Gastric Cancer

Gastric Cancer | Cancer of Stomach & Eosophagus

Stomach cancer, also known as gastric cancer, is cancer developing from the lining of the stomach

In India, the incidence rate of gastric is very low compared to that in western countries, and the number of new gastric cancer cases is approximately 34,000, with a male predominance (male-to-female ratio, 2:1). It is estimated that by the year 2020, approximately 50,000 new gastric cancer cases will be reported annually in India. The recent nationally representative survey of cancer mortality in India indicated that gastric carcinoma was the second most common cause of cancer-related deaths amongst men and women



Overview

Traditionally, incidence of gastric cancer has been higher in the north eastern states and southern states of India. While the exact cause of this is unknown, it may be driven to an extent because of the dietary patterns of these regions

Most stomach cancers are a type called adenocarcinoma. This means that the cancer started in the glandular tissue that lines the inside of the stomach. Other types of cancerous tumors that form in the stomach include lymphoma, gastric sarcoma, and carcinoid tumors, but these are rare


Risk Factors

Both exposure (environmental or occupational) to particular agents & an individual’s susceptibility to these agents are thought to contribute to one’s risk of developing stomach cancer

  • The incidence of gastric cancer shows a sharp increase after the age of 50 years. Most individuals are diagnosed with gastric cancer between their late 60s and 80
  • Bacteria. A common bacterium called Helicobacter pylori, also called H. pylori, causes stomach inflammation and ulcers. It is also considered one of the primary causes of stomach cancer. Testing for H. pylori is available and an infection can be treated with antibiotics. Testing for H. pylori is recommended if you have had a first-degree relative, such as a parent, sibling, or child, who has been diagnosed with stomach cancer or with H. pylori infection. Other family members could have it as well, and the infection should be treated if found.
  • High intake of pickled, smoked, salted, or preserved foods and a low intake of fruits and vegetables increase the risk of gastric cancer
  • Family history
  • Alcohol and tobacco consumption in the form of cigarettes and beedis
  • Race/ethnicity. Stomach cancer is more common in black, Hispanic, and Asian people than in white people.
  • Obesity. Excess body weight increases a man’s risk of developing stomach cancer. It is not clear whether obesity increases a woman’s risk of stomach cancer.

Symptoms

The following are the common symptoms of gastric cancer

  • Heartburn
  • Upper abdominal pain
  • Nausea
  • Vomiting
  • Difficulty in swallowing food
  • Blood in stool
  • Yellowing of skin and whites of eyes
  • Weight loss without any explanation
  • Bloating of the stomach after meals
  • Unexplained diarrhoea or Constipation

Diagnosis

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer.

Common tests used for diagnosis of gastric cancer include

  • Biopsy
  • X-ray scan
  • Barium Swallow
  • PET / CT Scan
  • MRI
  • Ultrasound Scan
  • Endoscopy
  • Laproscopy : A laparoscopy is a minor surgery in which the surgeon inserts a thin, lighted, flexible tube called a laparoscope into the abdominal cavity. It is used to find out if the cancer has spread to the lining of the abdominal cavity or liver. A CT or PET scan cannot often find cancer that has spread to these areas.

Treatment Options

Stomach cancer may be treated with surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Often, a combination of these treatments is used. It can be difficult to cure stomach cancer because it is often not found until it is at an advanced stage.

The staging and the patients immediate medical condition decide the treatment of the disease.

  • Note: Staging of gastric cancer is usually done through the TNM staging system. However, in certain countries like Japan/South Korea a different staging is adopted.

Like all other cancer, Gastric cancer is often treated/managed by a team of doctors called as multi-disciplinary team (MDT). Typically the following specialities are involved in the treatment of the disease.

  • Gastroenterologist
  • Surgeon or surgical oncologist
  • Medical oncologist
  • Radiation oncologist
  • Pathologist
  • Radiologist

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. The type of surgery used depends on the stage of the cancer

  • Early Stage
    • In early stages (stages 0 or I), when the cancer is still only in the stomach, surgery is used to remove the part of the stomach with cancer and nearby lymph nodes. This is called a subtotal or partial gastrectomy. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine
    • f the cancer has spread to the outer stomach wall with or without having spread to the lymph nodes, surgery plus chemotherapy or chemotherapy and radiation therapy may be used (see below). The surgeon can perform a subtotal gastrectomy or a total gastrectomy, which is the removal of all of the stomach. During a total gastrectomy, the surgeon attaches the esophagus directly to the small intestine.
    • Regional lymph nodes are often removed during surgery because the cancer may have spread to those lymph nodes. This is called a lymphadenectomy.
  • metastatic stage
    • When the cancer is diagnosed as Stage IV, surgery is typically not recommended as the main treatment and other forms of treatment is advised.

    Side effects of gastrectomy

    • Both partial and complete gastrectomy have significant side effects on the food/diet intake and lifestyle of the patient
    • Typically after the surgery, a patient is able to eat only a small amount of food at a time
    • Another common side effect is the "dumping syndrome". In this the patient experiences cramps, nausea, diarrohea and dizziness after eating
    • Patients are advised to monitor their vitamin B12 levels as the body might not be able to absorb this essential vitamin through the stomach

Chemotherapy

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy.

Currently, there is no single standard chemotherapy treatment regimen that is used worldwide. However, most chemotherapy treatments for stomach cancer are based on the combination of at least 2 drugs

Common chemo therapy regimens include:

  • Cisplatin (Platinol)
  • Fluorouracil (5-FU, Adrucil)
  • Capecitabine (Xeloda)
  • Docetaxel (Docefrez, Taxotere)
  • Irinotecan (Camptosar)
  • Oxaliplatin (Eloxatin)
  • Paclitaxel (Taxol)

Targeted Therapy

  • HER2-targeted therapy
    • Some cancers may make too much of the protein called human epidermal growth factor receptor 2 (HER2). This type of cancer is called HER2-positive cancer. Trastuzumab (Herceptin) plus chemotherapy may be an option for patients with later-stage HER2-positive stomach cancer.
  • Anti-angiogenesis therapy.
    • Anti-angiogenesis therapy is a type of targeted therapy. It is focused on stopping angiogenesis, which is the process of making new blood vessels. For patients whose tumor has grown while receiving initial chemotherapy, the drug ramucirumab (Cyramza) may be an additional option

immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. This is an active area of research for stomach cancer.

metastatic Gastric cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer

The goal of treatment at this stage is typically to lengthen a patient’s life and care for the symptoms of the cancer. Surgery is rarely used, and the main treatment is usually chemotherapy and/or radiation therapy


Further Reading/References

There are many resources on the net for reading further about cancer

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