What is Stomach Cancer (Gastric Cancer)?
The stomach is located in our upper abdomen and is part of our digestive system. It connects the esophagus (gullet) with the small intestine. It acts as a food reservoir, mixes the food ingested and secretes liquid substances that aid digestion. Stomach Cancer (Gastric Cancer) usually occurs when cells in the inner layer of the stomach wall grow and divide without stopping. Over time, these cells will form lumps called tumours and the cancer may invade more deeply into the stomach wall.
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Who is at risk?
- Family history of stomach cancer (gastric cancer)
- A history of Helicobacter Pylori infection
- Previous history of stomach lymphoma and stomach polyps
- Long term stomach inflammation (chronic gastritis)
- A diet high in salty and smoked foods
- A diet low in fruits and vegetables
*People who think they may be at risk should discuss this with their doctor.
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What are the signs and symptoms?
Early stomach cancer (gastric cancer) may not show any noticeable signs or symptoms. Below are some symptoms of stomach cancer (gastric cancer) although other conditions may also cause those symptoms:
- Upper abdominal pain (Dyspepsia)
- Constant indigestion
- Loss of appetite
- Unintended weight loss
- Black stool
- Nausea and vomiting
*A doctor should be consulted if the symptoms above occur.
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What can you do to prevent Stomach Cancer (Gastric Cancer)?
There are two ways to prevent Stomach Cancer (Gastric Cancer):
- Avoid diets that are high in salt, smoked or pickled foods
- Choose a diet high in fresh fruits, vegetables and whole grain foods
Most often these symptoms can often be a result of other diseases other than cancer, only a doctor can tell for sure. Follow up and make an appointment immediately with your doctor if you experience these symptoms.
Stomach cancer (gastric cancer) is curable if detected early.
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How is Stomach Cancer (Gastric Cancer) diagnosed?
If you experience any of the symptoms mentioned, the doctor may refer you to see a specialist after asking about your personal and family medical history and a physical examination.
The following tests are used to diagnose stomach cancer (gastric cancer):
Your doctor uses an endoscope (a flexible tube with a miniature camera attached to the end) to look directly at the stomach. If necessary, the doctor can take a small sample of the tissue (a biopsy) to be examined. This is inserted through the mouth into the stomach.
You will have to swallow a liquid containing Barium (Barium is a metallic compound that shows up in x-rays). X-Ray pictures will then be taken when the Barium flows down to the stomach and reveals the structure and abnormalities of the stomach. The test will take about 15 minutes and it is not painful. If a cancer is found, other tests are required to find out whether it has spread to other organs.
Computed Tomography Scan (CT Scan)
An X-ray that produces detailed cross-sectional images of your body, the Computed Tomography Scan (CT scan) takes many pictures as it rotates around you. These pictures are then combined into images of slices of the part of your body being studied by a computer.
The stomach can be viewed fairly through the CT scan and can often confirm the location of the cancer. The CT scan can also show organs near the stomach such as the liver, lymph nodes, and distant organs where the cancer might have spread. The CT scan can help determine the extent or stage of cancer and indicate whether surgery may be a good treatment option.
Endoscopic Ultrasound (EUS)
During an Endoscopic Ultrasound (EUS), a small transducer is placed on the tip on an endoscope. You will then be sedated as the endoscope passes down your throat and into your stomach. The transducer will then rest directly on your stomach wall where the cancer is.
Through an EUS, layers of the stomach wall as well as the nearby lymph nodes and other structures just outside the stomach can be seen. An EUS typically has better picture quality than a standard ultrasound due to the shorter distance the sound waves take to travel.
An EUS is most useful in determining how far a cancer may have spread into the stomach wall, nearby tissues, or nearby lymph nodes. It can also be used to extract tissue samples.
Diagnostic Laparoscopy - Peritoneal Metastasis from Stomach Cancer (Gastric Cancer)
A Diagnostic Laparoscopy is typically performed in an operating room with the patient under general anaesthesia. A laparoscope (a thin, flexible tube) is then inserted through a small surgical opening in the patient's side.
The laparoscope has a small video camera attached to its ends, which allows pictures of the inside abdomen to be sent to a TV screen. Through these pictures, surfaces of the organs, nearby lymph nodes, and even extraction of small tissue samples can be obtained.
If cancer does not seem to have been detected, sometimes, a "washing" of the abdomen with saline (salt water) will be done. The fluid will then be removed and checked for cancer cells. This helps to check if the cancer has spread, even if it was failed to be captured by the laparoscope.
Sometimes, laparoscopy is combined with ultrasound to provide a clearer picture of the cancer.
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What are the treatment options?
There are different treatments available for stomach cancer (gastric cancer) depending on the stage, type and the position of the stomach cancer (gastric cancer). Factors other than the stage of the cancer that might have an impact on your treatment decision include your age, your overall health, and your own preferences. The three main types of treatment include surgery, radiation and chemotherapy.
Surgery is the most important treatment for stomach cancer (gastric cancer) in the early stages (where cancer is confined to the stomach). The most common treatment is called gastrectomy. There are two types:
- Partial Gastrectomy: the removal of part of the stomach. The remaining portion of the stomach is then reconnected to the esophagus or the small intestine.
- Total Gastrectomy: the removal of the entire stomach. The intestine is then reconnected directly to the esophagus. The lymph glands (nodes) close to the stomach will also be removed during the surgery.
If the cancer is too bulky to be removed, a connection will be made between the stomach and small intestine. This will relieve the symptoms but will not cure the cancer.
"Tailor Approach" Treatment Strategies
EMR / ESD
Laparoscopic Gastrectomy (LAG) - Trend at NUH (2005 - 2013)
Chemotherapy is the use of drugs to help kill cancer cells and shrink the size of the tumour. It can be given alone or combined with radiotherapy before or after surgery. It is also the treatment of choice if the patient is not suitable for surgery. The drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. In stomach cancer (gastric cancer), multiple chemotherapy sessions are usually required.
Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells or to keep them from growing. There are two types of radiation therapy – external and internal. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Radiation is usually administrated after surgery together with chemotherapy to kill very small remnants of the cancer that cannot be seen and removed during surgery. Radiation therapy can also be used to ease the symptoms of advanced stomach cancer (gastric cancer).
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