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Gastric Cancer

Most cancers of the stomach are adenocarcinomas , a type of cancer that develops in the mucosal cells that form the innermost lining of the stomach. Other types of stomach cancers include lymphomas and sarcomas . Stomach cancer can be hard to detect early. Often there are no symptoms in the early stages and, in many cases, the cancer has spread before it is found. As the disease progresses, the cancer may invade the stomach wall and/or metastasize (spread to other parts of the body).

Common throughout the world, gastric cancer affects all races. However, unexplained geographic and cultural differences in incidence occur; for example, mortality is high in Japan, Iceland, Chile, and Austria. In the United States, incidence has decreased 50% during the past 25 years, and the death rate from gastric cancer is one-third that of 30 years ago.

The decrease in gastric cancer incidence in the United States has been attributed, without proof, to the balanced American diet and to refrigeration, which reduces the number of nitrate-producing bacteria in food.

Causes

The cause of gastric cancer is unknown. This cancer is often associated with gastritis with gastric atrophy, which is now thought to be a result of gastric cancer rather than a precursor state. Predisposing factors include environmental influences, such as smoking and high alcohol intake.

Genetic factors have also been implicated because this disease occurs more frequently among people with type A blood than among those with type O; similarly, it is more common in people with a family history of such cancer.

Dietary factors also seem related, including types of food preparation, physical properties of some foods, and certain methods of food preservation (especially smoking, pickling, and salting).

Signs and symptoms

Early clues to gastric cancer are chronic dyspepsia and epigastric discomfort, followed in later stages by weight loss, anorexia, a feeling of fullness after eating, anemia, and fatigue. If the cancer is in the cardia, the first symptom may be dysphagia and, later, vomiting (typically coffee-ground vomitus). Affected patients may also have blood in their stools.

The course of gastric cancer may be insidious or fulminating. The patient typically treats himself with antacids until the symptoms of advanced stages appear

Diagnosis

• An upper GI series showing gastric cancer
• An EGD (esophagogastroduodenoscopy) and biopsy showing gastric cancer
• A CBC showing anemia (although there are many other reasons for anemia)
• A stool test that is positive for blood

Treatment

Surgery is often the treatment of choice. Excision of the lesion with appropriate margins is possible in more than one-third of patients. Even in patients whose disease isn't considered surgically curable, resection offers palliation and improves potential benefits from chemotherapy and radiation therapy.

Types of surgery

The nature and extent of the lesion determine what kind of surgery is most appropriate. Common surgical procedures include subtotal gastrectomy and total gastrectomy.

When cancer involves the pylorus and antrum, gastrectomy removes the lower stomach and duodenum (gastrojejunostomy or Billroth II). If metastasis has occurred, the omentum and spleen may also have to be removed.

If gastric cancer has spread to the liver, peritoneum, or lymph glands, palliative surgery may include gastrostomy, jejunostomy, or a total or subtotal gastrectomy. Such surgery may temporarily relieve vomiting, nausea, pain, and dysphagia while allowing enteral nutrition to continue.

Other treatments

Chemotherapy for GI cancers may help to control symptoms and prolong survival. Adenocarcinoma of the stomach has responded to several agents, including fluorouracil, carmustine, doxorubicin, cisplatin, methotrexate, and mitomycin.

Antiemetics can control nausea, which increases as the cancer advances. In the more advanced stages, sedatives and tranquilizers may be necessary to control ovelWhelming anxiety. Narcotics are often necessary to relieve severe and unremitting pain.

Radiation therapy has been particularly useful when combined with chemotherapy in patients who have unresectable or partially resectable disease. It should be given on an empty stomach and shouldn't be used preoperatively because it may damage viscera and impede healing.

Treatment with antispasmodics and antacids may help relieve GI distress.

Prevention

There is no way to prevent stomach cancer. However, you can help reduce your risk of getting stomach cancer by not drinking a lot of alcohol or smoking. Also, eat a diet high in fresh fruits and vegetables, and vitamin C. Vitamin C is found in foods such as oranges, grapefruit and broccoli.