Stomach cancer, also known as gastric cancer, is a formidable adversary that affects thousands of individuals worldwide. Understanding the nuances of this disease is crucial for early detection and effective management.

In this comprehensive guide, we’ll delve into the intricate details of stomach cancer, covering symptoms, diagnosis, and treatment options to empower individuals facing this challenging journey.

Types of Stomach Cancer

Stomach cancer is a heterogeneous disease with various types, each characterised by distinct features affecting specific layers of the stomach wall. The two primary categories are adenocarcinomas and non-adenocarcinomas.

Risk Factors

Stomach cancer arises from a complex interplay of genetic, environmental, and lifestyle factors. Understanding the risk factors is essential for early detection, prevention, and effective management of the disease:

Helicobacter pylori Infection: Chronic infection with Helicobacter pylori, a bacterium that colonises the stomach lining, is a major risk factor for stomach cancer. This infection can lead to chronic gastritis and stomach ulcers, increasing the likelihood of cancer development over time.

Genetic Predisposition: Individuals with a family history of stomach cancer are at a higher risk. Specific genetic mutations, such as those in the CDH1 gene, are associated with an increased likelihood of hereditary diffuse gastric cancer (HDGC). Genetic counselling and testing may be recommended for those with a family history.

Age: Stomach cancer is more common in older individuals, with the risk increasing significantly after the age of 50. However, it can occur at any age.

Gender: Men are more prone to develop stomach cancer than women. The reasons for this gender disparity are not entirely clear and may involve hormonal differences.

Dietary Factors:

• Diets high in salt, pickles, and preserved foods can elevate the risk of stomach cancer. Salt may damage the stomach lining, while certain preservatives can produce carcinogenic substances.
• Consumption of processed meats and excessive red meat intake have been linked to an increased risk of stomach cancer.
• A diet low in fruits and vegetables, which are rich in antioxidants and vitamins, may contribute to a higher risk.

Tobacco and Alcohol Use: Smoking and heavy alcohol consumption are associated with an elevated risk of stomach cancer. These substances may damage the stomach lining and contribute to the development of cancerous cells.

Recognising the Early Symptoms

Let us now look at some early warning signs that may lead to a stomach cancer diagnosis:

• Indigestion and Heartburn: Persistent indigestion and heartburn may be early indicators of stomach cancer. While these symptoms can be caused by various factors, their persistence should prompt further investigation.
• Unexplained Weight Loss: Sudden and unexplained weight loss can be a red flag. When the body is fighting cancer, it often redirects energy away from normal bodily functions, leading to weight loss.
• Abdominal Pain: Chronic abdominal pain, particularly in the upper abdomen, may signal the presence of stomach cancer. This pain can be mild initially but can intensify as the disease progresses.
• Nausea and Vomiting: Persistent nausea and vomiting, unrelated to other known conditions, should not be ignored. These symptoms can result from a tumour obstructing the stomach or affecting its normal function.

Early detection and intervention improve treatment outcomes. A balanced diet, exercise, and avoiding tobacco/alcohol reduce the risk. By being aware and taking action, individuals can control their health and prevent this disease.

Diagnosis and Intervention

Early detection is paramount for successful treatment. If you or any of your near ones are experiencing these symptoms, consult a doctor immediately. Here are some of the things your doctor might do, to understand the exact issue:

Medical Evaluation

The medical evaluation of suspected stomach cancer involves a systematic approach to gathering information about the patient’s health and identifying potential signs and symptoms. The initial steps include:

• Obtaining Medical History: Your doctor will take a detailed medical history, including personal and family health history. Information about symptoms, their duration, and any relevant risk factors, such as a family history of stomach cancer or previous gastrointestinal conditions, is crucial.
• Physical Examination: A thorough physical examination is conducted to assess the patient’s overall health. The healthcare provider may palpate the abdomen to check for any lumps, tenderness, or other abnormalities. The examination may also check for signs of nutritional deficiencies or other relevant physical findings.

Blood Tests

Blood tests may be conducted to assess the patient’s overall health and check for factors such as anaemia or abnormal liver function. Tumour markers, such as carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9 (CA 19-9), may be measured, although they are not definitive for stomach cancer. 

Imaging Tests

Imaging tests are crucial in visualising the stomach and surrounding structures. Some of the most common imaging tests conducted to detect stomach cancer are:

• a) Upper Endoscopy (Esophagogastroduodenoscopy or EGD): A flexible tube with a camera is passed through the mouth into the stomach to examine the lining for abnormalities or tumours.
• b) Upper Gastrointestinal (GI) Series: X-rays are taken after the patient drinks a contrast material to highlight the stomach and detect any abnormalities.
• c) Computed Tomography (CT) Scan: This imaging technique provides detailed cross-sectional images of the abdomen, helping to determine the extent of the cancer and whether it has spread to nearby structures.

Biopsy

If suspicious lesions or abnormalities are found during endoscopy or imaging, a biopsy is performed. Tissue samples are collected from the stomach lining for laboratory analysis to confirm the presence of cancer and determine its type.

The Staging Process

The staging process involves a combination of diagnostic tests, imaging studies, and sometimes surgical exploration to gather information for each of these three components.

Here’s how the staging process unfolds:

• Clinical Staging: This is the initial phase which is based on imaging studies, endoscopic findings, and biopsies before surgery. It provides a preliminary assessment of the extent of cancer.
• Pathological Staging: After surgical removal of the tumour (if possible), the pathologist examines the tumour and nearby lymph nodes. This provides a more accurate assessment of the cancer stage.
• AJCC Staging System: The American Joint Committee on Cancer (AJCC) incorporates the TNM staging information into an overall stage grouping, ranging from stage 0 (in situ) to stage IV (advanced). This grouping helps determine the prognosis and guides treatment decisions.

Understanding Treatment Options

Stomach cancer treatment is multifaceted and depends on factors like the cancer’s stage, location, and the overall health of the patient. The medical team decides the course of the treatment based on the medical evaluation of the patient.

Some of the common treatment options used to treat stomach cancer are:

Surgical Interventions

• Gastrectomy: In cases where the cancer is confined to the stomach, a partial or total gastrectomy may be recommended. This involves removing a portion of the entire stomach, depending on the extent of the disease.
• Lymphadenectomy: Surgical removal of nearby lymph nodes is often performed to prevent the spread of cancer to other parts of the body.

Chemotherapy and Radiation

• Chemotherapy: Chemotherapy uses drugs to kill cancer cells or impede their growth. It may be recommended before surgery to shrink tumours or after surgery to eliminate remaining cancer cells.
• Radiation Therapy: High-energy rays are used in radiation therapy to target and destroy cancer cells. This treatment may be employed before or after surgery, or as a palliative measure to alleviate symptoms in advanced cases.

Targeted Therapies and Immunotherapy

• Targeted Therapies: These therapies focus on specific molecules involved in cancer growth. Targeted therapies can be effective in cases where traditional chemotherapy may have limited success.
• Immunotherapy: Immunotherapy stimulates the body’s immune system to recognise and attack cancer cells. It has shown promise in treating various cancers, including stomach cancer.

Coping with Side Effects

Cancer treatment can be rigorous and can take a toll on the body as well as the mind. Keeping a healthy outlook is essential for the body to react positively to the treatment being administered. Some of the things to concentrate on for coping with the side effects in a better way are:

Nutritional Support:

Stomach cancer and its treatments can affect appetite and digestion. Nutritional support, including dietary changes and supplements, can help manage these challenges. Your medical team will draw out a diet chart for you. Following that can help you immensely.

Here are general dietary guidelines that individuals with stomach cancer may consider during treatment:

• Maintain Adequate Nutrition: Prioritise a well-balanced diet that includes a variety of nutrient-dense foods. Focus on obtaining sufficient calories, protein, vitamins, and minerals to support healing and prevent malnutrition.
• Small, Frequent Meals: Eat smaller, more frequent meals throughout the day rather than three large meals. This can help manage symptoms such as nausea, early satiety, and indigestion.
• Soft and Easily Digestible Foods: Opt for softer and easily digestible foods, especially if there are challenges with chewing or swallowing. Examples include mashed potatoes, pureed soups, yoghurt, and smoothies.
• Limit Foods that Irritate the Stomach: Avoid spicy, acidic, and heavily seasoned foods that may irritate the stomach lining. Opt for bland and mild options to reduce the risk of discomfort.
• Vitamin and Mineral Supplements: Depending on individual needs and treatment-related side effects, healthcare providers may recommend vitamin and mineral supplements to address potential deficiencies.

Emotional Support:

It is no secret that coping with a cancer diagnosis is emotionally taxing. Seek support from friends, family, or a mental health professional to navigate the emotional aspects of the journey.

Ask your medical team to provide a reference for a psychologist to help you cope mentally. Look for support groups on social media where you can talk to other patients suffering from the same disease. However, do not follow any suggestions without consulting with your medical team first.

Malaysia has several cancer-related support groups that you can take a look at such as the National Cancer Society Malaysia (https://cancer.org.my/get-help/support-groups/), Majlis Kanser Nasional (National Cancer Council – https://makna.org.my/), and Cancerlink Malaysia.

Sources:

• https://www.cancer.gov/types/stomach/coping
• https://www.cancer.gov/types/stomach/causes-risk-factors
• https://www.cancer.gov/types/stomach/symptoms
• https://www.cancer.gov/types/stomach/screening
• https://www.cancer.gov/types/stomach/diagnosis
• https://www.cancer.gov/types/stomach/treatment
• https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/
• https://my.clevelandclinic.org/health/diseases/stomach-cancer
• https://www.webmd.com/cancer/stomach-gastric-cancer