What is Stomach Cancer? What are the symptoms and treatment?

Stomach cancer is a type of cancer that occurs as a result of uncontrolled growth and proliferation of cells covering the surface of the stomach. It can occur at the junction of the esophagus and stomach or in the body of the stomach. It develops slower than other cancers.

What is Stomach Cancer?

Stomach cancer is a disease that describes malignant tumors that develop as a result of uncontrolled cell division in this organ. The stomach organ, shaped like a sac made of muscle, is located in the upper middle part of the abdomen, just below the ribs. The stomach, which preserves the food taken through nutrition for a while, also breaks down and digests various foods. Stomach cancer, also known as gastric cancer, can develop in any part of this organ. The most common place where it is detected is the body part, which is the main part of the stomach.

After stomach cancer is detected, treatment planning first takes into account which part of the stomach the cancer is located in. Treatment interventions, which generally target the removal of cancer tissue through surgical treatment, can in some cases be added to various other treatment practices.

What causes stomach cancer?

The stomach, together with the esophagus, forms the upper part of the digestive system. This organ, which preserves the food taken through nutrition for a while, then transmits the food mixture formed in it to the small intestine. The basic mechanism of stomach cancer is that normal healthy cells in this organ get out of control and form a tumor. This development usually occurs over many years.

There are various factors that can increase the development of stomach cancer in a person. Some of these factors can be broadly summarized as follows:

• Bacterial infections called Helicobacter pylori and characterized by the development of ulcers
• Tumor development in other parts of the digestive system
• stomach polyps
• Familial inherited syndromes such as Lynch or Li-Fraumeni

Apart from these cases, the risk groups in which stomach cancer cases are detected more frequently are as follows:

• Individuals aged 60 and over
• male gender
• tobacco use
• Overweight or obese individuals
• Having a family history of stomach cancer

Apart from personal medical history, there are different conditions that are considered risk factors for the development of stomach cancer:

• Excessive consumption of salty or processed food products
• consuming food frequently
• Lack of fruit consumption
• smoking
• Not getting enough exercise
• Consuming food that has not been stored under correct conditions or used the correct cooking methods

Since the risk of developing stomach cancer is increased in individuals with one or more of these factors, it is recommended to follow the person for stomach cancer with various screening methods. Screening practices enable early detection of the disease in risky individuals before they develop any symptoms.

Types of Stomach Cancer

• Adenocarcinoma (accounts for 90% of cases)
• lymphoma
• Gastrointestinal stromal tumor
• Carcinoid tumor (develops from the hormone-secreting cells of the stomach.)
• Squamous cell carcinoma
• small cell carcinoma
• Leiomyosarcoma

Stomach Cancer Risk Factors

Some risk factors that may cause stomach cancer have been identified. Some of these risks can be controlled, some cannot. For example, while smoking is a controllable risk factor, genetics cannot be controlled. The main causes of stomach cancer are:

• Stomach cancer is more common in men than in women.
• The risk of stomach cancer increases over the age of 50.
• Stomach cancer is more common in some breeds.
• Stomach cancer is more common in Japan, China, Southern and Eastern Europe, and South and Central America.
• Helicobacter pylori infection: There is a relationship between this bacterial infection and stomach cancer. However, not every person carrying H. Pylori microbe develops stomach cancer.
• Diet: Stomach cancer is more common in those who consume a lot of smoked and smoked foods, salted fish, meat and pickled vegetables. Dried meats contain plenty of nitrates. Eating lots of vegetables and fruits is protective against stomach cancer.
• Smoking: The risk of stomach cancer doubles in smokers. Cancer occurs especially at the junction of the stomach and esophagus.
• There is a tentative relationship between being overweight and stomach cancer.
• People who have had stomach surgery before have a higher risk of developing stomach cancer.
• Stomach cancer develops more frequently in people with pernicious anemia, which develops due to vitamin B12 deficiency.
• Although the cause is unknown, more stomach cancer has been reported in people with blood group A.
• Having cancer cases in the family
• People who carry mutations of the inherited breast cancer genes BRCA1 or BRCA2 may have a higher risk of stomach cancer.
• Stomach cancer is more common in patients with polyps in the stomach, intestines, nose, lungs and urinary bladder.
• Some cases of stomach cancer have a history of EBV infection.
• Workers in the coal, metal and rubber industries have a higher risk of stomach cancer.
• Patients with chronic atrophic gastritis may develop stomach cancer over time.

What are the symptoms of stomach cancer?

Stomach cancer symptoms may vary from person to person. Since the development of stomach cancer is a very slow process in some individuals, no complaints may occur for years.

In early stage stomach cancer, symptoms and findings similar to those experienced in the presence of a stomach ulcer may develop. These symptoms can be generally summarized as follows:

• Early satiety during meals
• swallowing problems
• Excessive bloating after meals
• Having a constant desire to burp
• heartburn
• persistent indigestion
• Stomache ache
• Feeling pain on the breastbone
• bloody vomit

When these complaints generally occur, they can be confused with the symptoms of different and simpler problems. However, it should not be forgotten that further examination and research is necessary in individuals at risk for stomach cancer, especially if there are problems with swallowing and swallowing.

In cases where stomach cancer progresses, more severe symptoms other than these complaints may also occur:

• Anemia
• Fluid accumulation in the stomach
• Darkening of stool color
• Weakness
• Loss of appetite
• unintentional weight loss

Stages of Stomach Cancer

After the diagnosis of stomach cancer is made, the physician will stage the cancer. Staging determines the severity of the cancer and its treatment. Survival rates vary depending on the stage of the cancer. If stomach cancer is stage 0, there are abnormal cells in the stomach. In stage 1, the muscle layer of the stomach and nearby lymph nodes are involved. In stage 4, the entire stomach is involved and metastasis has occurred to distant organs and lymph nodes. The most severe stage is stage 4.

Stomach Cancer Diagnosis

The doctor first takes a history from a patient who goes to the doctor with the symptoms listed above. You are asked about symptoms, their duration, lifestyle and habits. The following tests are then performed for diagnosis:

• Endoscopy: It is the most frequently performed procedure. During endoscopy, a biopsy is taken from the lesion and sent for pathological examination.
• Barium stomach radiography: It used to be used more frequently, but is now needed less frequently.
• Computed tomography: The location and size of the cancer and nearby organ metastases, if any, are determined.
• Laparoscopy: Laparoscopy is looking at the stomach with a camera under general anesthesia. It is checked whether the cancer has spread.
• Endoscopic ultrasound: With this method, the physician evaluates the upper region of the stomach and esophagus. It gives an idea about the lesion.
• Chest x-ray: It gives an idea about whether there is lung involvement.
• MRI: Used in cancer staging.
• PET: Detects the location of active cancer cells.
• Kidney ultrasound: It gives an idea about whether cancer has spread to the kidney.
• CEA: Cancer antigens are checked in the blood.

Stomach Cancer Treatment

Stomach cancer treatment is performed by a gastroenterologist, medical oncologist, cancer surgeon and radiation oncologist. The stage of the disease is taken into consideration when planning treatment. Main treatment methods:

1. Surgical: Stage 0, 1, 2, 3 patients are suitable for surgery. Depending on the stage of the cancer, part or all of the stomach may be removed. Nearby lymph nodes are cleaned. Surgery may be considered even if the cancer is at a very advanced stage. This prevents the tumor from bleeding and growing and blocking the stomach. This is called palliative surgery and is done to improve the patient’s quality of life. If cancer is detected at a very early stage, it can be removed endoscopically. The surgery can be performed laparoscopically or open surgery. Considering that some patients will have difficulty feeding after the surgery, a tube is placed in the intestine during the operation. Thus, liquid nutrients are given directly to the patient’s intestine. After stomach surgery, complications such as bleeding, clotting, and damage to nearby organs may occur. Sometimes there may be leakage from the incision sites. After surgery, patients may experience nausea, heartburn, abdominal pain and diarrhea. Patients are fed little by little and often. After the surgery, vitamin medications are given against vitamin deficiency.
2. Chemotherapy: Chemotherapy may be started before or after surgery, depending on the condition of the cancer. Chemotherapy before surgery is called Neoadjuvant therapy. It is applied to shrink the tumor. After surgery, chemotherapy is repeated. Giving chemotherapy after surgery is called Adjuvant therapy. The goal is to kill any remaining cancer cells. Concomitant radiotherapy may be given. It is especially preferred in cancers that cannot be completely removed by surgery. Chemotherapy may be planned as the main treatment for metastasized stomach cancer. After chemotherapy, patients may experience nausea and vomiting, loss of appetite, hair loss, diarrhea, more frequent infections, rapid skin bruising due to low platelet count, fatigue and shortness of breath. Cancer drugs can also cause neuropathy, heart damage, and hand-foot syndrome.
3. New generation targeted drug therapy: These drugs help healing by directly targeting cancer cells.
4. Radiotherapy: After surgery, radiotherapy is administered to kill cancer cells that cannot be removed. After radiation therapy, patients may experience skin flushing, nausea, vomiting, diarrhea, fatigue, and a decrease in blood cells.
5. Immunotherapy: This treatment is applied to the person’s immune cells to find and destroy cancer cells. Although it has some side effects, there are patients who benefit from it.

How to Prevent Stomach Cancer?

There is no sure way to prevent stomach cancer. However, the risk can be reduced with some measures. People with complaints such as stomach pain, indigestion and bloating should not use stomach medicine without consulting a doctor. It may cause a delay in diagnosis. Consumption of smoked foods, pickled foods, salted dried meat and fish can be reduced. Consumption of fresh vegetables and fruits can be increased. Whole wheat bread and legumes are beneficial. It is necessary to increase the amount of fiber in the diet. There are studies on the benefits of green tea. Weight control is necessary to reduce the risk of cancer. Excess weight increases the risk of cancer. It is beneficial to reduce salt and sugar. You should not consume excessively hot drinks. Regular exercise reduces the risk of all types of cancer. It is important to avoid tobacco use. If Helicobacter pylori infection is detected, it is necessary to have regular treatment. People with a genetic predisposition can have intermittent screening. This may enable the disease to be caught early.