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Stomach Cancer

What is stomach cancer?

According to popular statistics gastric cancer or stomach cancer ranks at #3 in the most common cancer diseases and deaths associated with it.

Anatomy The stomach, which begins at the gastroesophageal junction and ends at the duodenum, consists of three parts the cardia, the fundus and the pylorus. The distribution of cancer within these regions is 15% in the upper part or cardia, 40% in the lower part or pylorus, 40% at the middle part or fundus and 10% involves both the organs. Stomach cancers develop gradually over the years. The inner lining or mucosa of the stomach undergoes precancerous changes before transitioning into full-blown cancer. Most stomach cancers go undetected because they rarely cause symptoms.

Causes

  • Gender, age and ethnicity are some of the predominant causes of gastric cancer. Men are more prone to stomach cancer than women. Individuals over the age of 50 are more susceptible to stomach cancer. Hispanic and African Americans and Asian/Pacific Islanders are prone to stomach cancer.

  • Helicobacter pylori bacterium is one of the major causes of cancer especially in the distal part of the stomach. It can also cause chronic atrophic gastritis or inflammation of the inner lining of the stomach.

  • MALT – Mucosa-associated lymphoid tissue lymphoma also known as stomach lymphoma poses a high risk of development of adenocarcinoma in the stomach.

  • Smoking and tobacco use increase the risk of non-cardiac forms of stomach cancer.

  • Previous surgery – A gastric surgery alters the normal pH of the stomach. The luminal cells thus undergo metaplastic and dysplastic changes leading to malignancy.

  • Genetics and family history – Specific mutations and hereditary syndromes such as nonpolyposis colorectal cancer, familial adenomatous polyposis, Peutz-Jeghers syndrome and Li-Fraumeni syndrome can be considered as predispositions for stomach cancer.

  • After to a partial gastrectomy for gastric ulcer, the remaining portion of the stomach may develop cancer.

  • Being overweight and obese increases the risk of gastric cardia cancer.

  • Use of oral bisphosphonates can cause gastric and oesophageal cancers.

Signs and Symptoms

Early symptoms are not noticed except when patients have incidental complaints that may point to gastric cancer. Symptoms are noted only at an advanced stage of the disease.

  • Nausea

  • Vomiting

  • Indigestion

  • Dysphagia

  • Loss of appetite

  • Dysphagia

  • Hematemesis

  • Melena

  • Loss of weight

Complications

Some late complications may include:

  • Pleural and pathologic peritoneal effusions

  • Obstructions at the gastric outlet and gastroesophageal junction

  • Oesophagal varices can cause bleeding from the stomach; anastomosis after surgery can present similar symptoms

  • Extrahepatic and intrahepatic jaundice

  • Inanition due to starvation

Diagnosis

  • Physical examination may reveal an enlarged stomach, hepatomegaly and enlarged lymph nodes. Patients may also present with pallor due to anaemia.

  • EGD – Oesophagogastroduodenoscopy with 95% accuracy will provide a colour photograph of the lesion.

  • Biopsy – At least 6 specimens of the surrounding area of the lesion is obtained

  • Endoscopic ultrasound – helps in assessing the penetration of the tumor, its depth and its involvement in the adjoining structures. It is also useful in the preoperative assessment and staging of gastric cancer.

  • Double-contrast upper GI series – helps in delineating the extent of the disease

  • Barium swallow – will examine obstructive symptoms of the cancer

  • CT scan and MRI done for the chest, pelvis and abdomen evaluate areas of spread

  • CBC or complete blood count will identify anaemia due to bleeding, poor nutrition and liver dysfunction

  • CEA or carcinoembryonic antigen and cancer antigen (CA) are elevated

  • Electrolyte panels and liver function tests help to characterize state of cancer in the patient

Treatment and Medication

Where surgery is the inevitable treatment for an advanced stage gastric cancer, planning a multidisciplinary treatment is also essential. Medication with antineoplastics and antimetabolites such as Adrucil, Xeloda, Platinum Analogs like Carboplatin and Cisplatin can inhibit cell proliferation.

Dr. Deepak and his team of surgeons will first stage the cancer and assess approach conditions to effectively treat gastric cancer.

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