Skip to main content

Stomach Cancer

Stomach cancer

Definition

Stomach cancer (also known as gastric cancer) is a disease in which the cells forming the inner lining of the stomach become abnormal and start to divide uncontrollably, forming a mass called a tumor.

Description

The stomach is a J-shaped organ that lies in the left and central portion of the abdomen. The stomach produces many digestive juices and acids that mix with the food and aid in the process of digestion. There are five regions of the stomach that doctors refer to when determining the origin of stomach cancer. These are:

  • the cardia, area surrounding the cardiac sphincter which controls movement of food from the esophagus into the stomach;
  • the fundus, upper expanded area adjacent to the cardiac region;
  • the antrum, lower region of the stomach where it begins to narrow;
  • the prepyloric, region just before or nearest the pylorus;
  • and the pylorus, the terminal region where the stomach joins the small intestine.

Cancer can develop in any of the five sections of the stomach. Symptoms and outcomes of the disease will vary depending on the location of the cancer.

Demographics

Based on previous data from the National Cancer Institute and the United States Census, the American Cancer Society estimates that 21, 700 Americans will be diagnosed with stomach cancer during 2001 and approximately 13, 000 deaths will result from the disease. In most areas, men are affected by stomach cancer nearly twice as often as women. Most cases of stomach cancer are diagnosed between the ages of 50 and 70 but in families with a hereditary risk of stomach cancer, younger cases are more frequently seen.

Stomach cancer is one of the leading causes of cancer deaths in several areas of the world, most notably Japan and other Asian countries. In Japan it appears almost ten times as frequently as in the United States. The number of new stomach cancer cases is decreasing in some areas, however, especially in developed countries. In the United States, incidence rates have dropped from 30 individuals per 100, 000 in the 1930s, to only 8 in 100, 000 individuals developing stomach cancer by the 1980s. The use of refrigerated foods and increased consumption of fresh fruits and vegetables, instead of preserved foods with high salt content, may be a reason for the decline.

Causes and symptoms

While the exact cause for stomach cancer has not been identified, several potential factors have lead to increased numbers of individuals developing the disease and therefore, significant risk has been associated. Diet, work environment, exposure to the bacterium Helicobacter pylori, and a history of stomach disorders such as ulcers or polyps are some of these believed causes.

Studies have shown that eating foods with high quantities of salt and nitrites increases the risk of stomach cancer. The diet in a specific region can have a great impact on its residents. Making changes to the types of foods consumed has been shown to decrease likelihood of disease, even for individuals from countries with higher risk. For example, Japanese people who move to the United States or Europe and change the types of foods they eat have a far lower chance of developing the disease than do Japanese people who remain in Japan and do not change their dietary habits. Eating recommended amounts of fruit and vegetables may lower a person's chances of developing this cancer.

A high risk for developing stomach cancers has been linked to certain industries as well. The best proven association is between stomach cancer and persons who work in coal mining and those who work processing timber, nickel, and rubber. An unusually large number of these workers have been diagnosed with this form of cancer.

Several studies have identified a bacterium (Helicobacter pylori ) that causes stomach ulcers (inflammation in the inner lining of the stomach). Chronic (long-term) infection of the stomach with these bacteria may lead to a particular type of cancer (lymphomas or mucosa-associated lymphoid tissue [MALT]) in the stomach.

Another risk factor is the development of polyps, benign growths in the lining of the stomach. Although polyps are not cancerous, some may have the potential to turn cancerous. People in blood group A are also at elevated risk for this cancer for unknown reasons. Other speculative causes of stomach cancer include previous stomach surgery for ulcers or other conditions, or a form of anemia known as pernicious anemia.

Stomach cancer is a slow-growing cancer. It may be years before the tumor grows very large and produces distinct symptoms. In the early stages of the disease, the patient may only have mild discomfort, indigestion, heartburn, a bloated feeling after eating, and mild nausea. In the advanced stages, a patient will have loss of appetite and resultant weight loss , stomach pains, vomiting, difficulty in swallowing, and blood in the stool. Stomach cancer often spreads (metastasizes) to adjoining organs such as the esophagus, adjacent lymph nodes, liver, or colon.

Diagnosis

Unfortunately, many patients diagnosed with stomach cancer experience pain for two or three years before informing a doctor of their symptoms. When a doctor suspects stomach cancer from the symptoms described by the patient, a complete medical history will be taken to check for any risk factors. A thorough physical examination will be conducted to assess all the symptoms. Laboratory tests may be ordered to check for blood in the stool (fecal occult blood test ) and anemia (low red blood cell count), which often accompany gastric cancer.

In some countries, such as Japan, it is appropriate for patients to be given routine screening examinations for stomach cancer, as the risk of developing cancer in that society is very high. Such screening might be useful for all high-risk populations. Due to the low prevalence of stomach cancer in the United States, routine screening is usually not recommended unless a family history of the disease exists.

Whether as a screening test or because a doctor suspects a patient may have symptoms of stomach cancer, endoscopy or barium x-rays are used in diagnosing stomach cancer. For a barium x ray of the upper gastrointestinal tract, the patient is given a chalky, white solution of barium sulfate to drink. This solution coats the esophagus, the stomach, and the small intestine. Air may be pumped into the stomach after the barium solution in order to get a clearer picture. Multiple x rays are then taken. The barium coating helps to identify any abnormalities in the lining of the stomach.

In another more frequently used test, known as upper gastrointestinal endoscopy , a thin, flexible, lighted tube (endoscope) is passed down the patient's throat and into the stomach. The doctor can view the lining of the esophagus and the stomach through the tube. Sometimes, a small ultrasound probe is attached at the end of the endoscope. This probe sends high frequency sound waves that bounce off the stomach wall. A computer creates an image of the stomach wall by translating the pattern of echoes generated by the reflected sound waves. This procedure is known as an endoscopic ultrasound or EUS.

Endoscopy has several advantages, in that the physician is able to see any abnormalities directly. In addition, if any suspicious-looking patches are seen, biopsy forceps can be passed painlessly through the tube to collect some tissue for microscopic examination. This is known as a biopsy. EUS is beneficial because it can provide valuable information on depth of tumor invasion.

After stomach cancer has been diagnosed and before treatment starts, another type of x-ray scan is taken. Computed tomography (CT) is an imaging procedure that produces a three-dimensional picture of organs or structures inside the body. CT scans are used to obtain additional information in regard to how large the tumor is and what parts of the stomach it borders; whether the cancer has spread to the lymph nodes; and whether it has spread to distant parts of the body (metastasized), such as the liver, lung, or bone. A CT scan of the chest, abdomen, and pelvis is taken. If the tumor has gone through the wall of the stomach and extends to the liver, pancreas, or spleen, the CT will often show this. Although a CT scan is an effective way of evaluating whether cancer has spread to some of the lymph nodes, it is less effective than EUS in evaluating whether the nodes closest to the stomach are free of cancer. However, CT scans, like barium x rays, have the advantage of being less invasive than upper endoscopy.

Laparoscopy is another procedure used to stage some patients with stomach cancer. This involves a medical device similar to an endoscope. A laparoscopy is a minimally invasive surgery technique with one or a few small incisions, which can be performed on an outpatient basis, followed by rapid recovery. Patients who may receive radiation therapy or chemotherapy before surgery may undergo a laparoscopic procedure to determine the precise stage of cancer. The patient with bone pain or with certain laboratory results should be given a bone scan.

Benign gastric neoplasms are tumors of the stomach that cause no major harm. One of the most common is called a submucosal leiomyoma. If a leiomyoma starts to bleed, surgery should be performed to remove it. However, many leiomyomas require no treatment. Diagnosis of stomach cancers should be conducted carefully so that if the tumor does not require treatment the patient is not subjected to a surgical operation.

Clinical staging and prognosis

More than 95% of stomach cancers are caused by adenocarcinomas, malignant cancers that originate in glandular tissues. The remaining 5% of stomach cancers include lymphomas and other types of cancers. It is important that gastric lymphomas be accurately diagnosed because these cancers have a much better prognosis than stomach adenocarcinomas. Approximately half of the people with gastric lymphomas survive five years after diagnosis. Treatment for gastric lymphoma involves surgery combined with chemotherapy and radiation therapy.

Staging of stomach cancer is based on how deep the growth has penetrated the stomach lining; to what extent (if any) it has invaded surrounding lymph nodes; and to what extent (if any) it has spread to distant parts of the body (metastasized). The more confined the cancer, the better the chance for a cure.

One important factor in the staging of adenocarcinoma of the stomach is whether or not the tumor has invaded the surrounding tissue and, if it has, how deep it has penetrated. If invasion is limited, prognosis is favorable. Diseased tissue that is more localized improves the outcome of surgical procedures performed to remove the diseased area of the stomach. This is called a resection of the stomach.

Several distinct ways of classifying stomach cancer according to cell type have been proposed. The Lauren classification is encountered most frequently. According to this classification system, gastric adenocarcinomas are either called intestinal or diffuse. Intestinal cancers are much like a type of intestinal cancer called intestinal carcinoma . Intestinal tumors are more frequently found in males and in older patients. The prognosis for these tumors is better than that for diffuse tumors. Diffuse tumors are more likely to infiltrate, that is, to move into another organ of the body.

Treatment

Because symptoms of stomach cancer are so mild, treatment often does not commence until the disease is well advanced. The three standard modes of treatment for stomach cancer include surgery, radiation therapy, and chemotherapy. While deciding on the patient's treatment plan, the doctor takes into account many factors. The location of the cancer and its stage are important considerations. In addition, the patient's age, general health status, and personal preferences are also taken into account.

Surgery

In the early stages of stomach cancer, surgery may be used to remove the cancer. Surgical removal of adeno-carcinoma is the only treatment capable of eliminating the disease. Laparoscopy is often used before surgery to investigate whether or not the tumor can be removed surgically. If the cancer is widespread and cannot be removed with surgery, an attempt will be made to remove blockage and control symptoms such as pain or bleeding. Depending on the location of the cancer, a portion of the stomach may be removed, a procedure called a partial gastrectomy. In a surgical procedure known as total gastrectomy, the entire stomach may be removed. However, doctors prefer to leave at least part of the stomach if possible. Patients who have been given a partial gastrectomy achieve a better quality of life than those having a total gastrectomy and typically lead normal lives. Even when the entire stomach is removed, the patients quickly adjust to a different eating schedule. This involves eating small quantities of food more frequently. High-protein foods are generally recommended.

Partial or total gastrectomy is often accompanied by other surgical procedures. Lymph nodes are frequently removed and nearby organs, or parts of these organs, may be removed if cancer has spread to them. Such organs may include the pancreas, colon, or spleen.

Preliminary studies suggest that patients who have tumors that cannot be removed by surgery at the start of therapy may become candidates for surgery later. Combinations of chemotherapy and radiation therapy are sometimes able to reduce disease for which surgery is not initially appropriate. Preliminary studies are being performed to determine if some of these patients can become candidates for surgical procedures after such therapies are applied.

Chemotherapy

Whether or not patients undergoing surgery for stomach cancer should receive chemotherapy is a controversial issue. Chemotherapy involves administering anti-cancer drugs either intravenously (through a vein in the arm) or orally (in the form of pills). This can either be used as the primary mode of treatment or after surgery to destroy any cancerous cells that may have migrated to distant sites. Most cancers of the gastrointestinal tract do not respond well to chemotherapy, however, adenocarcinoma of the stomach and advanced stages of cancer are exceptions.

Chemotherapy medicines such as doxorubicin , mitomycin C , and fluorouracil , used alone, provide benefit to at least one in five patients. Combinations of agents may provide even more benefit, although it is not certain that this includes longer survival. For example, some doctors use what is called the FAM regimen, which combines fluorouacil, doxorubicin, and mitomycin. Some doctors prefer using fluorouracil alone to FAM since side effects are more moderate. Another combination some doctors are using involves high doses of the medications methotrexate , fluorouacil, and doxorubicin. Other combinations that have shown benefit include the ELF regimen, a combination of leucovorin , fluorouracil, and etoposide . The EAP regimen, a combination of etopo-side, doxorubicin, and cisplatin is also used.

Although chemotherapy using a single medicine is sometimes used, the best response rates are often achieved with combinations of medicines. Therefore, in addition to studies exploring the effectiveness of new medicines there are other studies attempting to evaluate how to best combine existing forms of chemotherapy to bring the greatest degree of help to patients.

Radiation therapy

Radiation therapy is often used after surgery to destroy the cancer cells that may not have been completely removed during surgery. To treat stomach cancer, external beam radiation therapy is generally used. In this procedure, high-energy rays from a machine that is outside of the body are concentrated on the area of the tumor. In the advanced stages of stomach cancer, radiation therapy is used to ease the symptoms such as pain and bleeding. However, studies of radiation treatment for stomach cancer have shown that the way it has been used it has been ineffective for many patients.

Researchers are actively assessing the role of chemotherapy and radiation therapy used before a surgical procedure is conducted. They are searching for ways to use both chemotherapy and radiation therapy so that they increase the length of survival of patients more effectively than current methods are able to do.

Prognosis

Overall, approximately 20% of patients with stomach cancer live at least five years following diagnosis. Patients diagnosed with stomach cancer in its early stages have a far better prognosis than those for whom it is in the later stages. In the early stages, the tumor is small, lymph nodes are unaffected, and the cancer has not migrated to the lungs or the liver. Unfortunately, only about 20% of patients with stomach cancer are diagnosed before the cancer had spread to the lymph nodes or formed a distant metastasis .

It is important to remember that statistics on prognosis may be misleading. Newer therapies are being developed rapidly and five-year survival has not yet been measured with these. Also, the largest group of people diagnosed with stomach cancer are between 60 and 70 years of age, suggesting that some of these patients die not from cancer but from other age-related diseases. As a result, some patients with stomach cancer may be expected to have longer survival than did patients just ten years ago.

Coping with cancer treatment

Many patients experience feelings of depression , anxiety, and fatigue when dealing with the knowledge and treatments associated with stomach cancer. Side effects such as nausea and vomiting may also present during treatment. Understanding what to expect as a result of the various treatments and learning about alternative methods for reducing these symptoms may improve the effectiveness of treatments and provide a more positive outlook in regard to the individual's situation. A doctor or other health professional should be consulted to develop strategies for managing any negative symptoms or feelings.

Prevention

Avoiding many of the risk factors associated with stomach cancer may prevent its development. Excessive amounts of salted, smoked, and pickled foods should be avoided, as should foods high in nitrates. A diet that includes recommended amounts of fruits and vegetables is believed to lower the risk of several cancers, including stomach cancer. The American Cancer Society recommends eating at least five servings of fruits and vegetables daily and choosing six servings of food from other plant sources, such as grains, pasta, beans, cereals, and whole grain bread.

Abstaining from tobacco and excessive amounts of alcohol will reduce the risk for many cancers. In countries where stomach cancer is common, such as Japan, early detection is important for successful treatment.

Special concerns

Following gastrectomy or partial gastrectomy it is important for the patient to carefully follow doctor's orders about what foods are eaten and when they should be eaten. In particular, the patient may be asked to have small, frequent meals.

Resources

BOOKS

Braunwald, Eugene, et al. Harrison's Principles of Internal Medicine. 15th ed. New York: McGraw-Hill, 2001.

Herfindal Eric T., and Dick R. Gourley. Textbook of Therapeu tics: Drug and Disease Management, 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2000.

Humes, H. David, ed-in-chief. Kelley's Textbook of Internal Medicine. Philadelphia: Lippincott Williams & Wilkins, 2000.

Pazdur, Richard et al. Cancer Management: A Multidiscipli-nary Approach: Medical, Surgical, & Radiation Oncolo gy, 4th ed. Melville, NY: PRR, 2000.

Souhami, Robert, and Jeffrey Tobias. Cancer and Its Manage ment, 3rd ed. London: Blackwell Science, 1998.

Steen, Grant, and Joseph Mirro. Childhood Cancer: A Hand book from St. Jude Children's Research Hospital. Cambridge, MA: Perseus Publishing, 2000.

ORGANIZATIONS

What You Need to Know About Stomach Cancer. PDQ Treat mentPatients: Gastric Cancer. The National Cancer Institute. (800) 4-CANCER. <http://www.nci.nih.gov>.

Stomach Cancer: Detection and Symptoms. Stomach Cancer: Prevention and Risk Factors. Stomach Cancer: Treat ment. Stomach Cancer: What Is It? American Cancer Society. (800) ACS-2345. <http://www.cancer.org>.

National Coalition for Cancer Survivorship. 1010 Wayne Ave., 7th Floor, Silver Spring, MD 20910-5600. (301) 650-9127 or (877) NCCS-YES. <http://www.cansearch.org>.

Lata Cherath, Ph.D.

Bob Kirsch

KEY TERMS

Adenocarcinoma

Malignant cancers that originate in the tissues of glands or that form glandular structures.

Anemia

A condition in which iron levels in the blood are low.

Barium x ray (upper GI)

An x-ray test of the upper part of the gastrointestinal (GI) tract (including the esophagus, stomach, and a small portion of the small intestine) after the patient is given a white, chalky barium sulfate solution to drink. This substance coats the upper GI and the x rays reveal any abnormality in the lining of the stomach and the upper GI.

Biopsy

Removal of a tissue sample for examination under the microscope to check for cancer cells.

Chemotherapy

Treatment of cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of the cancerous cells or by killing the cancer cells.

Endoscopic ultrasound (EUS)

A medical procedure in which sound waves are sent to the stomach wall by an ultrasound probe attached to the end of an endoscope. The pattern of echoes generated by the reflected sound waves are translated into an image of the stomach wall by a computer.

External radiation therapy

Radiation therapy that focuses high-energy rays from a machine on the area of the tumor.

Infiltrate

A tumor that moves into another organ of the body.

Polyp

An abnormal growth that develops on the inside of a hollow organ such as the colon, stomach, or nose.

Radiation therapy

Treatment using high-energy radiation from x-ray machines, cobalt, radium, or other sources.

Total gastrectomy

Surgical removal (excision) of the entire stomach.

Upper endoscopy

A medical procedure in which a thin, lighted, flexible tube (endoscope) is inserted down the patient's throat. Through this tube the doctor can view the lining of the esophagus, stomach, and the upper part of the small intestine.

QUESTIONS TO ASK THE DOCTOR

  • Has the cancer spread to the lymph nodes?
  • Has the cancer spread to the lungs, liver, or spleen?
  • (After endoscopy or barium x-rays and CT scan have been completed)Would I benefit from endoscopic ultrasound or laparoscopy?
  • (If surgery is recommended) Do recent studies show that it might be a good idea to also use chemotherapy or radiation therapy?
  • (If gastrectomy or partial gastrectomy was performed) How should I alter my diet and eating patterns?
  • (Following surgery) What foods should I be eating? Is there a registered dietitian I can speak with on a regular basis about what I should eat?

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Stomach Cancer." Gale Encyclopedia of Cancer. . Encyclopedia.com. 23 May. 2017 <http://www.encyclopedia.com>.

"Stomach Cancer." Gale Encyclopedia of Cancer. . Encyclopedia.com. (May 23, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/stomach-cancer

"Stomach Cancer." Gale Encyclopedia of Cancer. . Retrieved May 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/stomach-cancer

Stomach Cancer

Stomach Cancer

Definition

Stomach cancer (also known as gastric cancer) is a disease in which the cells forming the inner lining of the stomach become abnormal and start to divide uncontrollably, forming a mass called a tumor.

Description

The stomach is a J-shaped organ that lies in the left and central portion of the abdomen. The stomach produces many digestive juices and acids that mix with food and aid in the process of digestion. There are five regions of the stomach that doctors refer to when determining the origin of stomach cancer. These are:

  • the cardia, area surrounding the cardiac sphincter which controls movement of food from the esophagus into the stomach,
  • the fundus, upper expanded area adjacent to the cardiac region,
  • the antrum, lower region of the stomach where it begins to narrow,
  • the prepyloric, region just before or nearest the pylorus,
  • and the pylorus, the terminal region where the stomach joins the small intestine

Cancer can develop in any of the five sections of the stomach. Symptoms and outcomes of the disease will vary depending on the location of the cancer.

Based on previous data from the National Cancer Institute and the United States Census, the American Cancer Society estimates that 21,700 Americans will be diagnosed with stomach cancer during 2001 and approximately 13,000 deaths will result from the disease. In most areas, men are affected by stomach cancer nearly twice as often as women. Most cases of stomach cancer are diagnosed between the ages of 50 and 70, but in families with a hereditary risk of stomach cancer, younger cases are more frequently seen.

Stomach cancer is one of the leading causes of cancer deaths in several areas of the world, most notably Japan and other Asian countries. In Japan it appears almost ten times as frequently as in the United States. The number of new stomach cancer cases is decreasing in some areas, however, especially in developed countries. In the United States, incidence rates have dropped from 30 individuals per 100,000 in the 1930s, to only 8 in 100,000 individuals developing stomach cancer by the 1980s. The use of refrigerated foods and increased consumption of fresh fruits and vegetables, instead of preserved foods with high salt content, may be a reason for the decline.

Causes and symptoms

While the exact cause for stomach cancer has not been identified, several potential factors have lead to increased numbers of individuals developing the disease and therefore, significant risk has been associated. Diet, work environment, exposure to the bacterium Helicobacter pylori, and a history of stomach disorders such as ulcers or polyps are some of these believed causes.

Studies have shown that eating foods with high quantities of salt and nitrites increases the risk of stomach cancer. The diet in a specific region can have a great impact on its residents. Making changes to the types of foods consumed has been shown to decrease likelihood of disease, even for individuals from countries with higher risk. For example, Japanese people who move to the United States or Europe and change the types of foods they eat have a far lower chance of developing the disease than do Japanese people who remain in Japan and do not change their dietary habits. Eating recommended amounts of fruit and vegetables may lower a person's chances of developing this cancer.

A high risk for developing stomach cancers has been linked to certain industries as well. The best proven association is between stomach cancer and persons who work in coal mining and those who work processing timber, nickel, and rubber. An unusually large number of these workers have been diagnosed with this form of cancer.

Several studies have identified a bacterium (Helicobacter pylori ) that causes stomach ulcers (inflammation in the inner lining of the stomach). Chronic (long-term) infection of the stomach with these bacteria may lead to a particular type of cancer (lymphomas or mucosa-associated lymphoid tissue [MALT]) in the stomach.

Another risk factor is the development of polyps, benign growths in the lining of the stomach. Although polyps are not cancerous, some may have the potential to turn cancerous. People in blood group A are also at elevated risk for this cancer for unknown reasons. Other speculative causes of stomach cancer include previous stomach surgery for ulcers or other conditions, or a form of anemia known as pernicious anemia.

Stomach cancer is a slow-growing cancer. It may be years before the tumor grows very large and produces distinct symptoms. In the early stages of the disease, the patient may only have mild discomfort, indigestion, heartburn, a bloated feeling after eating, and mild nausea. In the advanced stages, a patient will have loss of appetite and resultant weight loss, stomach pains, vomiting, difficulty in swallowing, and blood in the stool. Stomach cancer often spreads (metastasizes) to adjoining organs such as the esophagus, adjacent lymph nodes, liver, or colon.

Diagnosis

Unfortunately, many patients diagnosed with stomach cancer experience pain for two or three years before informing a doctor of their symptoms. When a doctor suspects stomach cancer from the symptoms described by the patient, a complete medical history will be taken to check for any risk factors. A thorough physical examination will be conducted to assess all the symptoms. Laboratory tests may be ordered to check for blood in the stool (fecal occult blood test ) and anemia (low red blood cell count), which often accompany gastric cancer.

In some countries, such as Japan, it is appropriate for patients to be given routine screening examinations for stomach cancer, as the risk of developing cancer in that society is very high. Such screening might be useful for all high-risk populations. Due to the low prevalence of stomach cancer in the United States, routine screening is usually not recommended unless a family history of the disease exists.

Whether as a screening test or because a doctor suspects a patient may have symptoms of stomach cancer, endoscopy or barium x rays are used in diagnosing stomach cancer. For a barium x ray of the upper gastrointestinal tract, the patient is given a chalky, white solution of barium sulfate to drink. This solution coats the esophagus, the stomach, and the small intestine. Air may be pumped into the stomach after the barium solution in order to get a clearer picture. Multiple x rays are then taken. The barium coating helps to identify any abnormalities in the lining of the stomach.

In another more frequently used test, known as upper gastrointestinal endoscopy, a thin, flexible, lighted tube (endoscope) is passed down the patient's throat and into the stomach. The doctor can view the lining of the esophagus and the stomach through the tube. Sometimes, a small ultrasound probe is attached at the end of the endoscope. This probe sends high frequency sound waves that bounce off the stomach wall. A computer creates an image of the stomach wall by translating the pattern of echoes generated by the reflected sound waves. This procedure is known as an endoscopic ultrasound or EUS.

Endoscopy has several advantages, in that the physician is able to see any abnormalities directly. In addition, if any suspicious-looking patches are seen, biopsy forceps can be passed painlessly through the tube to collect some tissue for microscopic examination. This is known as a biopsy. EUS is beneficial because it can provide valuable information on depth of tumor invasion.

After stomach cancer has been diagnosed and before treatment starts, another type of x-ray scan is taken. Computed tomography (CT) is an imaging procedure that produces a three-dimensional picture of organs or structures inside the body. CT scans are used to obtain additional information in regard to how large the tumor is and what parts of the stomach it borders; whether the cancer has spread to the lymph nodes; and whether it has spread to distant parts of the body (metastasized), such as the liver, lung, or bone. A CT scan of the chest, abdomen, and pelvis is taken. If the tumor has gone through the wall of the stomach and extends to the liver, pancreas, or spleen, the CT will often show this. Although a CT scan is an effective way of evaluating whether cancer has spread to some of the lymph nodes, it is less effective than EUS in evaluating whether the nodes closest to the stomach are free of cancer. However, CT scans, like barium x-rays, have the advantage of being less invasive than upper endoscopy.

Laparoscopy is another procedure used to stage some patients with stomach cancer. This involves a medical device similar to an endoscope. A laparoscopy is a minimally invasive surgery technique with one or a few small incisions, which can be performed on an outpatient basis, followed by rapid recovery. Patients who may receive radiation therapy or chemotherapy before surgery may undergo a laparoscopic procedure to determine the precise stage of cancer. The patient with bone pain or with certain laboratory results should be given a bone scan.

Benign gastric neoplasms are tumors of the stomach that cause no major harm. One of the most common is called a submucosal leiomyoma. If a leiomyoma starts to bleed, surgery should be performed to remove it. However, many leiomyomas require no treatment. Diagnosis of stomach cancers should be conducted carefully so that if the tumor does not require treatment the patient is not subjected to a surgical operation.

Treatment

More than 95% of stomach cancers are caused by adenocarcinomas, malignant cancers that originate in glandular tissues. The remaining 5% of stomach cancers include lymphomas and other types of cancers. It is important that gastric lymphomas be accurately diagnosed because these cancers have a much better prognosis than stomach adenocarcinomas. Approximately half of the people with gastric lymphomas survive five years after diagnosis. Treatment for gastric lymphoma involves surgery combined with chemotherapy and radiation therapy.

Staging of stomach cancer is based on how deep the growth has penetrated the stomach lining; to what extent (if any) it has invaded surrounding lymph nodes; and to what extent (if any) it has spread to distant parts of the body (metastasized). The more confined the cancer, the better the chance for a cure.

One important factor in the staging of adenocarcinoma of the stomach is whether or not the tumor has invaded the surrounding tissue and, if it has, how deep it has penetrated. If invasion is limited, prognosis is favorable. Disease tissue that is more localized improves the outcome of surgical procedures performed to remove the diseased area of the stomach. This is called a resection of the stomach.

Several distinct ways of classifying stomach cancer according to cell type have been proposed. The Lauren classification is encountered most frequently. According to this classification system, gastric adenocarcinomas are either called intestinal or diffuse. Intestinal cancers are much like a type of intestinal cancer called intestinal carcinoma. Intestinal tumors are more frequently found in males and in older patients. The prognosis for these tumors is better than that for diffuse tumors. Diffuse tumors are more likely to infiltrate, that is, to move into another organ of the body.

Because symptoms of stomach cancer are so mild, treatment often does not commence until the disease is well advanced. The three standard modes of treatment for stomach cancer include surgery, radiation therapy, and chemotherapy. While deciding on the patient's treatment plan, the doctor takes into account many factors. The location of the cancer and its stage are important considerations. In addition, the patient's age, general health status, and personal preferences are also taken into account.

Surgery

In the early stages of stomach cancer, surgery may be used to remove the cancer. Surgical removal of adenocarcinoma is the only treatment capable of eliminating the disease. Laparoscopy is often used before surgery to investigate whether or not the tumor can be removed surgically. If the cancer is widespread and cannot be removed with surgery, an attempt will be made to remove blockage and control symptoms such as pain or bleeding. Depending on the location of the cancer, a portion of the stomach may be removed, a procedure called a partial gastrectomy. In a surgical procedure known as total gastrectomy, the entire stomach may be removed. However, doctors prefer to leave at least part of the stomach if possible. Patients who have been given a partial gastrectomy achieve a better quality of life than those having a total gastrectomy and typically lead normal lives. Even when the entire stomach is removed, the patients quickly adjust to a different eating schedule. This involves eating small quantities of food more frequently. High-protein foods are generally recommended.

Partial or total gastrectomy is often accompanied by other surgical procedures. Lymph nodes are frequently removed and nearby organs, or parts of these organs, may be removed if cancer has spread to them. Such organs may include the pancreas, colon, or spleen.

Preliminary studies suggest that patients who have tumors that cannot be removed by surgery at the start of therapy may become candidates for surgery later. Combinations of chemotherapy and radiation therapy are sometimes able to reduce disease for which surgery is not initially appropriate. Preliminary studies are being performed to determine if some of these patients can become candidates for surgical procedures after such therapies are applied.

Chemotherapy

Whether or not patients undergoing surgery for stomach cancer should receive chemotherapy is a controversial issue. Chemotherapy involves administering anti-cancer drugs either intravenously (through a vein in the arm) or orally (in the form of pills). This can either be used as the primary mode of treatment or after surgery to destroy any cancerous cells that may have migrated to distant sites. Most cancers of the gastrointestinal tract do not respond well to chemotherapy, however, adenocarcinoma of the stomach and advanced stages of cancer are exceptions.

Chemotherapy medicines such as doxorubicin, mitomycin C, and 5-fluorouracil, used alone, provide benefit to at least one in five patients. Combinations of agents may provide even more benefit, although it is not certain that this includes longer survival. For example, some doctors use what is called the FAM regimen, which combines 5-fluorouacil, doxorubicin, and mitomycin. Some doctors prefer using 5-fluorouracil alone to FAM since side effects are more moderate. Another combination some doctors are using involve high doses of the medications methotrexate, 5-fluorouracil, and doxorubicin. Other combinations that have shown benefit include the ELF regimen, a combination of leucovorin, 5-fluorouracil, and etoposide. The EAP regimen, a combination of etoposide, doxorubicin, and cisplatin is also used.

Although chemotherapy using a single medicine is sometimes used, the best response rates are often achieved with combinations of medicines. Therefore, in addition to studies exploring the effectiveness of new medicines there are other studies attempting to evaluate how to best combine existing forms of chemotherapy to bring the greatest degree of help to patients.

Radiation therapy

Radiation therapy is often used after surgery to destroy the cancer cells that may not have been completely removed during surgery. To treat stomach cancer, external beam radiation therapy is generally used. In this procedure, high-energy rays from a machine that is outside of the body are concentrated on the area of the tumor. In the advanced stages of gastric cancer, radiation therapy is used to ease symptoms such as pain and bleeding. However, studies of radiation treatment for stomach cancer have shown that the way it has been used it has been ineffective for many patients.

Researchers are actively assessing the role of chemotherapy and radiation therapy used before a surgical procedure is conducted. They are searching for ways to use both chemotherapy and radiation therapy so that they increase the length of survival of patients more effectively than current methods are able to do.

Prognosis

Overall, approximately 20% of patients with stomach cancer live at least five years following diagnosis. Patients diagnosed with stomach cancer in its early stages have a far better prognosis than those for whom it is in the later stages. In the early stages, the tumor is small, lymph nodes are unaffected, and the cancer has not migrated to the lungs or the liver. Unfortunately, only about 20% of patients with stomach cancer are diagnosed before the cancer had spread to the lymph nodes or formed a distant metastasis.

KEY TERMS

Adenocarcinoma Malignant cancers that originate in the tissues of glands or that form glandular structures.

Anemia A condition in which iron levels in the blood are low.

Barium x ray (upper GI) An x-ray test of the upper part of the gastrointestinal (GI) tract (including the esophagus, stomach, and a small portion of the small intestine) after the patient is given a white, chalky barium sulfate solution to drink. This substance coats the upper GI and the x rays reveal any abnormality in the lining of the stomach and the upper GI.

Biopsy Removal of a tissue sample for examination under the microscope to check for cancer cells.

Chemotherapy Treatment of cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of the cancerous cells or by killing the cancer cells.

Endoscopic ultrasound (EUS) A medical procedure in which sound waves are sent to the stomach wall by an ultrasound probe attached to the end of an endoscope. The pattern of echoes generated by the reflected sound waves are translated into an image of the stomach wall by a computer.

External radiation therapy Radiation therapy that focuses high-energy rays from a machine on the area of the tumor.

Infiltrate A tumor that moves into another organ of the body.

Polyp An abnormal growth that develops on the inside of a hollow organ such as the colon, stomach, or nose.

Radiation therapy Treatment using high-energy radiation from x-ray machines, cobalt, radium, or other sources.

Total gastrectomy Surgical removal (excision) of the entire stomach.

Upper endoscopy A medical procedure in which a thin, lighted, flexible tube (endoscope) is inserted down the patient's throat. Through this tube the doctor can view the lining of the esophagus, stomach, and the upper part of the small intestine.

It is important to remember that statistics on prognosis may be misleading. Newer therapies are being developed rapidly and five-year survival has not yet been measured with these. Also, the largest group of people diagnosed with stomach cancer are between 60 and 70 years of age, suggesting that some of these patients die not from cancer but from other age-related diseases. As a result, some patients with stomach cancer may be expected to have longer survival than did patients just ten years ago.

Prevention

Avoiding many of the risk factors associated with stomach cancer may prevent its development. Excessive amounts of salted, smoked, and pickled foods should be avoided, as should foods high in nitrates. A diet that includes recommended amounts of fruits and vegetables is believed to lower the risk of several cancers, including stomach cancer. The American Cancer Society recommends eating at least five servings of fruits and vegetables daily and choosing six servings of food from other plant sources, such as grains, pasta, beans, cereals, and whole grain bread.

Abstaining from tobacco and excessive amounts of alcohol will reduce the risk for many cancers. In countries where stomach cancer is common, such as Japan, early detection is important for successful treatment.

Resources

BOOKS

Braunwald, Eugene, et al. Harrison's Principles of Internal Medicine. 15th ed. New York: McGraw-Hill, 2001.

Herfindal Eric T., and Dick R. Gourley. Textbook of Therapeutics: Drug and Disease Management. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2000.

Humes, H. David, editor. Kelley's Textbook of Internal Medicine. Philadelphia: Lippincott Williams & Wilkins, 2000.

Pazdur, Richard, et al. Cancer Management: A Multidisciplinary Approach: Medical, Surgical, & Radiation Oncology. 4th ed. Melville, NY: PRR, 2000.

Steen, Grant, and Joseph Mirro. Childhood Cancer: A Handbook from St. Jude Children's Research Hospital. Cambridge, MA: Perseus Publishing, 2000.

ORGANIZATIONS

National Coalition for Cancer Survivorship. 1010 Wayne Ave., 7th Floor, Silver Spring, MD 20910-5600. (301) 650-9127 or (877) NCCS-YES. http://www.cansearch.org.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Stomach Cancer." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. 23 May. 2017 <http://www.encyclopedia.com>.

"Stomach Cancer." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. (May 23, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/stomach-cancer-0

"Stomach Cancer." Gale Encyclopedia of Medicine, 3rd ed.. . Retrieved May 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/stomach-cancer-0

Stomach Cancer

Stomach Cancer

How Does Stomach Cancer Develop?

Who Gets Stomach Cancer, and Why?

What Happens When People Have Stomach Cancer?

How Is Stomach Cancer Treated?

Living with Stomach Cancer

Resources

Stomach cancer, also called gastric cancer, is a disease in which the cells in the stomach divide without control or order and take on an abnormal appearance. These cancerous cells often spread to nearby organs and to other parts of the body.

KEYWORDS

for searching the Internet and other reference sources

Digestive system

Oncology

How Does Stomach Cancer Develop?

The stomach is the sac-like organ located in the upper abdomen, under the ribs, which plays a role in the digestion of food. It connects the esophagus (e-SOF-a-gus), the tube that carries swallowed food, with the small intestine, which absorbs the nutrients needed by the body. When food enters the stomach, the muscles in its wall create a rippling motion that mixes and mashes it. The glands in the lining of the stomach release juices that help to digest the mixture. After a few hours, the food becomes a liquid and moves into the small intestine. This makes it easier for the intestine to absorb the substances that the body needs for energy.

Stomach cancer begins when some of the cells in its lining take on an abnormal appearance and begin to divide without control or order. If left untreated, these cancer cells can grow through the stomach wall, and they can spread to nearby organs, or to nearby lymph nodes. Through the lymphatic system, the cancer cells can spread to distant areas of the body, including the lungs and the ovaries.

Who Gets Stomach Cancer, and Why?

Each year, about 24,000 people in the United States learn that they have cancer of the stomach. Like most other forms of cancer, stomach cancer occurs most frequently in older people, usually aged 55 or older. Fortunately, for reasons that scientists cannot fully explain, the number of people who get this disease has been dropping steadily for the past 60 years. Stomach cancer is much more common in other countries, especially Japan, Chile, and Iceland. Researchers think the reason may be that people in these countries eat many foods that are preserved by drying, smoking, salting, or pickling. Eating foods preserved in this way may raise someones risk for developing stomach cancer. People who smoke cigarettes also may be at higher risk of developing stomach cancer.

What Happens When People Have Stomach Cancer?

Symptoms

At first, stomach cancer does not cause any symptoms. And when it does eventually cause symptoms, they often are mistaken for less serious stomach problems, such as indigestion, heartburn, or a virus. Therefore, it is hard to find stomach cancer early, which makes it more difficult to treat. Possible symptoms include:

  • indigestion or a burning sensation in the stomach
  • discomfort or pain in the abdomen
  • nausea and vomiting after meals
  • bloating of the stomach after meals
  • anemia
  • weakness, fatigue, or weight loss
  • vomiting blood or passing black, tar-like stools.

Diagnosis

When people report these symptoms to their family doctor, they may be referred to a gastroenterologist (gas-tro-en-ter-OL-o-jist), a doctor who specializes in diagnosing and treating digestive problems. The gastroenterologist may order additional diagnostic tests to figure out what is wrong.

One of the most common procedures is called endoscopy (en-DOS-ko-pee), which involves passing a very thin, lighted tube down the esophagus and into the stomach. This allows doctors to look directly at the inside of the stomach. If an abnormal area is seen, they can remove some tissue through the tube and have it examined under a microscope. This process, called a biopsy (BY-op-see), determines whether or not cancer cells are present.

A person also might have an upper GI series, which is a series of x-rays of the upper gastrointestinal (gas-tro-in-TES-ti-nal) tract, including the esophagus and stomach. These pictures are taken after the person drinks a thick, chalky liquid called barium (BA-ree-um). The barium outlines the stomach on the x-rays, helping doctors locate tumors or other abnormal areas.

The doctor also might want to test for blood in the stool, the solid waste that people produce when they go to the bathroom. This involves placing a small amount of stool on a slide and having it tested in the laboratory. Sometimes, blood in the stool is a sign of stomach cancer or other cancers of the digestive tract.

If cancer is diagnosed, then doctors need to find out whether it has spread to other parts of the body. They often use imaging tests such as CT scans* or ultrasound* to check for this possibility.

* CT scans
(CAT scans) are computerized axial tomography (to-MOG-ra-fee), which uses x-rays and computers to view structures inside the body.
* ultrasound
is a painless procedure in which sound waves passing through the body create images on a computer screen.

How Is Stomach Cancer Treated?

Because the symptoms associated with stomach cancer seem so minor at first, people rarely report them right away. Therefore, the cancer usually has spread into the stomach wall or even beyond the stomach when it is found. This makes it difficult to cure.

The most common treatment is an operation called gastrectomy (gas-TREK-to-mee), during which surgeons remove part or all of the stomach and some of the surrounding tissue. If all of the stomach needs to be removed, then surgeons connect the esophagus directly to the small intestine. The nearby lymph nodes usually are removed, too.

People with stomach cancer may also be treated with radiation therapy or chemotherapy, either in an attempt to destroy some of the cancer cells or to ease some of their symptoms, such as pain. Radiation therapy focuses high-energy rays on the body to destroy cancer cells and to stop or slow their growth. During chemotherapy, anti-cancer drugs are given by mouth or by injection into a muscle or blood vessel.

Because stomach cancer is so difficult to cure, researchers are looking at new ways to treat this disease. Studies called clinical trials are being conducted to evaluate some of these new treatments in cancer patients. One example is biological therapy, which triggers the bodys own immune system to attack and destroy cancer cells.

Living with Stomach Cancer

Because people with stomach cancer often have part or all of the stomach removed, they need time to readjust to eating after the surgery. At first, patients are fed intravenously (in-tra-VEE-nus-lee), through a vein in the hand or arm. Within several days, they usually can start taking in liquids, then soft foods, and then more solid foods. Often they need to follow a special diet until they can adjust to having a smaller stomach or none at all. People with stomach cancer need to work with dietitians and nutritionists to make sure that they are getting the nutrients their bodies need.

See also

Cancer

Colorectal Cancer

Pancreatic Cancer

Peptic Ulcer

Tumor

Resources

U.S. National Cancer Institute (NCI), Bethesda, MD 20892. NCI posts the fact sheet What You Need to Know About Stomach Cancer at its website, along with a glossary, referrals, information about healthy eating for cancer patients, and information about clinical trials. Telephone 800-4-CANCER http://cancernet.nci.nih.gov/wyntk_pubs/stomach.htm

American Cancer Society (ACS), 1599 Clifton Road N.E., Atlanta, GA 30329-4251. ACS has a Stomach Cancer Resource Center at its website, which answers frequently asked questions and posts information about survivorship, prevention, and treatment. Telephone 800-ACS-2345 http://www3.cancer.org/cancerinfo

United Ostomy Association (UOA), 36 Executive Park, Suite 120, Irvine, CA 92612-2405. Telephone 800-826-0826

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Stomach Cancer." Complete Human Diseases and Conditions. . Encyclopedia.com. 23 May. 2017 <http://www.encyclopedia.com>.

"Stomach Cancer." Complete Human Diseases and Conditions. . Encyclopedia.com. (May 23, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/stomach-cancer-1

"Stomach Cancer." Complete Human Diseases and Conditions. . Retrieved May 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/stomach-cancer-1