stomach cancer?

The available treatment options for gastroesophageal junction or stomach cancers depend on the stage of your cancer, general status of health and preferences.

Surgical Intervention

Stomach cancer surgery is required to remove the area, where the tumor is located in esophagus or stomach, in case of a gastroesophageal junction cancer which does not spread.  The goal of the operation is to remove all of the cancer and healthy tissue around the cancer inside stomach, if possible. The nearby lymph nodes are also generally removed.

The goal of the stomach cancer operation is to remove all of the stomach cancer and healthy tissue around it, if possible. Among the available options, the following ones are included:

  • Removal of early stage tumors from inner gastric lining. Very small cancers, limited with the cells which cover the inner surface of stomach, can be removed with an operation, named endoscopic mucosal resection by using an endoscope. Endoscope is a hose, which is moved down towards your stomach from your throat and has a camera and light source. The physician uses special tools in order to remove the stomach cancer and a part of healthy tissue around its edge.
  • Removal of a part of stomach (subtotal gastrectomy). In subtotal gastrectomy, the surgeon removes only the part of stomach which is affected by cancer.
  • Removal of entire stomach (total gastrectomy). Total gastrectomy includes the removal of entire stomach and a part of tissue around it. Later on, esophagus is directly connected to small intestine in order to allow foods to move throughout the digestive system.
  • Removal of lymph nodes to examine cancer. The surgeon examines and removes the lymph nodes inside your abdominal cavity in order to search the cancer cells.
  • The operation which aims to alleviate the findings and indications. By the removal of a part of stomach, the findings and indications, which people with advanced stomach cancers experience, can be alleviated. In this case, the operation does not cure the advanced stomach cancer, but it can make you feel better.

The operation has the risks of bleeding and infection. You can experience digestion problems, if your entire stomach or a part of it is removed.

Radiation treatment.

Radiation treatment uses strong energy bundles, such as X-Rays and protons, in order to kill cancer cells. Energy bundles are created by a machine which moves around you while you are lying on the table.

Like how it is in stomach cancer, the radiation treatment can be used in order to reduce the size of the tumor to be able to remove it easier in gastroesophageal junction cancer (neoadjuvant radiation). Radiation treatment can be used after the operation in order to kill the cancer cells which might be left around your esophagus or stomach (neoadjuvant radiation).

In gastroesophageal junction cancer, radiation and chemotherapy are used the most before the operation at the same time (chemoradiotherapy).

Receiving a radiation treatment in your stomach can cause diarrhea, indigestion, nausea and vomiting. Radiation treatment for esophagus can cause pain and difficulties while swallowing. In order to avoid these side-effects, it can be recommended to use a feeding tube, which is put into your stomach through a small incision in your stomach until your esophagus is recovered.

In advanced cancer cases, radiation treatment can be used in order to alleviate the side-effects, caused by a large tumor.

Chemotherapy

Chemotherapy is a medical treatment, in which chemicals are used to kill cancer cells. Chemotherapy medicines kill cancer cells, which might have spread beyond stomach by circulating around the general body.

Chemotherapy can be given before an operation to help to reduce the size of a tumor in order to remove it easier (neoadjuvant chemotherapy). Chemotherapy can also be given to kill the cancer cells that might be left after operation (adjuvant chemotherapy). Chemotherapy is frequently combined with radiation treatment. Chemotherapy can be used alone in the people, diagnosed with advanced stomach cancers, in order to help alleviation of the findings and indications.

The side-effects of chemotherapy belong to the used medicines.

Medicines used in goal-oriented treatment

Goal-oriented treatment uses the medicine, which attacks specific anomalies in cancer cells or directs your immune system to kill cancer cells (immunotherapy). The following ones are included in the goal-oriented treatment to treat stomach cancer:

  • Trastuzumab (Herceptin) – For stomach cancer cells which produce excessive amount of HER2.
  • Ramucirumab (Cyramza) – For advanced stomach cancers which do not give any response to other treatments.
  • İmatinib (Gleevec) – For a rare type of stomach cancer, named gastrointestinal stromal tumor.
  • Sunitinib (Sutent) – For gastrointestinal stromal tumors
  • Regorafenib (Stivarga) – For gastrointestinal stromal tumors

For the treatment of gastroesophageal junction cancer, the medicines, with various goals, are studied, but only two of these medicines (ramusirumab and trastuzumab) have been approved to be used.

The goal-oriented medicines are generally used together with standard chemotherapy medicines. The examinations which will be made on your cancer cells will show your physician the possibility of these treatments to work on you.

Supplementary (palliative) treatment

Palliative treatment is a special medical care which focuses on alleviating the pain and other indications of serious diseases. Palliative care specialists work together with you, your family and other physicians in order to provide a separate support, capable of complementing your ongoing treatment. Palliative care can be used while taking such aggressive treatments as operation, chemotherapy or radiation.

When palliative care is used together with other compatible treatments, people, suffering from cancer, can feel better and live longer.

Palliative care is provided by a team, which includes physicians, nurses and specially trained other health experts. Palliative treatment teams intend to increase the life qualities of people, suffering from cancer, and their families. This type of care is provided as well as medicinal treatments or other treatments.

Potential treatments

All around the world, researchers are working on new medicines, which are named immunotherapy and benefit from the strength of immune system, in order to eliminate cancer.