Let's learn about Stomach Cancer in simple terms!

Today we are going to talk about a topic that is a bit serious, but important to many people. That is stomach cancer, some also call it `(Gastric Cancer)` . Imagine, what would happen if the cells inside our stomach, that is, the stomach, suddenly started dividing uncontrollably, like crazy? That is what happens with stomach cancer. These cancer cells can form anywhere in the stomach. Most of the time, especially in countries like America, this cancer forms at the point where the stomach and our esophagus (that is, the tube that goes down from the throat) join, which we call `(gastroesophageal junction)` . But in some countries like Sri Lanka, where stomach cancer is common, it forms more often in the main part of the stomach.

The important thing is that about 95% of stomach cancers start in the lining of the stomach, the top layer of the wall. But they grow very quickly. If not treated properly, these cells can grow together to form a tumor and grow into the stomach wall. Sometimes, this tumor can spread (metastasize) to other nearby organs, such as the liver and pancreas.

Who is at higher risk of developing stomach cancer?

In fact, anyone can develop stomach cancer. However, there are certain factors that increase the risk. For example:

• If you are 65 years of age or older .
• If you are a man (men are at higher risk than women).
• This is common among some ethnic groups in the world (for example, South or Central American, Eastern European, etc.).

How common is stomach cancer?

Stomach cancer is one of the most common types of cancer worldwide. However, it is less common in some Western countries, such as the United States. In fact, stomach cancer accounts for only 1.5% of all newly diagnosed cancers in the United States. And the number of cases there has been steadily declining over the past 10 years.

What are the symptoms of stomach cancer?

This is the problem that many people have. In the early stages of stomach cancer , there are usually no symptoms . That is the most dangerous part of it. Even the most common early symptoms, such as stomach pain and unexplained weight loss, appear only after the cancer has progressed a little.

These are some of the symptoms that may occur in stomach cancer:

• Anorexia , the feeling of not feeling hungry.
• Difficulty swallowing (as if something is stuck in the throat).
• Constant fatigue or weakness .
• Nausea and vomiting .
• Weight loss without reason.
• Stomach ache and indigestion (just like gas).
• Black stools or vomiting blood .
• Feeling of fullness in the stomach, as if the stomach is full of air after eating.
• Abdominal pain , especially above the belly button.
• Feeling full even after eating a small meal.

Important: These symptoms can often be seen in other medical conditions, so if you have these symptoms, it's important to see a doctor to determine if it's stomach cancer or something else.

Can you catch a stomach cancer tumor?

Depending on how far the cancer has spread, a doctor may be able to feel a lump in your stomach when you are examined. But most often, symptoms are sensations in your stomach. Your stomach may feel swollen, full, or painful. This pain may start out mild at first and become more severe as the disease progresses.

What causes stomach cancer?

Simply put, stomach cancer is caused by a genetic mutation in the DNA of our stomach cells. You know, this DNA is like a code that tells our cells when to grow and when to die. Because of that genetic mutation, instead of dying, the cells grow rapidly and eventually form a tumor . These cancer cells can overtake healthy cells and spread to other parts of the body.

Researchers still don't know exactly what causes this genetic change. However, they have identified some factors that increase the risk of developing stomach cancer. They include:

• If someone in the family has had stomach cancer (hereditary link).
• Bacterial infection (Helicobacter pylori - H. pylori) . This is a very important factor.
• Gastroesophageal reflux disease (GERD) (stomach acid coming up into the throat).
• Gastritis (inflammation of the stomach).
• Epstein-Barr virus infection.
• If you have previously had stomach ulcers or polyps .
• Excessive consumption of oily, salty, smoked or pickled foods .
• Eating a diet low in fruits and vegetables .
• Frequent exposure to substances like coal, metal, and rubber.
• Smoking, vaping, or chewing tobacco .
• Excessive alcohol consumption .
• Obesity .
• `(Autoimmune atrophic gastritis)` (a condition in which the immune system attacks stomach cells).

Additionally, there are several genetic conditions that increase the risk of stomach cancer:

• `(Lynch syndrome)`
• `(Peutz-Jeghers syndrome)`
• `(Li-Fraumeni syndrome)`
• ``(Familial adenomatous polyposis)`
• ``(Hereditary diffuse gastric cancer)''
• `(Common variable immunodeficiency - CVID)`

Although researchers are unable to pinpoint the exact cause, it has been observed that people with blood type 'A' have a tendency to develop stomach cancer.

How is stomach cancer diagnosed?

When you see a doctor, they will ask about your medical history, ask about your symptoms, and do a physical exam to check for any lumps in your stomach. They may then do several tests to diagnose stomach cancer and determine how far it has spread (the `stage`).

It is very important to know the stage of the cancer . This is what helps the doctor understand how far the cancer has spread. In stomach cancer, these stages range from 0 (zero) to IV (four). Stage 0 means that the cancer has not spread beyond the lining of the stomach. Stage IV means that it has spread to other organs.

These are the tests that are usually done:

• Upper endoscopy: This is the most common way to diagnose stomach cancer. In this procedure, the doctor inserts a thin tube (called an endoscope) with a small camera on the end through your mouth and down into your stomach. Small surgical instruments are passed through the endoscope to take a small piece of tissue (a biopsy) from the stomach wall. The tissue is then sent to a lab to be tested for cancer cells.
• Endoscopic ultrasound: This is also a special type of endoscopy. It helps determine the stage of the cancer. The endoscope used in this is equipped with an ultrasound probe, which can take pictures of the stomach. This can be used to see if the cancer has spread from the lining of the stomach to the stomach wall.
• Radiologic tests: These include CT scans , barium swallows ( where you drink a special liquid that makes the lining of your stomach visible on an X-ray), and MRIs . These can help identify cancerous tumors and other abnormalities that may be related to cancer. A PET scan can also be used to see if cancer has spread throughout your body.
• Blood tests: These can provide information about how your organs are working. If an organ is not working properly, it can indicate that cancer may have spread to that organ.
• Laparoscopy: This is a type of surgery. It is done when less invasive methods such as imaging do not provide enough information about the extent of the cancer. In this, the doctor makes several small cuts in your abdomen and inserts a small camera through them to look directly at the organs.

Because stomach cancer is relatively rare in countries like the United States, it is not a routine screening test for everyone. However, if you have a condition that increases your risk of developing stomach cancer, your doctor may recommend that you have regular tests, such as upper endoscopy, to check for cancerous changes. Ask your doctor what you should do based on your risk.

How is stomach cancer treated?

Treatment options depend on how far your cancer has spread, your overall health, and your treatment preferences. This usually involves a team of doctors, including your family doctor, an oncologist, and a gastroenterologist . They will advise you on the best treatment options for you.

Surgery

Depending on the extent of the cancer, your doctor may recommend surgery to remove the cancer cells, the tumor, or part or all of the stomach.

• Removal by upper endoscopy: In the early stages, when the cancer is limited to the superficial layers of the stomach, the cancer can be removed through an upper endoscopy. This procedure is called endoscopic submucosal dissection or endoscopic mucosal resection . In this, the gastroenterologist cuts the cancerous tumor from the stomach wall and removes it through your mouth.
• Gastrectomy: When cancer has spread beyond the surface layers of the stomach, surgery may be needed to remove part or all of the stomach. Subtotal gastrectomy removes only the part of the stomach affected by cancer. Total gastrectomy removes the entire stomach. After the entire stomach is removed, the doctor will connect your esophagus and small intestine so that you can continue to eat.

Other treatments

These treatments directly attack cancer cells.

• `(Chemotherapy - chemo)` (chemical therapy): This uses drugs to shrink cancer cells. This makes them easier to remove before surgery. `(Chemotherapy)` is also used to kill any remaining cancer cells after surgery. It is usually given together with radiation therapy. `(Targeted drug therapy)` can also be given with `(chemo)`.
• Radiation therapy: This uses targeted energy beams, such as X-rays, to kill cancer cells. Radiation therapy alone is not very effective for stomach cancer. However, it can be given together with chemotherapy before and after surgery. Radiation therapy can also help relieve symptoms.
• Targeted drug therapy: This targets the weaknesses in cancer cells and causes them to die. It is often given with chemo for cancers that have recurred or are more advanced.
• Immunotherapy: This helps your own immune system to identify and destroy hard-to-detect cancer cells. This is also often used for recurrent or aggressive cancers.
• Palliative care: This helps improve your quality of life as a person living with cancer. Palliative care is a specialized medical service. It may include doctors, nurses, and other specialists who can help relieve symptoms. You can get this support in addition to the services you get from your regular doctors. You can get this palliative care along with other treatments.

Can stomach cancer be prevented?

Although stomach cancer cannot be completely prevented, you can reduce your risk by doing the following:

• If you are tested for H. pylori infection , get treatment . H. pylori infection is a major risk factor for stomach cancer.
• Get prompt treatment for stomach ulcers, gastritis, and other stomach conditions. Untreated stomach diseases, especially those caused by the bacteria H. pylori, increase the risk of stomach cancer.
• Eat a healthy diet. Eating a healthy diet that is high in fruits and vegetables and low in salt and red meat can reduce your risk of stomach cancer. Foods rich in vitamin C, beta-carotene, and carotenoids (e.g., citrus fruits, green vegetables, carrots) are good sources of these key nutrients.
• Avoid smoking and using tobacco products. Tobacco use increases the risk of not only stomach cancer, but many other types of cancer.
• Maintain a healthy weight. What constitutes a healthy weight varies from person to person. Ask your doctor what a healthy weight is for you.

Can stomach cancer be cured?

Stomach cancer can be cured if detected early. However, most of the time, symptoms appear too late by the time the disease is diagnosed, meaning the cancer may be at an advanced stage. Talk to your doctor about factors that can affect the outcome of your treatment.

What is the prognosis for people with stomach cancer?

The outlook for stomach cancer depends on the stage of the cancer. Those diagnosed in the early stages have a better prognosis than those diagnosed in the advanced stages. The 5-year survival rate for stomach cancer can range from as high as 70% (if the cancer is poorly spread) to as low as 6% (if it is advanced spread), depending on how far the cancer has spread.

Talk to your doctor for a more accurate assessment of your condition. The type of cancer you have, how far it has spread, your general health, and how your cancer responds to treatment all affect your prognosis.

When should I see a doctor?

If you are at high risk for stomach cancer, talk to your doctor about the pros and cons of getting regular screenings. Otherwise, pay attention to your symptoms. Many of the symptoms associated with stomach cancer can also be signs of other conditions. Only a doctor can make a definitive diagnosis.

See a doctor if you have symptoms such as stomach pain and unexplained weight loss, with or without the following symptoms:

• Difficulty eating.
• Diarrhea.
• Nausea.
• Bloody or black stools.

What questions should I ask my doctor?

You can ask questions like these:

• Where is the cancer?
• What stage of cancer do I have?
• How does this affect my prognosis?
• What treatments can I get?
• What are the benefits of this treatment? What are the possible risks?
• Are there other treatment options?
• How will my cancer diagnosis and treatment affect my daily life?
• Should I get a second opinion?

Finally, remember (Take-Home Message)

Stomach cancer may not always be preventable. But if it is detected early, it is more likely to be treated and cured. Depending on your cancer diagnosis, your doctor may recommend surgery to remove the cancer cells or tumors. Or they may suggest a combination of treatments that can kill or shrink the cancer cells.

Most importantly, your outlook will depend on several things you can discuss with your doctor. Don't hesitate to ask about treatment options, their benefits, and risks. Seek guidance from your doctors about how your cancer diagnosis will affect you. It is your right to be heard and understood without fear or doubt. Stay healthy!

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