Stomach Cancer: Types, Symptoms, Risk Factors, Complications, Prevention
Stomach cancer definition
Stomach cancer also known as gastric cancer, refers to cancer that develops in any part of the stomach. The stomach is an integral part of the digestive system that helps digest food. Stomach cancer occurs when cells in any area of the stomach multiply and divide abnormally. Tumors can develop anywhere in the stomach, although the majority begin in the glandular tissue of the stomach's inner surface.
Symptoms can be nonspecific in the early stages but may include chronic indigestion, unexplained weight loss, nausea, difficulty swallowing, and abdominal discomfort. Collaboration with an interprofessional team, including
oncologists,
gastroenterologists, radiologists, and surgeons, improves patient outcomes by providing complete treatment.
Stomach cancer meaning
The term "stomach cancer" is derived from the Latin word "cancer," meaning "crab," and the Greek word "karkinos", both meaning "crab." This name refers to tumors that resemble crabs and have finger-like projections. The condition primarily relates to gastric adenocarcinoma, a cancer that originates in the stomach lining and is influenced by factors like diet and chronic infections such as Helicobacter pylori.
Gastric cancer prevalence
Gastric cancer statistics worldwide
In 2020, stomach cancer caused around 11 lakh new cases in the world, making it the fifth most prevalent cancer and the fourth most common cause of cancer-related deaths, with approximately 7,70,000 fatalities reported that year. The incidence rates show significant regional diversity, with the highest rates seen in Eastern Asia, specifically in nations like China and Japan.
Gastric cancer statistics in India
In India, the northeastern state of Mizoram has the highest prevalence of stomach cancer, with an age-adjusted incidence rate of nearly 50.6 per 100,000 persons. On the other hand, states like Madhya Pradesh have much lower rates, with an incidence of around 1.6 per 100,000 people, demonstrating the regional variations in stomach cancer prevalence across India.
Types of stomach cancer
Stomach cancer, commonly referred to as gastric cancer, is categorized into several types based on the tumor's origin and histological features. The most common type is adenocarcinoma, which accounts for approximately 90-95% of stomach cancers. The following are the main types of stomach cancer:
- Adenocarcinoma of the stomach
- Gastroesophageal junction adenocarcinoma (GEJ)
- Gastrointestinal neuroendocrine tumors
- Gastrointestinal stromal tumors (GIST)
- Primary gastric lymphoma
Adenocarcinoma of the stomach: It begins with mucus-producing cells in the stomach's innermost lining. Adenocarcinoma accounts for nearly all stomach cancers. Stomach adenocarcinoma is classified into two types based on where cancer develops in the stomach:
- Gastric cardia cancer: It develops in the upper portion of the stomach, right below where it enters the esophagus.
- Non-cardia gastric cancer: It develops in all other parts of the stomach.
Adenocarcinoma of the stomach can be classified as intestinal or diffuse, based on how the cells appear under a microscope:
- Intestinal adenocarcinomas: These are well differentiated, which means the cancer cells look similar to normal cells under a microscope.
- Diffuse adenocarcinomas: These are undifferentiated or poorly differentiated, which means the cancer cells seem different from normal cells under a microscope. They grow and spread faster than intestinal cancers and are more difficult to treat.
Gastroesophageal junction adenocarcinoma (GEJ): This cancer develops where the esophagus meets the stomach cardia. GEJ cancers can be treated similarly to stomach cancer or esophageal cancer.
Gastrointestinal neuroendocrine tumors: These are cancers that start in neuroendocrine cells (a type of cell that is both a nerve cell and a hormone-producing cell) in the gastrointestinal system. Neuroendocrine cells produce hormones that regulate digestive juices and the muscles responsible for transporting food through the stomach and intestines.
Gastrointestinal stromal tumors (GIST): These originate in nerve cells present in the stomach wall and other digestive organs. GIST is classified a soft tissue sarcoma.
Primary gastric lymphoma: It is a non-Hodgkin lymphoma that originates in the stomach. The majority of primary gastric lymphomas are mucosa-associated lymphoid tissue (MALT) or diffuse large B-cell lymphoma of the stomach.
Other types of cancer, squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, can also develop in the stomach.
Stomach cancer symptoms
Stomach cancer rarely causes symptoms in its starting stages, making it difficult to diagnose. Symptoms of stomach cancer typically appear after the cancer has spread. Below are the signs and symptoms of stomach cancer:
Early symptoms of stomach cancer
Symptoms of stomach cancer in its early stages may include:
- Indigestion
- Stomach discomfort
- Loss of appetite
- Mild nausea
- Heartburn
- Feeling bloated after eating
Late-stage stomach cancer symptoms
Symptoms of advanced stomach cancer (cancer that spreads outside the stomach to other areas of the body) may include symptoms of early-stage stomach cancer and also the following symptoms:
- Unintended weight loss
- Blood in the stool
- Vomiting
- Stomach pain
- Unexplained weakness or tiredness
- Jaundice (yellowish discoloration of eyes and skin)
- Ascites (buildup of fluid in the abdomen)
- Difficulty in swallowing
- Dark coloured or sticky stool
Stomach cancer causes and risk factors
Though the exact cause of stomach cancer is not known, there are numerous factors that can increase the risk of stomach cancer. Below are the risk factors of stomach cancer:
Modifiable risk factors
- Helicobacter pylori infection: Chronic infection of the stomach mucosal layer with H. pylori is a major risk factor for developing stomach cancer. This bacterium is transmitted from one person to another through direct contact with vomit, saliva, or stool. However, many people with persistent H. pylori infections do not have symptoms; some develop stomach ulcers or atrophic gastritis (inflammation of the stomach).
- Dietary factors: High salt intake (salt-preserved foods), N-nitroso compound consumption, smoking, a vitamin A and vitamin C deficient diet, excessive consumption of smoked or cured foods, a lack of refrigerated foods, and contaminated drinking water are also considered as dietary risk factors.
- Smoking: Individuals who smoke regularly are more prone to develop stomach cancer than nonsmokers. Additionally, smoking reduces the efficacy of H. pylori treatment. Smokers who stop smoking can reduce their chances of developing stomach cancer over time.
- Obesity: High body mass index (BMI) raises the risk of proximal gastric and GEJ cancers.
- Alcohol consumption: Consuming more amounts of alcohol has been linked to an increased risk of gastric cancer. Alcohol may contribute to carcinogenesis because of its metabolic byproducts and effects on nutritional absorption.
Non-modifiable risk factors
- Age: The incidence of stomach cancer rises with age, with most cases affecting people over the age of 50.
- Gender: Men are at a greater risk of developing stomach cancer than women, with studies indicated considerable gender differences in incidence rates.
- Genetic predispositions: Genetic factors influence stomach cancer risk, with specific inherited conditions increasing susceptibility. For example, mutations in genes like CDH1 are associated with hereditary diffuse gastric cancer (HDGC) syndrome.
- Family history: A family history of stomach cancer increases an individual's risk, indicating both environmental and genetic variables may contribute to this increased susceptibility.
Complications of stomach cancer
Stomach cancer or gastric cancer can cause several complications, mainly in the advanced stages. These consequences can have a major impact on the patient's quality of life and long-term prognosis. The following are the main complications related to stomach cancer:
- Gastrointestinal bleeding: Tumor erosion into blood vessels can cause bleeding, resulting in haematemesis (bloody vomit) or melena (black, tarry stools). This condition can cause significant anemia and may require immediate medical intervention.
- Gastric perforation: The tumor may spread through the stomach wall, resulting in perforation. This causes bleeding of gastric contents into the abdominal cavity, leading to peritonitis, a life-threatening condition that requires rapid surgical treatment.
- Bowel obstruction: Stomach cancer can result in gastrointestinal tract obstruction, especially if the tumor is near the pylorus or if it has metastasized to the peritoneum. Symptoms include severe abdominal discomfort, vomiting, and the inability to pass faeces or gas.
- Ascites: Fluid accumulation in the abdominal cavity called ascites, is prevalent in individuals with advanced gastric cancer, particularly those with peritoneal metastasis. This may result in abdominal swelling and discomfort.
- Obstructive jaundice: If the cancer advances to the bile ducts, it can cause obstructive jaundice, which yellows the skin and eyes. Biliary drainage procedures may be necessary to reduce symptoms in this condition.
- Malnutrition: Malnutrition is common among patients because of symptoms such as loss of appetite, nausea, and early fullness. This can cause weight loss and further deteriorate the patient's overall condition.
- Thrombosis: Patients with stomach cancer are at a higher risk for thromboembolic events, such as
deep vein thrombosis (DVT) and pulmonary embolism (PE), due to parameters like immobility and hypercoagulability associated with cancer.
Stomach cancer diagnosis
The diagnosis of stomach cancer (gastric cancer) requires a systematic approach that comprises a few essential steps. Below are the steps involved in the diagnosis of stomach cancer:
- Personal and family medical history
- Physical examination
- Blood tests
- Complete blood count
- Comprehensive metabolic panel
- Tumor markers: CA 19-9 and Carcinoembryonic Antigen (CEA)
- Stool tests
- Imaging tests
- X rays
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Positron emission tomography (PET) scan
- Ultrasound
- Barium swallow
- Endoscopic procedures
- Upper endoscopy (EGD)
- Endoscopic ultrasound (EUS)
- Laparoscopy
- Biopsy
- Biomarker testing
- HER2
- PD-L1
- Microsatellite instability (MSI)
- Mismatch repair deficiency(dMMR)
- Tumor mutational burden (TMB)
- NTRK.
Stomach cancer treatment
Once the diagnosis and the stage of the cancer is confirmed, the Medical Oncologist and the Surgical Oncologist decide the stomach cancer treatment based on the stage and general condition of the patient.
There are different types of treatment for patients with stomach cancer, such as:
- Surgery
- Curative Surgery: Total Gastrectomy, Subtotal Gastrectomy
- Endoscopic Resection: Gastrointestinal endoscopic mucosal resection (EMR), Endoscopic submucosal dissection (ESD)
- Chemotherapy
- Radiation therapy
- Chemoradiation
- Targeted therapy
- Immunotherapy
Stomach cancer prevention
The main goal of primary prevention is to eliminate or minimize illness risk factors to prevent their occurrence. Below are some of the preventive measures for stomach cancer:
- Maintaining a healthy diet: Consuming a diet high in fruits, vegetables, and whole grains while eliminating processed and red meats, which have been associated with an increase in cancer risk. Intake of vitamin C rich vegetables and fruits may lower the incidence of stomach cancer.
- Avoiding smoking and excessive alcohol: Smoking cessation and reducing consumption of alcohol is essential because both are high-risk factors for stomach cancer. Smoking cessation can significantly reduce the risk over time.
- Regular physical activity: Regular exercise promotes a healthy weight and reduces the likelihood of numerous cancers, including stomach cancer. People should plan for at least 30 minutes of moderate activity on most days.
- Maintaining a healthy weight: Maintaining a healthy body weight (BMI less than 25) can help minimize the risk of stomach cancer, as obesity is related to greater incidence rates.
- Treating H. pylori Infection: Chronic Helicobacter pylori infection is related to an increased risk of gastric cancer. Treating this illness with suitable medications can help decrease risk.
- Limiting salt and smoked foods: Reducing high-salt intake and avoiding smoked or pickled foods can lessen the risk, as these foods may harm the stomach lining.
- Regular screening and check-ups: Regular medical check-ups and screenings can help in the early detection of precancerous diseases, thus ensuring proper treatment.
Difference between Stomach ulcer and Cancer
Stomach ulcer vs Cancer
Stomach ulcers and stomach cancer are two separate gastrointestinal conditions that can have a major impact on a person's health. While they may have some similar symptoms, the underlying causes, modalities of treatment, and implications for patient prognosis are wildely distinct. Understanding these differences is crucial for correct diagnosis and treatment.
Below are the parameters that help in differentiating stomach ulcers and stomach cancer:
| Parameters | Stomach ulcer | Stomach cancer |
|---|---|---|
| Definition | A sore on the stomach's lining that results from erosion. | A cancerous tumour in the stomach lining or tissue. |
| Causes | Frequently caused by Helicobacter pylori infection, NSAIDs, or high acid production. | Chronic inflammation, H. pylori infection, genetic predisposition, and environmental effects. |
| Symptoms | Symptoms include abdominal pain, bloating, indigestion, nausea, and perhaps bleeding. | Unexplained weight loss, swallowing difficulties, stomach pain, and gastrointestinal bleeding. |
| Diagnosis | Endoscopy, biopsies, and imaging tests such as X-rays or CT scans are used to make the diagnosis. | Endoscopic biopsies, imaging tests (CT, MRI), and biomarker analysis are used to make the diagnosis. |
| Treatment options | Treatment includes medications (antacids, proton pump inhibitors), lifestyle adjustments, and, in severe cases, surgery. | Surgery (gastrectomy), chemotherapy, radiotherapy, targeted therapy, and immunotherapy are all options for treatment. |
Frequently Asked Questions (FAQs) on Stomach cancer
Is stomach cancer curable?
Stomach cancer can be cured, especially in the early stages. Surgical resection is the primary curative treatment, with a 5-year survival rate of over 95% for early-stage gastric cancer patients. However, survival chances decrease considerably in later stages, emphasizing the need for early diagnosis and care.
Is stomach cancer genetic?
Stomach cancer can have a genetic component, particularly in hereditary disorders such as hereditary diffuse gastric cancer (HDGC), which is related to CDH1 gene changes and increases the risk of developing stomach cancer by up to 70%. Other syndromes, such as Lynch syndrome and familial adenomatous polyposis, contribute to hereditary susceptibility but account for a lower percentage of overall cases.
What happens if stomach cancer is left untreated?
If stomach cancer remains untreated, it usually spreads quickly, progressing from early to advanced stages in about 34 months. The median survival rate for untreated individuals varies considerably by stage, with a 5-year survival rate of nearly 46.2% for stage I and decreasing to 0% for stages II, III, and IV, illustrating a poor prognosis as the disease advances without intervention.
Can ultrasound detect stomach cancer?
Ultrasound can identify stomach cancer; however, its efficacy varies depending on the disease stage. Studies have shown that transabdominal ultrasonography is more effective in detecting advanced gastric cancers (stages pT2 and above), but early-stage cancers (pT1) are frequently missed. Ultrasound has a reported sensitivity of nearly 92.5% for diagnosing stomach cancer, making it a helpful tool in the diagnostic procedure. However, endoscopy with biopsy remains the gold standard.
Can aspirin cause stomach cancer?
Aspirin is often associated with a lower risk of stomach cancer rather than an increase in it. Studies have shown that intake of aspirin on a regular basis can reduce the risk by 20% to 54%, depending on the dosage and frequency. While aspirin may cause stomach mucosal injury, its overall influence appears to prevent the development of gastric cancer.
Can stomach cancer cause back pain?
Stomach cancer can cause back pain, especially in the more advanced stages when the cancer has spread to nearby tissues or bones. As the condition progresses, patients may have back pain, which is frequently accompanied by abdominal discomfort and weight loss. While back pain is not a common first symptom, it can arise in some situations, especially when there are complications such as bone metastasis.
What is the prognosis for stomach cancer?
The prognosis for stomach cancer differs considerably depending on the stage of diagnosis. The overall 5-year relative survival rate is approximately 36%, with rates of 75% for localized cancer, 36% for regional spread, and only 7% for metastatic cancer. Early diagnosis is essential because survival rates drop severely in advanced stages, emphasizing the necessity of quick diagnosis and therapeutic approaches.
Are all stomach nodules cancerous?
Not all stomach nodules are malignant(cancerous); some may be benign illnesses like polyps or inflammatory lesions. While gastric cancer is primarily diagnosed as adenocarcinomas, the majority of stomach nodules require further investigation via endoscopy and biopsy to confirm their etiology, as only a small number proceed to malignancy. Early diagnosis and classification of benign and malignant nodules are essential for successful management and treatment.
The fourth stage of stomach cancer is called as metastatic stomach cancer. In this stage, the cancer spreads outside the stomach to other organs, such as the liver, lungs, or peritoneum, significantly lowering the prognosis. At this stage, treatment is often focused on palliative care to reduce symptoms rather than curative treatment.
Stomach Cancer Awareness Month is held every November. This month's goal is to promote awareness of stomach cancer, its symptoms, risk factors, and the significance of early identification and treatment choices. The effort began in 2010 with the goal of educating the public and promoting research to improve results in the treatment of this frequently ignored condition.
How long is chemotherapy for stomach cancer?
Chemotherapy for stomach cancer usually takes three to six months, depending on the treatment regimen and type of chemotherapy used. Treatment is often given in cycles, with sessions every two to four weeks to allow time for recovering between doses. For example, a typical regimen may include six cycles over a period of around five months.
How long does it take to develop stomach cancer?
Stomach cancer often develops over several years, advancing slowly from basic cellular alterations to severe stages. Early gastric cancer can have a doubling period of 577 to 3462 days, whereas advanced cases can double in size within 69 to 305 days, illustrating variation in growth rates based on the stage and individual factors.
Can barium swallow detect stomach cancer?
A barium swallow can help diagnose stomach cancer by outlining the stomach and showing X-ray abnormalities like tumors or ulcers. However, its sensitivity for early gastric cancer is relatively low, with false-negative rates reaching up to 50%, making it less dependable for conclusive diagnosis compared to endoscopy, which is still the gold standard for finding alarming lesions and getting specimens.
Can you feel stomach cancer by touching your stomach?
Touching one's stomach will usually not detect stomach cancer, particularly in the early stages when symptoms are generally nonspecific or mild. In advanced cases, a palpable epigastric mass may be seen during a physical examination, indicating a significant tumor or metastasis. Most symptoms, like as abdominal pain and weight loss, usually develop later and are not identified through touch alone.
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