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STOMACH CANCER

Stomach cancer, also called gastric starts from the cells that line the stomach wall.

The stomach is part of the digestive system an dis located at the upper left-hand side of the abdomen. It stores and helps to digest eaten.

This is the second most common cancer that causes deaths. However, one of the positive points of stomach cancer is that its number of cases is declining. Some of the reasons for this include good hygiene practices and good nutrition.

Stomach cancer is the ninth most common reason for cancer–related deaths in Africa. These statistics are based on research by GLOBOCAN in 2008. Within Africa, Mali has the highest incidence of stomach cancer cases.    

Stomach cancer is also more common in older people aged 70 and over and it is more prominent in men than women.

Types of Stomach cancer

There are various types of stomach cancers. The types of stomach cancer depend on the cells that it affects. Following are the types of gastric cancer 

Adenocarcinoma

The majority of stomach cancers belong to this type. This accounts for almost 90 to 95% of the cases. Adenocarcinoma usually develops in the lining of the gland cells that make mucus and stomach juices

Lymphoma

These types of cancers affect the tissues of the immune system. In some of the cases, it may affect the wall of the stomach.  

Squamous cell cancer

They grow from the flat, surface covering cells (squamous cells) found in the lining of the stomach

Gastrointestinal Stromal Tumor (GIST)

GISTs are a type of soft tissue sarcoma that can start anywhere in the digestive system. Most of them start in the small intestine or stomach. They are most common in people aged 50 to 60

Carcinoid Tumour

Also, known as neuroendocrine tumours develop from the cells responsible for producing hormone. A positive point of these types of tumors is that it does not spread to other organs. There are three types of stomach NETs (Type 1, Type 2 and Type 3)

Symptoms of Stomach Cancer

Early stages of stomach cancer present no symptoms. Even if the symptoms appear, they may appear to be non-specific.  Symptoms may include:

  • Heartburn/indigestion that does not go away
  • feeling full quickly
  • Difficulty swallowing
  • unexplained weight loss
  • Pain or swelling in stomach area or upper abdomen
  • Continuous vomiting  
  • Blood in stool

 Remember indigestion  and heartburn are common and may be related to other benign conditions.

Causes/risk factors of Stomach Cancer

There are multiple factors that can increase the risk of getting stomach cancers. They include: 

 Helicobacter pylori

This infection is responsible for about 50% of stomach cancers. This infection lives and causes inflammation in the lining of the stomach. Long term infection can lead to stomach cancer.

Age

The risk of getting stomach cancer increases as people get older. Almost half of stomach cancers develop in people aged 70 or over. Men are more likely to get this type of cancer  compared to women.

Infection with Epstein Barr Virus 

About 5 to 16% of the stomach cancer patients have the presence of Epstein Barr virus. This implies that there may a significant role of this infection in causing stomach cancer. Epstein Barr virus is also more common in men than women.

Lifestyle Factors

Lifestyle factors like smoking, eating a bad diet, alcohol and being overweight can lead to an increased risk of getting stomach cancer.

People who are very overweight have an increased risk of cancer in the gastro-oesophageal junction (GOJ). Eating a lot of processed meats, smoked/grilled foods,too much salty foods and not enough  fresh fruit and vegetables can increasing the risk of getting stomach cancer.

Existing medical conditions

Medical conditions like Pernicious anaemia and Atrophic gastritis  cause changes to the stomach lining. As a result, this increases the risk of stomach cancer.

 

Diagnosis

Early diagnosis of stomach cancer is important to improve the outcome of the disease. With the help of an early diagnosis, treatment without surgery is possible. 

The following are diagnostic tests used to check for stomach cancer

Endoscopy

The specialist passes a tiny tube with a camera down your throat  and into the stomach. If any growths or abnormal looking areas are found, some pieces of tissue can be taken for analysis at the same time.

Endoscopic ultrasound

This is the same thing as an endoscopy , but with an ultrasound probe at the end. This is to help determine the size of the cancer and whether it has spread. 

Other imaging Tests

Imaging tests like CT, MRI and PET scans would be used to check your other organs to find out where the cancer is and whether it has spread.

Laparoscopy

This involves making several incisions in your abdomen and using a laparoscope (a camera) to look at the outside of the stomach and nearby organs. It is done under general anaesthetic.

Staging

According to the AJCC system, various factors help to stage stomach cancer. These stages are as follows;  

Stage 0

This is a high–grade dysplasia which means that the cells in the inner lining of the stomach look abnormal microscopically. These usually appear on the topmost layer of the mucosa. The other name for this stage is Carcinoma in situ. Stage 0 stomach cancer has not spread to lymph nodes or nearby sites. 

Stage I

This means

  • The cancer is still confined within the lining of the stomach with no lymph node involvement (stage 1A or T1, NO, MO in the TNM staging system) or
  • The cancer is still within the stomach lining but has spread to one or two nearby lymph nodes (stage 1B or or T1, N1, MO in the TNM staging system
Stage 2

This means

  • The cancer is still confined within the stomach lining but has spread to between 3 and 6 lymph nodes, ( stage 2A and T1,N2, M0 in the TNM staging system) or
  • The cancer is still confined within the stomach lining but has spread to more than 7 lymph nodes (stage 2B and  T1,N3, M0 in the TNM staging system )
Stage 3

This means

  • The cancer has grown into the muscle layer of the stomach but has spread to more than 7 lymph nodes (stage 3A and  T2, N3, M0 in the TNM staging system ) or
  • The cancer has grown into the outer layer of the stomach but has spread to more than 7 lymph nodes (stage 3B and T3, N3, M0 in the TNM staging system ) or
  • The cancer has either grown through the stomach wall and more than 7 nearby lymph nodes contain cancer (stae 3C and T4a, N3, M0 in the TNM staging system )
Stage 4

This is metastatic stomach cancer and means the cancer has spread into other body organs like the brain, bones or lungs.

Treatment

The following are some of the possible treatment options for different types of gastric cancer 

Surgery

The surgeon make perform surgery to remove early stage cancers limited to the lining of the stomach. This can be carried out using endoscopy in a procedure endoscopic mucosal resection.

It could also be performed to remove part of the stomach affected by cancer (subtotal gastrectomy) or the entire stomach and some surrounding healthy tissue.

If any part or the entire stomach is removed, this may cause digestive issues.

Chemotherapy

This uses cytotoxic drugs to kill cancer cells. It can be given before surgery to shrink a tumour so that it can be easily taken out or given after surgery to kill any floating cancer cells. It can also be used in people with advanced stomach cancer to help control symptoms.

Radiotherapy

This uses high energy x-rays to kill cancer cells. This can be given before surgery  (neoadjuvant radiation) to shrink a tumour so that it can be easily taken out or given surgery to kill any floating cancer cells. It can also be used in people with advanced stomach cancer to help control symptoms.

Targeted drugs

They can alter the way that cells work and help the body control the growth of cancer.  A targeted drug may be used with chemotherapy to treat advanced stomach cancer.

REFERENCES 

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