Gastric Cancer: Let's talk about it simply

Many of us often experience problems like heartburn, indigestion, and gastritis, right? We usually try to make a home remedy for it, or take a small pill to suppress the pain. But did you know that sometimes these symptoms, which we think are minor, can actually be an early sign of a more serious condition, namely stomach cancer. Don't worry, not all stomach problems are cancer. However, it is very important for us to be aware of this. So today, let's talk about stomach cancer, or 'Gastric Cancer'.

Simply put, what is stomach cancer?

Stomach cancer is when cells in our stomach, that is, the stomach, start to grow out of control. Like a weed, these cancer cells divide rapidly and spread, destroying healthy cells.

This cancer can develop anywhere in the stomach. But it is most common in the area where the food we eat travels, the esophagus, where it connects to the stomach. This condition usually starts in the innermost layer of the stomach wall. It grows very slowly at first. But if left untreated, these cancer cells can grow together to form a tumor , grow deep through the stomach wall, and spread (metastasize) to nearby organs such as the liver and pancreas.

Who is most at risk of developing this disease?

Although anyone can develop stomach cancer, some people are at a slightly higher risk.

• For people over 65: As we age, the cells in our body are more likely to change.
• For men: Men are slightly more likely to develop this disease than women.
• Some ethnic groups: This disease is more common in some parts of the world, such as Eastern Europe. This may be due to their dietary patterns and genetic influences.

We need to be concerned about this disease in countries like Sri Lanka. Stomach cancer is one of the most common types of cancer in the world.

What are the symptoms of this disease? How to recognize it?

The biggest challenge here is that stomach cancer often doesn't show any symptoms in the early stages . Sometimes, the cancer may have already progressed by the time symptoms appear. So it's important to be aware of these symptoms.

Imagine that you feel full after eating, or that you have a burning sensation in your stomach. We call this "gastritis." But if these things continue to happen, and if you lose weight for no reason , don't ignore it. Those are the two main early signs of stomach cancer.

Let's learn more about these symptoms in the table below.

Why does stomach cancer develop? What are the risk factors?

Stomach cancer develops when a genetic mutation occurs in the DNA of stomach cells. Simply put, the instructions that tell cells "when to divide and when to die" go awry. Then those cells divide uncontrollably and become cancerous.

Although the exact cause of this genetic change has not yet been found, several factors have been identified that increase the risk of cancer.

• *Helicobacter pylori (H. pylori)* Bacterial infection: This is a major risk factor for stomach cancer. This bacteria lives in our stomach and can damage the stomach wall over time, causing gastritis, stomach ulcers, and eventually cancer.
• Gastritis and gastroesophageal reflux disease (GERD): Long-term gastritis and conditions that cause stomach acid to reflux into the esophagus can cause changes in the cells of the stomach wall.
• Unhealthy diet: People who regularly eat salty, oily, smoked, and pickled foods are at higher risk. Also, eating less fruits and vegetables also increases the risk.
• Smoking and alcohol: The chemicals in tobacco go directly to the stomach and damage cells. The same goes for heavy alcohol consumption.
• Family history: If someone in your family (mother, father, sibling) has had stomach cancer, you may also be at risk.
• Obesity: Hormonal changes and inflammatory conditions caused by excess body fat increase the risk of cancer.
• Certain genetic diseases: People with very rare, inherited genetic diseases such as *Lynch syndrome* and *Li-Fraumeni syndrome* are also at increased risk of stomach cancer.
• Blood type: People with blood type A have been found to have a slightly higher risk of developing this cancer, but the reason for this is not yet clear.

What tests are used to diagnose the disease?

If you have the symptoms mentioned earlier, your doctor will examine you and refer you for these tests if necessary.

• Upper Endoscopy: This is the most important and accurate test for diagnosing stomach cancer. In this test, a thin, flexible tube with a camera is inserted through the mouth and the esophagus, stomach, and the first part of the small intestine are examined. If there is any suspicious area, a small instrument is passed through the tube and a small piece of tissue (biopsy) is taken and sent to the laboratory to check for cancer cells.
• Endoscopic Ultrasound: This is similar to an endoscopy, but it also uses an ultrasound scanner along with a camera. This can help determine exactly how deep the cancer has spread into the stomach wall.
• Radiologic Tests:
• CT Scan: This can take cross-sectional images of the body to determine the size of the cancer and whether it has spread to other organs.
• Barium Swallow: In this test, a liquid called barium is swallowed. When this liquid is applied to the stomach wall, an X-ray can be taken to clearly see the shape and abnormalities of the stomach.
• Blood Tests: These can detect whether the cancer has affected other organs, such as the liver, or whether there is anemia.
• Laparoscopy: In some cases, if scans are not able to determine exactly how far the cancer has spread, this surgery is performed. In this procedure, several small incisions are made in the abdomen, a camera is inserted, and the organs are examined directly.

If these tests confirm that there is cancer, the doctor will determine its stage . There are stages from 0 to IV (four). In the first stage (Stage 0), the cancer is only in the superficial layer of the stomach wall. Stage IV means that the cancer has spread to distant organs. Treatment is determined based on this stage.

What are the treatments for stomach cancer?

The treatment plan depends on the stage of the cancer, your overall health, and your preferences. Typically, an oncologist and a gastroenterologist work together to develop the best treatment plan for you.

Surgery

The main treatment for stomach cancer is to remove the cancer through surgery.

• Endoscopy: If the cancer is in its very early stages, that is, on the surface of the stomach wall, the cancerous part can be cut out and removed during the endoscopy.
• Gastrectomy: If the cancer has spread deep into the stomach wall, surgery may be needed to remove the part of the stomach that contains the cancer (subtotal gastrectomy) or the entire stomach (total gastrectomy). If the entire stomach is removed, the surgeon will connect your esophagus directly to your small intestine. Don't worry, even if your stomach is completely removed, you will still be able to eat normally , but you won't be able to eat large meals at once; you will need to eat small meals several times a day.

Other treatments

This treatment is used in addition to or along with surgery.

• Chemotherapy: This involves giving the body drugs that kill cancer cells. This treatment is given to shrink the tumor before surgery, or to kill any remaining cancer cells after surgery.
• Radiation therapy: This involves using high-energy rays (like X-rays) to destroy cancer cells. This is usually given along with chemotherapy.
• Targeted Drug Therapy: These drugs target and attack specific weaknesses in cancer cells without harming normal cells.
• Immunotherapy: This involves stimulating our own body's immune system to recognize and destroy cancer cells.
• Palliative Care: This is something that many people misunderstand. Palliative care is not something that is given at the end of treatment. It is a specialized medical service that is provided to improve the patient's quality of life by controlling discomforts such as pain, nausea, and loss of appetite caused by the disease while cancer is being treated.

Can stomach cancer be cured? How can it be prevented?

Yes, it definitely can! Stomach cancer can be completely cured if detected early . That's why we say don't ignore even minor symptoms. The more advanced the cancer, the more difficult it becomes to treat. Talk to your doctor to get the most accurate information about your condition.

Although cancer cannot be prevented 100%, there are many things we can do to reduce the risk.

• Treat H. pylori infection: If you have gastritis, ask your doctor to test you for H. pylori infection. If so, treat the infection with the right antibiotics.
• A healthy diet:
• Include fresh fruits and vegetables in your daily diet. Oranges, grapefruits, and green vegetables, which are rich in vitamin C, are especially good.
• Reduce the consumption of salty, oily, preserved, smoked foods (such as sausages, bacon) and red meat (beef, pork).
• Quit smoking completely: If you smoke, quit today. It's the biggest help you can do.
• Maintain a healthy weight: Try to maintain a healthy weight for your height. Regular exercise is very important.

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