Understanding Stomach Cancer: A Comprehensive Guide

Introduction

Stomach cancer, also known as gastric cancer, has been a significant global health concern since the late 19th century. Its history is marked by both advancements in medical technology and shifts in dietary habits. Over the years, the incidence of stomach cancer has decreased in many countries, thanks to improvements in food preservation and increased understanding of risk factors. However, it remains one of the leading causes of cancer-related deaths worldwide. This article aims to provide comprehensive information about stomach cancer, enabling you to understand its nature, progression, and risk factors. Our goal is to guide you towards informed discussions with your healthcare provider and to empower you with knowledge for your health journey.

Description of Stomach Cancer

Stomach cancer is a disease characterized by the uncontrolled growth of cells in the lining of the stomach. This abnormal growth can lead to the development of a tumor, which can then invade nearby structures or spread (metastasize) to other parts of the body.

The progression of stomach cancer is typically categorized into four stages. Early stages (I and II) are generally confined to the stomach lining and may not present any symptoms. As the disease progresses to later stages (III and IV), the cancer can invade deeper layers of the stomach and spread to distant organs, often resulting in more severe symptoms.

According to the American Cancer Society, stomach cancer ranks as the 15th most common cancer in the United States. However, it’s more prevalent in other parts of the world, particularly Eastern Asia. Despite the decrease in incidence over the years, the overall survival rate remains low due to late-stage diagnosis.

Risk Factors for Developing Stomach Cancer

Lifestyle Risk Factors

Several lifestyle factors can increase the likelihood of developing stomach cancer. These include a diet high in salty and smoked foods, and low in fruits and vegetables. Regular consumption of processed foods and those preserved by pickling can also contribute to the risk. Smoking is another significant factor, with smokers having twice the risk of developing the disease compared to non-smokers. Chronic alcohol abuse has also been linked to an increased risk of stomach cancer.

Medical Risk Factors

Previous medical conditions can also increase the risk of stomach cancer. These include chronic gastritis, stomach polyps, and long-term infection with Helicobacter pylori, a bacterium that causes stomach ulcers. People with certain types of anemia (Pernicious Anemia) or those who have undergone stomach surgery for other conditions may also have a higher risk.

Genetic and Age-Related Risk Factors

Stomach cancer is more common in older adults, particularly those aged 55 and above. Certain genetic conditions, such as hereditary diffuse gastric cancer (HDGC), can significantly increase the risk. Additionally, people with a family history of stomach cancer or certain genetic syndromes like Lynch syndrome or familial adenomatous polyposis (FAP) are more prone to developing this disease. It’s important to discuss your family history with your healthcare provider to understand your individual risk.

Clinical Manifestations of Stomach Cancer

Abdominal Pain or Discomfort

Approximately 50% of people diagnosed with stomach cancer report experiencing abdominal pain or discomfort. It’s often vague and located in the upper abdomen, and may be mistaken for indigestion or a stomach ulcer. This symptom is more common in the later stages of the disease when the cancer has grown large or spread.

Persistent Indigestion or Heartburn

Chronic indigestion or heartburn occurs in about 70% of stomach cancer cases. This discomfort is due to the irritation of the stomach lining by the growing cancer. It is often mistaken for common gastrointestinal issues and may be overlooked, delaying the diagnosis.

Nausea or Vomiting

Nausea or vomiting is experienced by approximately 30% of people with stomach cancer. It can result from the stomach’s inability to empty properly due to the growing tumor or from the general irritation caused by the disease.

Loss of Appetite

About 50% of patients may experience a loss of appetite, often due to discomfort or fullness following small meals. This symptom can lead to significant weight loss over time.

Unexplained Weight Loss

Unexplained weight loss is a common symptom in many types of cancer, including stomach cancer, occurring in about 60% of cases. It’s usually a result of a combination of factors like loss of appetite, inability to absorb nutrients, and the energy demands of the cancer itself.

Feeling Full After Eating Small Amounts

Early satiety, or feeling full after eating small amounts, is reported by approximately 45% of patients. The presence of the tumor can restrict the stomach’s capacity, leading to this feeling.

Abdominal Bloating

Bloating, a feeling of fullness in the abdomen, occurs in about 35% of stomach cancer cases. It can result from the tumor affecting the normal function of the stomach, leading to gas build-up and bloating.

Blood in the Stool or Vomit

Blood in the stool or vomit is a symptom in about 20% of cases and generally indicates advanced disease. The tumor’s invasion of the stomach wall can cause bleeding, which may appear as black, tarry stools or bloody vomit.

Fatigue

Fatigue, experienced by nearly 70% of stomach cancer patients, is a common symptom of many cancers and can result from the body’s continuous battle against the disease. It may also be linked to anemia caused by internal bleeding.

Weakness

General weakness occurs in about 50% of patients and is often associated with fatigue, loss of appetite, and weight loss. This symptom often worsens as the disease progresses.

Diagnostic Evaluation of Stomach Cancer

Stomach cancer is diagnosed using a combination of patient history, physical examination, and various tests. This comprehensive approach is necessary to confirm the presence of a cancerous growth and to determine its extent (stage), which informs the appropriate treatment plan.

Upper Endoscopy (EGD)

Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a common initial test for diagnosing stomach cancer. It involves inserting a thin, flexible tube with a camera (endoscope) through the mouth and down into the stomach to visualize any abnormalities. If suspicious areas are observed, samples (biopsies) can be taken for further testing.

Results suggestive of stomach cancer might include a visible growth, irregularities in the stomach lining, or areas of inflammation or ulceration. If the endoscopy shows no signs of cancer but symptoms persist, further tests may be needed to determine the cause.

Biopsy

A biopsy involves taking a small sample of tissue, usually during an endoscopy, which is then examined under a microscope for cancer cells. This is the definitive method for diagnosing stomach cancer.

Stomach cancer cells would appear irregular and chaotic compared to healthy cells. A negative biopsy result may be a relief, but if symptoms continue, additional testing should be pursued to identify the problem.

Imaging Tests (CT Scan, MRI, PET Scan)

Imaging tests such as CT scans, MRIs, and PET scans provide detailed images of the body’s internal structures, aiding in the detection of stomach cancer and determining its stage. These tests can reveal the size of the tumor, its exact location, and whether it has spread to other areas.

Results indicating stomach cancer might include a visible mass, swollen lymph nodes, or signs of cancer spread to other organs. If these tests do not show evidence of cancer but symptoms persist, further investigation is necessary.

Endoscopic Ultrasound (EUS)

Endoscopic ultrasound (EUS) is a procedure that combines endoscopy and ultrasound to obtain images and information about the digestive tract and the surrounding tissue and organs. It’s particularly useful for determining how far the cancer has penetrated the stomach wall and whether it has spread to nearby lymph nodes.

Findings that suggest stomach cancer include a thickening of the stomach wall or enlarged lymph nodes. If EUS findings are negative but symptoms persist, additional tests might be necessary.

Blood Tests

Blood tests can’t diagnose stomach cancer directly, but they can provide clues about a person’s overall health, detect anemia that could be caused by bleeding, or identify liver function abnormalities suggesting metastasis.

Abnormal blood test results suggestive of stomach cancer might include low red blood cell counts (anemia) or elevated liver enzymes. If blood tests are normal but symptoms continue, other diagnostic measures may be required.

Stool Tests

Stool tests are used to detect hidden (occult) blood in the stool, which could indicate a bleeding tumor in the stomach. Although not specific for stomach cancer, this test might suggest the need for further investigation, like an endoscopy.

If you have a positive stool test but other diagnostic tests do not indicate stomach cancer, it may be necessary to look for other causes of gastrointestinal bleeding. If symptoms persist despite negative test results, a more thorough investigation is needed.

Tumor Marker Tests

Tumor markers are substances made by cancer cells that can be found at higher levels in the blood of people with certain types of cancer. For stomach cancer, the most common tumor marker is called carbohydrate antigen (CA) 19-9. However, these tests aren’t specific or sensitive enough to be used for diagnosis alone, and are often used alongside other diagnostic methods.

Elevated CA 19-9 levels may suggest the presence of stomach cancer, especially if other symptoms and test results are consistent with the disease. However, this marker can also be elevated in other conditions.

If symptoms persist but the tumor marker test is negative, further tests may be necessary.

X-ray

X-rays of the chest and abdomen can be used to detect stomach cancer, especially if the disease is advanced. X-rays are less sensitive than endoscopy and are typically used when other tests are not possible.

An abnormal X-ray suggesting stomach cancer could show a mass in the abdomen, fluid accumulation, or signs of spread to the lungs. If an X-ray is negative but symptoms persist, other diagnostic tests should be considered.

Laparoscopy

Laparoscopy is a surgical procedure that allows the doctor to view the organs in the abdomen and take tissue samples if needed. It’s especially useful when there is a need to confirm the spread of stomach cancer to other organs or to the lining of the abdomen (peritoneum).

A positive laparoscopy may reveal spread of the cancer not detected by other imaging methods. If laparoscopy findings are negative but symptoms continue, other investigations should be carried out.

Lymph Node Biopsy

A lymph node biopsy involves removing a sample of lymph node tissue for examination under a microscope. This is often performed if imaging tests suggest the cancer has spread to the lymph nodes.

A positive lymph node biopsy showing cancer cells confirms that the disease has spread beyond the stomach. If the lymph node biopsy is negative but other signs and symptoms suggest stomach cancer, further diagnostic evaluation is necessary.

What if all Tests are Negative but Symptoms Persist?

If all tests come back negative but symptoms persist, it’s crucial not to ignore your symptoms. There might be other conditions causing your symptoms, or stomach cancer may be present despite initial negative tests. Discuss this with your healthcare provider who can determine if other diagnostic procedures or specialist consultations are necessary.

Health Conditions with Similar Symptoms to Stomach Cancer

Gastritis

Gastritis is inflammation of the stomach lining, often resulting from infection, long-term use of NSAIDs, or excessive alcohol intake. Symptoms like stomach pain, bloating, and nausea are similar to stomach cancer.

However, gastritis may also cause a burning sensation in the stomach and belching, which are less common in stomach cancer. Additionally, the presence of Helicobacter pylori bacteria detected by breath, blood, or stool tests is a strong indication of gastritis, not stomach cancer.

Peptic Ulcer Disease

Peptic ulcer disease involves open sores (ulcers) forming in the lining of the stomach or upper part of the small intestine. Similar to stomach cancer, it can cause abdominal pain, bloating, and nausea.

Unlike stomach cancer, peptic ulcer disease can cause a burning stomach pain that feels better after eating, and worse on an empty stomach. Testing for Helicobacter pylori or an upper gastrointestinal endoscopy can help differentiate between the two conditions, as ulcers can be directly observed.

Gastroesophageal Reflux Disease (GERD)

GERD is a chronic condition where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This can cause heartburn and discomfort after eating – similar to stomach cancer.

However, GERD often causes a sour taste in the mouth and the sensation of a lump in your throat, which are not common symptoms of stomach cancer. Diagnosing GERD may involve an endoscopy, ambulatory acid probe tests, or esophageal manometry, which measures the rhythm of muscle contractions in your esophagus.

Gallbladder Disease

Gallbladder disease refers to several types of conditions that can affect your gallbladder, such as gallstones. It can cause abdominal pain, nausea, and vomiting.

Distinctive symptoms of gallbladder disease include severe abdominal pain, especially after eating fatty foods, and pain that radiates to your right shoulder or back. Imaging tests like an ultrasound or a HIDA scan, which tracks the production and flow of bile from your liver to your small intestine, can help differentiate this from stomach cancer.

Pancreatitis

Pancreatitis is inflammation of the pancreas that can cause abdominal pain, nausea, and vomiting, which can mimic symptoms of stomach cancer.

However, pancreatitis often presents with pain that radiates to the back, and elevated levels of pancreatic enzymes (amylase and lipase) in the blood. These specific features can help distinguish pancreatitis from stomach cancer.

H. Pylori Infection

H. pylori is a type of bacteria that can infect the stomach, often causing gastritis and peptic ulcers. Symptoms like stomach pain, bloating, and nausea can be similar to stomach cancer.

Tests for H. pylori include breath, blood, or stool tests, and a negative result can help rule out H. pylori as the cause of symptoms. Additionally, H. pylori infections can often be resolved with antibiotics, leading to symptom resolution.

Esophageal Cancer

Esophageal cancer is cancer that occurs in the esophagus. It may cause difficulty swallowing, chest pain, and weight loss, which are also seen in stomach cancer.

Distinct symptoms of esophageal cancer include painful swallowing and heartburn, which are less common in stomach cancer. Tests like an endoscopy or imaging studies can help differentiate esophageal cancer from stomach cancer based on the location and appearance of the tumor.

Colon Cancer

Colon cancer develops in the large intestine and can present with abdominal pain, bloating, and a change in bowel habits, which are also seen in stomach cancer.

However, colon cancer may also cause rectal bleeding and narrow stool, which are less common in stomach cancer. A colonoscopy or imaging tests can help differentiate between the two by locating the tumor and observing its characteristics.

Pancreatic Cancer

Pancreatic cancer develops in the pancreas and can present with abdominal pain, loss of appetite, and weight loss, which are also seen in stomach cancer.

However, pancreatic cancer often causes pain that radiates to the back and jaundice (yellowing of the skin and eyes). Tests like a CT scan or endoscopic ultrasound can help differentiate between pancreatic cancer and stomach cancer.

Non-ulcer Dyspepsia

Non-ulcer dyspepsia is a functional disorder that causes indigestion and stomach discomfort without an identifiable cause like an ulcer. It shares some symptoms with stomach cancer, such as abdominal pain and bloating.

Non-ulcer dyspepsia, however, does not generally cause weight loss, which is a common symptom of stomach cancer. Tests like endoscopy or imaging studies can help rule out other causes, such as ulcers or cancer, leaving non-ulcer dyspepsia as the most likely diagnosis.

Treatment Options

1. Medications

Chemotherapy drugs: Chemotherapy uses drugs to kill or slow the growth of cancer cells. It can be given orally or intravenously and is often used before or after surgery, or as a standalone treatment for advanced stomach cancer.
Immunotherapy drugs: Immunotherapy drugs help your immune system recognize and attack cancer cells. They may be used in advanced stomach cancer when other treatments have been unsuccessful.
Targeted therapy drugs: Targeted therapy drugs work by attacking specific proteins or genes that contribute to cancer cell growth. These drugs are used in cases where the cancer has specific genetic markers that make it susceptible to targeted therapy.
Pain relievers: Pain relievers help manage pain and discomfort associated with stomach cancer. They may include over-the-counter medications like acetaminophen or stronger prescription painkillers, depending on the severity of the pain.
Antiemetics: Antiemetic medications are used to prevent and control nausea and vomiting, common side effects of chemotherapy or stomach cancer itself.
Acid suppressors: Acid suppressors, such as H2 blockers or proton pump inhibitors (PPIs), help reduce stomach acid production and may be used to manage symptoms like heartburn or acid reflux.
Anticoagulants: Anticoagulant medications may be used to prevent blood clots in patients with stomach cancer, as cancer increases the risk of clot formation.
Nutritional supplements: Nutritional supplements, such as vitamins or minerals, may be recommended to help maintain or improve the patient’s nutritional status, as malnutrition can be a concern with stomach cancer.
Supportive care medications: These medications can help manage other symptoms or side effects related to stomach cancer or its treatment, such as fatigue, diarrhea, or constipation.

2. Procedures

Surgery (partial or total gastrectomy): Surgery to remove part (partial) or all (total) of the stomach is often the main treatment for stomach cancer if it can be completely removed. Surgery can also help relieve symptoms in more advanced cases.
Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. It can be used before or after surgery, or in more advanced cases to help relieve symptoms.
Endoscopic mucosal resection (EMR) and Endoscopic submucosal dissection (ESD): These procedures remove early-stage cancer and precancerous growths from the stomach lining. They involve passing a special tool through an endoscope to remove the cancerous tissue.
Laparoscopic surgery: This minimally invasive surgical approach uses small incisions and a laparoscope to remove the cancer. It can result in less pain and a quicker recovery time than traditional open surgery.
Palliative procedures: Palliative procedures aim to relieve symptoms and improve quality of life in advanced stomach cancer. They may include surgery to bypass a blockage, placing a stent to keep the stomach open, or other interventions to manage specific symptoms.
Peritoneal lavage: Peritoneal lavage involves washing out the abdominal cavity to remove or reduce the amount of cancerous cells present. It’s generally used in cases where stomach cancer has spread to the peritoneum (the lining of the abdominal cavity).
Chemotherapy: Besides using it as a standalone treatment, chemotherapy is often administered after surgery (known as adjuvant therapy) to kill any remaining cancer cells, or before surgery (neoadjuvant therapy) to shrink tumors. For advanced stomach cancer, chemotherapy can help to relieve symptoms and improve the quality of life.
Targeted therapy: These treatments target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. They often have fewer side effects than conventional chemotherapy drugs.
Immunotherapy: This innovative therapy boosts the body’s natural defenses to fight cancer. It can be used when stomach cancer has come back or if it has spread, and when other treatments have not worked.
Radiation therapy: Radiation uses high-energy rays (similar to X-rays) to kill cancer cells. It may be used before surgery to shrink a tumor, after surgery to destroy any remaining cancer cells, or in combination with chemotherapy.

Improving Stomach Cancer: Home Remedies and Seeking Medical Help

Living with stomach cancer can present many challenges, but there are steps you can take to manage symptoms and improve your quality of life. The following home remedies can supplement your medical treatment and provide some relief:

Dietary changes: Soft or pureed foods may be easier to digest and cause less discomfort.
Eating smaller, more frequent meals: This can help to prevent feelings of fullness or bloating, which are common in stomach cancer.
Adequate hydration: Drinking enough fluids, especially water, can help manage digestion and prevent dehydration.
Maintaining a healthy weight: A balanced diet and moderate exercise can help to maintain your weight, which is beneficial for overall health.
Smoking cessation: Quitting smoking can help to reduce the risk of further complications and other types of cancer.
Alcohol moderation: Limiting your alcohol intake can help to reduce irritation of the stomach lining.
Stress management techniques: Practices such as meditation, deep breathing, and yoga can help to manage stress and improve your overall sense of wellbeing.
Gentle exercise: Regular physical activity, such as walking or stretching, can help to improve energy levels and maintain strength.
Emotional and psychological support: Joining a support group, talking with a counselor, or confiding in loved ones can provide emotional comfort.
Nutritional counseling: A registered dietitian can help to develop a personalized meal plan that accommodates your nutritional needs and preferences.

Prevention and Management of Stomach Cancer: When to Seek Medical Help

If your symptoms worsen, or you experience new symptoms, it’s crucial to seek medical help immediately. In the era of digital health, telemedicine has emerged as a convenient and effective way to consult with healthcare providers. Our primary care practice offers telemedicine services, allowing you to access professional medical advice from the comfort of your own home.

Living with Stomach Cancer: Tips for Better Quality of Life

Living with stomach cancer can be challenging, but with the right treatment, support, and lifestyle adaptations, you can maintain a good quality of life. Regularly review your symptoms and treatment plan with your healthcare provider, follow a balanced diet, engage in gentle exercise, and ensure you have strong emotional and psychological support. Keep the lines of communication open with your healthcare team, and don’t hesitate to ask questions or express any concerns. Your wellbeing and comfort should always be the top priority.

Conclusion

Stomach cancer can be a formidable condition, but with early diagnosis and the right treatment approach, many individuals can manage their symptoms and live a fulfilling life. Regular consultations with your healthcare provider, combined with lifestyle adaptations, can make a significant difference in your journey with this condition. Always remember that help is available, and you don’t have to navigate this alone. Our primary care practice, with its robust telemedicine services, is always here to offer support, advice, and care – all from the comfort of your own home. Take the first step towards better health today.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.