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Cancer Information

Stomach Cancer (Gastric Cancer)

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.


  • Family history of Stomach Cancer (Gastric Cancer)
  • A history of Helicobacter Pylori infection
  • Previous history of stomach l​ymphoma and stomach polyps
  • Long term stomach inflammation (chronic gastritis)
  • A diet high in salty and smoked foods
  • A diet low in fruits and vegetables
  • Smoking
*People who think they may be at risk should discuss this with their doctor.

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
  • Heartburn 
  • Nausea and vomiting 
  • Anaemia 

*A doctor should be consulted if the symptoms above occur. 


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.


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):

Endoscopy

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.

Type I

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Type II

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Type III​

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Type IV - Linitus Plastica

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Barium X-Rays

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.

Computed Tomography Scan (CT Scan)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)

Diagnostic LaparoscopyA 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.

 



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

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

gastric-EMR

Laparoscopy

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Open

gastric-open  

Laparoscopic Gastrectomy (LAG) - Trend at NUH (2005 - 2013)

gastric-LAGstage1 

Chemotherapy

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

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).



gastric-clinicalcare

Optimising Clinical Care​

Surgery is the main form of treatment used in the cure of Stomach Cancer (Gastric Cancer). At the NCIS, we have a Upper Gastrointestinal (UGI) tumour multidisciplinary team (MDT) comprising of surgeons, medical and radiation oncologists, radiologists, pathologists, nurse clinicians and research nurses. The team is dedicated to optimising the level of care for our patients at the clinical level. This is done through weekly MDT meetings for discussions on patient conditions and how to provide the best treatment support for our patients with expert opinions from various cancer specialists.

The care for our patients does not stop after the treatments are administered. At the NCIS, the patients and family members are educated on how to cope and manage the illness through our Patient Supportive Care Programmes.

Research

In order to constantly provide the most effective treatment options and improve the disease outcome, our team is active in conducting many clinical trials and have initiated several studies involving different centres and countries across the region.

In 2007, the National University Health System (NUHS) established the Singapore Gastric Cancer Consortium (SGCC) from a translational Research flagship grant under the National Medical Research Council (NMRC). To keep abreast on activities conducted by the SGCC, click here.

For novel therapy, our researchers have established a real-time genomic platform which provides a molecular classification that can predict both prognosis and drug responses. In addition, through the use of multiple gene expression platforms, this has led to the identification of new therapeutic targets that allow for specific targeted therapy. In addition, our researchers have also identified stomach cancer (gastric cancer) stem cells aiding in the understanding of the cancer biology and the development of new treatment processes. To find out more about the findings, click here.

Patient Supportive Care Programmes

At the NCIS, we strongly believe that it is important to provide patients and their family members with an environment where they can seek psychological, educational and therapeutic support. At the NCIS, we offer a range of Patient Supportive Care Programmes to provide a platform for Stomach Cancer (Gastric Cancer) survivors, patients and their caregivers to come together and share their experiences with one another in their fight against Stomach Cancer (Gastric Cancer) alongside the support from our surgeons, oncologists, nurses and allied health workers.

Interactive activities are also organised regularly to allow our patients to feel at ease in communicating with others which in turn encourages mutual sharing and support in the process.

For more information about our Patient Supportive Care Programmes, click here.