Gastric Cancer: Diagnosis And Treatment Options
JOHN C. LAYKE, D.O. University of Illinois Metropolitan Group Hospitals, Chicago, Illinois
PETER P. LOPEZ, M.D. University of Miami School of Medicine, Miami, Florida
Am Fam Physician. 2004 Mar 1 69:1133-1141.
The overall incidence of gastric cancer in the United States has rapidly declined over the past 50 years. Gastric cancer is now 13th most common cause of cancer mortality in the United States, with an estimated 12,100 deaths in 2003.1 However, in developing countries, the incidence of gastric cancer is much higher and is second only to lung cancer in rates of mortality.
The typical patient with gastric cancer is male and between 40 and 70 years of age . Native Americans, Hispanic Americans, and blacks are twice as likely as whites to have gastric carcinoma.
Ninety-five percent of all malignant gastric tumors are adenocarcinomas the remaining 5 percent include lymphomas, stromal tumors, and other rare tumors.2 The overall declining incidence of gastric carcinoma is related to distal stomach tumors caused by Helicobacter pylori infection. Proximal stomach tumors of the cardiac region have actually increased in incidence in recent years.3 This trend has been attributed to the increased incidence of Barretts esophagus and its direct correlation with the development of esophageal adenocarci-noma.4 This review discusses diagnosis, treatment, and survival outcomes in patients with gastric adenocarcinoma.
Treatment For Gastric Cancer With Hdgc
Therefore, individuals from HDGC families should also discuss the option of prophylactic total gastrectomy. The lifetime risk of stomach cancer is very high in CDH1 carriers and without a proven effective screening test, surgery is a realistic and reasonable option. Gastrectomy in CDH1 gene carriers has to date been performed in only a very few patients. However, our experience at Stanford suggests that this may be the best approach to prevention at the current time. Meet our team of experts at the Stanford Cancer Genetics Program.
Living With Advanced Cancer
Advanced cancer usually means cancer that is unlikely to be cured. Some people can live for many months or years with advanced cancer. During this time palliative care services can help.
Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.
Treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:
- Slow down how fast the cancer is growing.
- Shrink the cancer.
- Help you to live more comfortably by managing symptoms, like pain.
Treatment depends on:
- How far it has spread.
- Your general health.
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Current Nationwide Screening Programs
Japan and South Korea are countries with ongoing nationwide organized GC screening programs. The screening program was launched in 1960 in Japan, with the only recommended screening method being photofluorography . From February, 2013, H. pylori eradication is reimbursed in Japan, but organized screening program. Upper endoscopy is used in conjunction with photofluorography screening in South Korea.
Kazakhstan has also decided to introduce bi-annual screening, with upper endoscopy for esophageal and gastric cancers for the age group 50-60. Starting from the beginning of 2013, this has been implemented in 6 of the 16 regions in the country with the intention to expand it to the entire country. However, the set-up of the program is unlikely to adopt or correspond to the criteria required of an organized program, giving little expectation that the target will be reached.
Tumour Markers Blood Test
As well as blood tests to check your general health, your doctor may test for cancer markers. Markers are chemical substances that can show up in the bloodstream in some types of cancer.
For example, the markers CEA and CA 19-9 are sometimes raised in stomach cancer, as well as other cancers. But some people with stomach cancer do not have raised levels in their blood and they can be raised in non cancerous conditions.
If your tumour markers are raised at diagnosis, your doctor might check the levels again after treatment and as part of your follow up.
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Gastric Cancer In Hdgc Syndrome
Diagnosing gastric cancer in its early stages provides the best chance for survival but is a difficult task. Symptoms due to gastric cancer often do not appear until the disease is more advanced and are generally non-specific. When the diagnosis of gastric cancer is established, it is most often advanced. A total gastrectomy is indicated in an individual with HDGC and any evidence of stomach cancer, as typically even a small number of cancer cells on a biopsy means there are multiple areas of hidden tumor throughout the entire stomach.
Treatment For Stomach Cancer
Treatment for stomach cancer depends on the stage of the cancer, your age, medical history, nutritional needs and general health.
You might feel confused or unsure about your treatment options and decisions. Its okay to ask your treatment team to explain the information to you more than once. Its often okay to take some time to think about your decisions.
Surgery
Surgery is the main treatment for stomach cancer that has not spread to other parts of the body. Surgery aims to remove all of the stomach cancer while keeping as much normal tissue as possible. There are two main types of surgery for stomach cancer:
- Endoscopic resection very early-stage tumours that have not spread from the stomach walls may be removed with a long, flexible tube that is passed down your throat and oesophagus, and into your stomach.
- Gastrectomy this procedure removes all or part of the stomach, leaving as much healthy tissue as possible.
Chemotherapy
Chemotherapy is the use of drugs to kill or slow the growth cancer cells. For stomach cancer, chemotherapy is often given before surgery to shrink large tumours and destroy any cancer cells that may have spread. It may also be used after surgery to reduce the chance of the cancer coming back.
Targeted therapy
Targeted therapy is a type of drug treatment that attacks specific parts of cancer cells to stop the cancer growing and spreading. Targeted therapy is only available for certain types of stomach cancer.
Radiation therapy
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Does Stomach Cancer Affect Men And Women Differently
It is important to look for signs of stomach cancer in adults over the age of 55. However, it most commonly affects those in their 60s or 70s. While it is crucial to be aware of the signs of stomach cancer in females, men are more likely to develop stomach cancer. In 2020, 16,980 men and 10,620 women are projected to be diagnosed with the disease. Men have a lifetime risk of 1 in 95 of developing stomach cancer, while women have a 1 in 154 risk. The signs of stomach cancer in men are typically no different than in women.
Why Choose The University Of Kansas Cancer Center For Stomach Cancer Diagnosis And Treatment
For a diagnosis as crucial as stomach cancer, there are many benefits to trusting our cancer team with your care. Our cancer center is 1 of only 71 NCI-designated cancer centers nationwide, and we have experts for diagnosing and treating stomach cancer. We are a pioneer in new clinical trial research that leads to innovative treatments. In addition, our hospital continues to rank as the best in Kansas City and in Kansas according to U.S. News & World Report.
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High Grade Gastric Epithelial Dysplasia
Most patients who develop high-grade gastric epithelial dysplasia are at high risk for developing invasive gastric carcinoma. According to the MAPS guidelines, histological diagnosis of high-grade dysplasia in the absence of endoscopic data indicates an immediate need for endoscopic re-examination with wide biopsy sampling and subsequent surveillance at six-month to one-year intervals.
Gastric Cancer Causes And Clues
Gastric or stomach cancer is almost always caused by the chronic presence of bacteria called Helicobacter pylori. The bacteria first leads to infection and inflammation. There is already a breath test for the bacteria, but it detects only the bacterianot cancer.
Dr. Sheraz Markar, a clinical trials fellow at Imperial College, explains how the tumors themselves can now be discovered: “Because cancer cells are different to healthy ones, they produce a different mixture of chemicals. This study suggests that we may be able detect these differences and use a breath test to indicate which patients are likely to have cancer of the esophagus and stomach, and which do not.”
“With a screening test like this, it may push gastric cancers up to a much earlier diagnosis where an outpatient endoscopic procedure can cure the cancer.”
Researchers determined the specific chemical combination by testing them against the breath samples of over 300 people who had undergone an endoscopy to investigate upper digestive tract issues.
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What Is The Prognosis For People Who Have Stomach Cancer
The outlook for stomach cancer depends on the stage of the cancer. People in the early stages of stomach cancer have a much greater rate of survival than those at a later stage:
- If stomach cancer is found in its earliest stage and can be removed with an endoscope, the five-year survival rate is higher than 90 percent.
- If the cancer is found after it has spread to areas surrounding the stomach, the five-year survival rate is 28 percent.
- If the cancer has spread to areas beyond those surrounding the stomach, the five-year survival rate is 4 percent.
Last reviewed by a Cleveland Clinic medical professional on 02/17/2019.
References
How Can You Detect Stomach Cancer Early
Be sure to contact your medical provider if you feel like something is not right. There are screening tests for stomach cancer when people are at risk for or are experiencing signs and symptoms. Diagnostic evaluations for gastric cancer include:
- Complete medical history and physical exam
- Upper gastrointestinal endoscopy to view the esophagus, stomach and small intestine after sedation. A small, flexible tube is inserted into the mouth with a tiny camera on the end that allows the doctor to see inside your stomach.
- Biopsy of stomach tissue to be evaluated under a microscope
- CT scan to visualize organs during X-ray
- Endoscopic ultrasound to diagnose and treat stomach cancer at the same time by visualizing organs and nearby blood vessels
- Positron emission tomography scan to illuminate cancer cells. A radioactive sugar tracer is used because cancer cells use more sugar than healthy cells and the tracer illuminates the cancer cells.
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Stomach Cancer Is On The Decline
The really good news is that this type of cancer is very rare in the United States, and its actually decreasing in incidence, says Dr. El-Hayek. Less than 2 percent of all new cancer diagnoses are from stomach cancer.
The main reason for the decrease in cases is probably that infections from Helicobacter pylori, a type of bacteria known more commonly as H. pylori, are being diagnosed earlier than they used to be, Dr. El-Hayek notes. H. pylori is believed to be one of the major causes of stomach cancer because it can cause chronic inflammation in your stomach lining, as well as ulcers.
Now that were making the diagnosis of H. pylori earlier when patients get symptoms, theyre treated with antibiotics, the infection is eradicated and the overall risk of stomach cancer is presumably decreased, Dr. El-Hayek says.
Although H. pylori infections are extremely common, many people dont ever have any symptoms. For those who do get symptoms, its normally this dull, achy pain after eating, says Dr. El-Hayek. You might also notice nausea, bloating, burping, weight loss and lack of appetite. If you experience any of these, Dr. El-Hayek recommends that you see your doctor for testing.
Screening Tests Have Risks
Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.
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What Are The Different Stages Of Stomach Cancer
Stomach cancer is staged based on the severity of cancerous cell growth and spread. Adenocarcinoma is initially evaluated by the tumor, node metastasis system.
- T: How deeply has the tumor spread into the stomach wall?
- N: Has the stomach cancer spread to the lymph nodes?
- M: Has the stomach cancer spread to other parts of the body?
After the TNM staging information has been taken into account, the cancer is staged at 0 or 1 to 4. Tumor classifications for staging are as follows:
- Stage 0 is early cancer on the surface of the stomach lining.
- Stage 1A or 1B
- Stage 2A or 2B, commonly with deeper stomach wall involved
- Stage 3A or 3B or 3C, commonly with lymph node involvement
- Stage 4 means cancer has metastasized elsewhere in the body outside of the stomach.
Cancer Delineation Using Nbi
NBI endoscopy may also help in assessing the extent of lesions ,and in improving safety margins and cure rates during endoscopic resection of EGC.
As described before, different studies have reported various descriptions of GC mucosal and vascular patterns, as well as the demarcation line . A recent invited review suggested the VS classification system for making a differential diagnosis between cancerous and noncancerous lesions for NBI-ME endoscopy.
This simple but structured system classed the microvascular and microsurface patterns into three categories: regular, irregular and absent.
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The Risks Of Stomach Cancer Screening Include The Following:
Finding stomach cancer may not improve health or help you live longer.
Screening may not improve your health or help you live longer if you have advancedstomach cancer.
Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer may have serious side effects.
False-negative test results can occur.
Screening test results may appear to be normal even though stomach cancer is present. A person who receives a false-negative result may delay seeking medical care even if there are symptoms.
False-positive test results can occur.
Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result can cause anxiety and is usually followed by more tests and procedures which also have risks.
Side effects may be caused by the screening test itself.
Upper endoscopy may cause the following rare, but serious, side effects:
- A small hole in the esophagus or stomach.
- Heart problems.
- Lunginfection from inhaling food, fluid, or stomach acid into the lung.
- Severe bleeding that needs to be treated at a hospital.
- Reactions to medicine used during the procedure.
After A Diagnosis Of Stomach Cancer
After being diagnosed with a stomach cancer, you may feel shocked, upset, anxious or confused. These are normal responses. A diagnosis of a stomach or oesophageal cancer affects each person differently. For most it will be a difficult time, however some people manage to continue with their normal daily activities.
You may find it helpful to talk about your treatment options with your doctors, family and friends. Ask questions and seek as much information as you feel you need. It is up to you as to how involved you want to be in making decisions about your treatment.
Learn more about best stomach cancer care:
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What Are The Main Causes Of Stomach Cancer
There is no single cause of stomach cancer and sometimes it happens without any known risk factors. Lifestyle choices can increase the likelihood of stomach cancer. However, those who experience long-term stomach inflammation from either lifestyle choices or chronic illness are at higher risk.
The are often related to a medical history that includes:
- H. pylori bacterial infections: A common stomach infection that often causes ulcers.
- Tumors: Other tumors occurring elsewhere in the gastrointestinal tract.
- Stomach polyps: Abnormal tissue growth in the stomach lining.
- Stomach reflex
There are lifestyle changes you can make that may decrease your risk of stomach cancer. These include:
- Having a healthy diet and avoiding
- Processed foods
- Salted foods or increased sodium
Risk factors for stomach cancer that you cannot change, include:
- Your age
- Being male
- Being of Asian, South American or Belarusian descent
- Having a family history of stomach cancer
- Having a history of stomach surgery
- Having pernicious anemia, which is a vitamin deficiency that may be related to either lifestyle or disease
There Are Different Types Of Treatment For Children With Stomach Cancer
Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
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Tests Are Used To Screen For Different Types Of Cancer When A Person Does Not Have Symptoms
Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection helps a person live longer or decreases a person’s chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.