A cancer arising in the lining of the stomach. It usually affects people in late middle-age, and tends not to be recognized until a late stage, when it has invaded through the stomach wall and infiltrated adjacent organs. It also spreads in the blood to the liver. Presentation is with weight loss, upper abdominal pain, and nausea. The lesion may obstruct the passage of food through the stomach, leading to vomiting, or may bleed slowly over a long period, leading to anaemia. Surgical treatment requires the removal of all or part of the stomach, but the prognosis is poor.
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Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs; It may also spread, through the stomach wall, to nearby lymph nodes and organs such as the liver, pancreas, and the lungs, or to distant organs such as the lymph nodes above the collar bone, the colon, and the ovaries. Metastasis (the spread of cancer from its primary site to other places in the body) to the ovaries can result in Krukenberg tumors.
Epidemiology
Stomach cancer represents roughly 2% (21,500) cases of all new cancer cases yearly in the United States, but it is much more common in Japan, Great Britain, South America, and Iceland. Hereditary Diffuse Gastric Cancer (HDGC) has only recently been identified and research is ongoing, but genetic testing and treatment options are available for families at risk (Brooks-Wilson et al., 2004).
Metastasis occurs in 80-90% of individuals with stomach cancer, with a five year survival rate of 75% in those diagnosed in early stages and less than 30% of those diagnosed in late stages.
Symptoms
Stomach cancer is often asymptomatic or causes only nonspecific symptoms in its early stages. By the time symptoms occur, the cancer has generally metastasized to other parts of the body, one of the main reasons for its poor prognosis. Stomach cancer can cause the following signs and symptoms:
Early
Indigestion or a burning sensation (heartburn) Loss of appetite, especially for meatLate
Abdominal pain or discomfort in the upper abdomen Nausea and vomiting Diarrhea or constipation Bloating of the stomach after meals Weight loss Weakness and fatigue Bleeding (vomiting blood or having blood in the stool), which can lead to anemiaThese can be symptoms of other health problems, such as a stomach virus or gastric ulcer, and diagnosis should be done by a gastroenterologist or an oncologist.
Diagnosis
To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical exam, and may order laboratory studies. A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells. Histologically, there are two major types of gastric cancer (Lauren classification): intestinal type and diffuse type.
Staging
If cancer cells are found in the tissue sample, the next step is to stage, or find out the extent of the disease. Various tests determine whether the cancer has spread and, if so, what parts of the body are affected. Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a CT scan, an ultrasound exam, or other tests to check these areas.
Treatment
Like any cancer, treatment is adapted to fit each person's individual needs and depends on the size, location, and extent of the tumor, the stage of the disease, and general health. Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. Treatment for stomach cancer may include surgery, chemotherapy, and/or radiation therapy.
Surgery
Surgery is the most common treatment for stomach cancer. The surgeon removes part (subtotal or partial gastrectomy) or all (total gastrectomy) of the stomach, as well as some of the tissue around the stomach, with the basic goal of removing all cancer and a margin of normal tissue. Endoscopic mucosal resection is a treatment for early gastric cancer that has been pioneered in Japan, but is available in the United States at some centers. In this procedure, the tumor is removed from the wall of the stomach using an endoscope, with the advantage in that it is a smaller operation than removing the stomach.
Chemotherapy
Chemotherapy is the use of systemic drugs to fight the stomach cancer. Unfortunately, gastric cancer has not been especially sensitive to these drugs until recently, and historically served to palliatively reduce the size of the tumor and increase survival time. Some drugs used in stomach cancer treatment include: 5-FU(fluorouracil), BCNU (carmustine), methyl-CCNU (Semustine), and doxorubicin (Adriamycin), as well as Mitomycin C, and more recently cisplatin and taxotere in various combinations. Scientists are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells. Chemotherapy also is being studied as a treatment for cancer that has spread, and as a way to relieve symptoms of the disease.
Radiation therapy
Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing.
Multimodality Therapy
While previous studies of multimodality therapy (combinations of surgery, chemotherapy and radiation therapy) gave mixed results, the Intergroup 0116 (SWOG 9008) study ( NEJM study abstract) showed a survival benefit to the combination of chemotherapy and radiation therapy in patients with nonmetastatic, completely resected gastric cancer. Patients were randomized after surgery to the standard group of observation alone, or the study arm of combination chemotherapy and radiation therapy.
Biological therapy
Biologic therapy is still in the testing stages for stomach cancer.
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