Stomach Cancer (Gastric)
What is stomach cancer? Stomach cancer is a malignant tumor that starts in the cells of the stomach. The word “malignant” means that the tumor is cancerous and can spread (metastasize) to other parts of the body.
The stomach is part of the digestive system. It is a sac-like muscular organ located in the upper part of the abdomen. In the stomach, food mixes with digestive juices, which are made by glands in the lining of the stomach. These juices help break down food into a semi-solid mixture which is then passed into the small intestine.
Stomach cells sometimes go through changes that make the way they grow or behave abnormally. These changes can lead to the formation of non-cancerous or benign tumors, such as gastric polyps, small gastrointestinal stromal tumors (TSGIs), or lipomas.
Changes in the cells of the stomach can also lead to precancerous conditions. This means that cells are not yet cancerous, but could become cancerous if left untreated. Precancerous conditions that can develop in the stomach are gastric adenoma, or adenomatous polyp, and gastric epithelial dysplasia.
In some cases, the modified cells in the stomach can become cancerous. Cancer most often develops in glandular cells in the inner lining of the stomach wall, called the stomach lining. This type of cancer is called adenocarcinoma of the stomach. It accounts for about 95% of all stomach cancers.
Rare types of stomach cancer can also occur. Gastric non-Hodgkin lymphomas and soft tissue sarcomas are examples.
The stomach is part of the digestive system and is connected to the following organs:
the esophagus – a tube-like organ that connects the mouth and throat to the stomach. The point of contact between the esophagus and the stomach is called the esophagogastric (OG) junction.
the small intestine (sometimes called the small intestine) – a long tube-like organ that runs from the stomach to the colon (large intestine). The first part of the small intestine, the one that communicates with the stomach, is called the duodenum.
The stomach is surrounded by a large number of lymph nodes.
Regions of the stomach
The stomach is divided into 5 regions.
The cardia is the initial region of the stomach. It is located under the esophagus with which it communicates. It contains the cardial sphincter, a thin ring of muscle that prevents stomach contents from moving up into the esophagus.
The fundus is a rounded region located to the left of the cardia and below the diaphragm.
The body is the main and largest part of the stomach, where food is stirred and begins to break down.
The antrum (sometimes called the pyloric antrum) is the lower part of the stomach. The den stores broken down food until it is ready to be passed into the small intestine.
The pylorus is the part of the stomach that communicates with the small intestine. This region includes the pyloric sphincter, a thick ring of muscles that acts like a valve to regulate the emptying of stomach contents (called chyme) into the duodenum (the first part of the small intestine). The pyloric sphincter also prevents the contents of the duodenum from moving up into the stomach.
Layers of the stomach wall
The stomach is made up of several layers of tissue.
The mucous membrane (mucous membrane) is the inner lining of the stomach. When the stomach is empty, the lining is wrinkled. These gastric folds (wrinkles) smooth out as the stomach fills with food.
The next layer is the submucosa, which covers the mucous membrane. It is made up of connective tissue which includes large blood and lymphatic vessels, nerve cells, and fibers.
The muscularis (external muscularis or muscularis propria) is the next layer, which covers the submucosa. It is the main muscle in the stomach and is made up of 3 layers of muscles.
The serosa is the fibrous membrane that covers the outside of the stomach. The serosa of the stomach is also called the visceral peritoneum.
The stomach has 3 main functions:
temporary storage of food that arrives from the esophagus and is retained in the stomach for 2 hours or more
mixing and disintegration of food through the contraction and relaxation of the muscle layers of the stomach
The lining contains specialized cells and glands that produce hydrochloric acid and digestive enzymes to digest food. The lining of the cardial and pyloric regions secretes mucus to protect the lining of the stomach from acid produced for digestion. Other specialized cells in the lining of the pylorus secrete a hormone called gastrin into the blood. Gastrin stimulates the secretion of acids and enzymes by the mucous membrane and helps the onset of contractions of the stomach muscles.
The food is broken down into a thick, acidic mixture called chyme. The pyloric sphincter relaxes once the chyme is fully formed, then the chyme passes into the duodenum. The duodenum plays a big role in absorbing food, but the stomach does not. The stomach only absorbs water, alcohol, and some medicines.
Non-cancerous tumors of the stomach
A non-cancerous, or benign, tumor of the stomach is a lump that does not spread to other parts of the body (not metastasize). Non-cancerous tumors are usually not life threatening. Usually, they are removed by surgery and they do not reappear (no recurrence).
There are many types of non-cancerous stomach tumors, but most are rare:
Gastric polyps are the most common non-cancerous tumors of the stomach. A gastric polyp is a mass that grows in the lining of the stomach. Polyps can look like fungi, with a head and a foot (pedicled polyps). They can also be flat and grow along the inner surface of the stomach wall (sessile polyps).
There are several types of gastric polyps:
Fundic gland polyps – These polyps are usually less than 1 cm in size and can occur by chance or in people with polyposis syndromes.
Hyperplastic polyps – These polyps are usually less than 2 cm in size and often occur in people with gastritis (inflammation of the stomach).
Inflammatory fibrous polyps – These polyps are hard, red, and swollen (inflamed). They can grow to the point of blocking the passage.
xanthomas – These yellowish masses that contain fat are usually very small (most are less than 3mm).
Hamartomatous polyps – These polyps are surrounded by normal stomach lining and can occur by chance or in people with polyposis syndromes.
Polyposis syndromes are inherited (genetic) disorders in which a large number of polyps develop in the digestive tract (or gastrointestinal tract), usually the colon or small intestine.
Mild gastric polyps can develop in the presence of the following polyposis syndromes:
familial adenomatous polyposis (FAP)
Familial adenomatous polyposis (FAP) causes hundreds or even thousands of adenomas (also called adenomatous polyps) to form on the lining of the colon, rectum, and in some cases other parts of the digestive tract, including the ‘stomach. People with PAF may also have benign fundic gland polyps.
Other non-cancerous tumors of the stomach
Other types of non-cancerous stomach tumors are rare. Among these tumors are:
gastrointestinal stromal tumors (TSGIs) – small TSGIs may be non-cancerous, but larger ones often are
lipomas – made up of fat cells (which contain fat)
leiomyomas – composed of smooth muscle cells
tumors of the peripheral nerves – for example, schwannoma and neurofibroma
aberrant, or heterotopic, pancreas – made up of pancreatic cells
hemangiomas – composed of abnormal blood vessels
lymphangiomas – appear in the lymphatic vessels
glomus tumors, or perivascular tumors – appear around blood vessels
fibroids, or fibromyomas – made up of fibrous tissue
cystic tumors – appear when a mucus-secreting gland is blocked
Gastric polyps can appear because of an inherited disorder or because an area of the stomach is inflamed or damaged. Fundic gland polyps can also occur in people taking medicines that reduce the amount of acid made in the stomach (such as proton pump inhibitors). However, the risk factors for other non-cancerous stomach tumors are not well understood because these tumors are very rare.
Non-cancerous stomach tumors rarely cause signs and symptoms. Most tumors are detected by chance during an upper gastrointestinal endoscopy done for other reasons. Signs and symptoms may appear if the polyp becomes very large. These include:
- pain in the upper abdomen
- gastric orifice obstruction – (blocked opening between the stomach and the small intestine)
- digestive problems such as nausea and vomiting or a feeling of fullness after a light meal (early satiety)
- lump in the abdomen (if the tumor is large)
Non-cancerous stomach tumors are usually found when tested for other reasons. If you have symptoms of non-cancerous stomach tumors, or if your doctor thinks you may have them, you will be checked for tests. Tests done to diagnose non-cancerous stomach tumors include:
- upper digestive endoscopy
- endoscopic biopsy
The standard treatment for non-cancerous stomach tumors is surgery. The choice of the type of surgery depends mainly on the size of the tumor. Types of surgery include:
endoscopic biopsy – to remove a single polyp 2 cm or smaller
gastrostomy – an incision in the wall of the stomach to remove polyps larger than 5 cm or multiple flat, or sessile polyps
gastric resection – to remove a small tumor as well as a margin of healthy tissue
removal of part or all of the stomach (gastrectomy) – can be used to remove many polyps
Several treatments may be needed to remove polyps in some people with polyposis syndromes. No treatment may be necessary if the tumor is small (less than 1 cm) and is not causing any signs or symptoms. However, you may want to have regular check-ups including an endoscopy to check if the tumor is growing or if its appearance changes.
Symptoms or signs of stomach cancer
In its early stages, stomach cancer may not cause any signs or symptoms because the tumor is small. In addition, the abdomen and stomach are large structures that can expand, so a tumor can grow there without causing symptoms. Symptoms often appear after the tumor has spread into nearby tissues and organs. Symptoms of stomach cancer can also be caused by other medical conditions. If you experience these symptoms, see your doctor.
The signs and symptoms of stomach cancer include:
- abdominal pain or discomfort (may be mild)
- digestive changes, such as loss of appetite, feeling full after a light meal (early satiety), heartburn (difficulty
- digesting) or nausea
- difficulty swallowing or painful swallowing
- vomiting, in which there may be blood
- abdominal bloating, especially after meals
- blood in stool
- jaundice (the skin and the whites of the eyes turn yellow and the urine is dark yellow)
- accumulation of fluid in the abdomen (called ascites)
- lump in the abdomen that can be palpated on physical examination
- mass on an ovary (Krukenberg tumor)
- mass in the pelvis (Blumer’s plate), which can be palpated during a digital rectal exam
- lump in the navel area (a swollen lymph node, sometimes called Sister Mary Joseph’s node)
- lump above the left collarbone (one or more swollen lymph nodes, sometimes called Troisier’s or Virchow’s
- lymph nodes)
- lump in the left armpit (a swollen lymph node)
- darkening of the skin in the folds of the body (acanthosis nigricans)
- wart-like growths on the skin (seborrheic keratosis)
Risks of stomach cancer
Certain behaviors, substances, or conditions can affect your risk, or likelihood, of getting cancer. There are things that increase your risk while others decrease it. Most cancers are caused by many risks. But cancer sometimes appears in people who are not at risk.
Helicobacter pylori infection is the greatest risk of stomach cancer.
More men than women get stomach cancer. The risk increases with age; it is highest after 50 years. Some studies link low socioeconomic status to an increased rate of stomach cancer.
Stomach cancer is more common in Japan, China, South America and Eastern Europe. It is not as present in North America. In Canada, the number of new cases of stomach cancer diagnosed each year has been declining since the 1980s.
Precancerous conditions of the stomach include gastric epithelial dysplasia and gastric adenoma. These conditions are not cancerous, but they can turn into stomach cancer if left untreated. Some of the things that increase your risk for stomach cancer can also cause these precancerous conditions. Find out more about precancerous stomach conditions.
Some people with particular genetic disorders have a higher than average risk of developing stomach cancer. Discuss your risk with your doctor. If you have a genetic disorder that increases your risk for stomach cancer, you may need to see your doctor more often to check for stomach cancer. Your doctor will tell you which tests to take and how often.
The following may increase or reduce your risk of stomach cancer. There are things you can do to lower your risk and help protect yourself from cancer.
Family history of stomach cancer
Certain stomach disorders
Previous gastric surgery
Contact with ionizing radiation
Work in the rubber industry
Blood group A
Salt and salty foods
Infections with the following viruses and bacteria increase your risk of getting stomach cancer.
Helicobacter pylori (H. pylori) is a type of bacteria that causes stomach ulcers and inflammation of the lining of the stomach (gastritis). Although H. pylori can increase your risk, not everyone with H. pylori infection will get stomach cancer. H. pylori can work with other factors to increase the risk of stomach cancer. The age at which a person gets this infection can also affect the risk of developing stomach cancer.
Epstein-Barr virus (EBV) is a type of herpes virus that causes mononucleosis (mono, or kissing disease). Infection with EBV may increase the risk of developing non-Hodgkin lymphoma in the stomach, a rare type of stomach cancer. It may also increase your risk of adenocarcinoma, the most common type of stomach cancer.
Find out more about the Epstein-Barr virus (EBV).
Smoking tobacco increases your risk of stomach cancer.
Tobacco in all its forms – cigarettes, cigars and pipes – increases your risk.
The longer you smoke and the longer you smoke, the higher your risk. After you quit smoking, your risk of getting stomach cancer decreases over time.
Family history of stomach cancer
If one of your first-degree relatives has had stomach cancer, you are more likely to have it. This increased risk may be due to inherited disorders. It can also be caused by risk factors common to other family members such as diet, smoking and H. pylori infections.
A genetic disorder is a disease caused by a change (mutation) in one or more genes. Having certain genetic disorders increases your risk for stomach cancer.
Hereditary diffuse gastric cancer (CGDH) increases the risk of having the diffuse form of adenocarcinoma (cancer of the stomach). This type of cancer is characterized by cancer cells spreading throughout the lining of the stomach that do not form a tumor in an area. Cancer of the Stomach associated with CGDH usually appears before the age of 40. The doctor may suspect a CGDH when the stomach cancer has affected several members of the same family.
Familial adenomatous polyposis (FAP) is an inherited disorder that causes hundreds or thousands of polyps to form, mainly on the lining of the colon and rectum.
People with FAP have an increased risk of developing colorectal cancer and cancer of the small intestine. FAP also increases the risk of cancers of the stomach, adrenal gland and large thyroid.
Lynch syndrome is an inherited disorder that causes a large number of polyps to form on the lining of the colon and rectum, but in fewer quantities than in familial adenomatous polyposis (FAP). Lynch syndrome is also called hereditary nonpolyposis colorectal cancer (HNPCC).
There are 2 types of Lynch syndrome. Type A increases the risk of colorectal cancer, while type B increases the risk of several cancers, including colorectal cancer and other cancers of the digestive system, as well as ovarian and ovarian cancers. uterus in women.
Peutz-Jeghers syndrome is an inherited disorder that causes dark spots to form on the mouth and fingers, as well as polyps in the large and small intestines.
Peutz-Jeghers syndrome increases the risk of colorectal cancer, cancers of the small intestine, stomach, pancreas and breast, and other types of cancer.
Juvenile polyposis syndrome causes polyps to form in the digestive tract, including the stomach, before the age of 20 years.
Li-Fraumeni syndrome is an inherited disorder associated with an increased risk for certain types of cancer, including breast cancer, brain tumors, acute leukemia, soft tissue sarcoma, osteosarcoma and adrenocortical carcinoma.
People with Li-Fraumeni syndrome tend to develop several types of cancer before the age of 45.
Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) normally help control the growth of cancer cells. Changes in these genes (which can be inherited from either parent) increase the risk of breast and ovarian cancer.
Certain stomach disorders
The following non-cancerous stomach conditions increase your risk of stomach cancer.
Chronic atrophic gastritis is characterized by inflammation of the lining of the stomach. It is usually caused by an infection with H. pylori. It can also occur if the immune system attacks healthy tissue in the lining of the stomach by mistake, called autoimmune atrophic gastritis.
Intestinal metaplasia is characterized by the replacement of cells in the stomach by cells that normally line the intestine. It can be caused by H. pylori infection, an inherited disorder, diet or other factors.
Ménétrier’s disease is a rare disease characterized by the excessive growth of cells in the lining of the stomach, which creates large folds in the lining.
Pernicious anemia is a type of anemia (lower than normal red blood cell count) that occurs when the digestive tract is unable to absorb vitamin B12. The body needs vitamin B12 to make red blood cells. Polyps may form in the stomachs of people with pernicious anemia.
Previous gastric surgery
Surgery to remove part of the stomach is called a partial gastrectomy. It may be used to treat stomach ulcers. People who have had stomach surgery have a higher risk of developing stomach cancer. This may be because the bile in the small intestine travels up to the remaining part of the stomach and causes inflammation. It is not clear whether this is due to an infection with H. pylori, a decrease in the amount of acid produced by the stomach, or something else.
Surgery to treat ulcers in the first part of the small intestine, the duodenum, does not appear to increase the risk of stomach cancer.
Contact with ionizing radiation
People who came into contact with ionizing radiation in Japan following an atomic bomb explosion during World War II are at greater risk of developing stomach cancer, especially if they were children during such contact. Studies have shown that people exposed to radiation emitted during nuclear accidents or nuclear fallout are also at greater risk of developing stomach cancer.
Some studies suggest that people treated with some forms of radiation therapy are at higher risk of developing stomach cancer. These include a radioisotope to treat cancer of the thyroid gland or external beam radiation therapy given for Hodgkin’s disease. The risk of developing stomach cancer after radiation therapy depends on many factors. Only very few people get cancer from radiation therapy. The benefits of treating cancer often far outweigh the risk of developing stomach cancer in the future.
Work in the rubber industry
People who make and process rubber are at increased risk of developing stomach cancer because they come in contact with cancer-causing chemicals commonly used in the rubber industry.
Blood group A
People with blood group A have a higher risk of developing stomach cancer, but the reason is not known.
Drinking alcohol increases your risk of stomach cancer. The more you drink, the more your risk increases. Studies have shown that the risk increases when you drink more than 3 drinks per day.
Being overweight increases the risk of stomach cancer.
Salt and salty foods
Data shows that eating salt and salty foods increases the risk of stomach cancer. There is also a link between salt consumption and intestinal metaplasia.
Researchers are not sure whether salt alone increases the risk of stomach cancer or increases the risk when combined with other risk factors such as H. pylori.
Studies also link the lack of refrigeration of food to an increased risk of stomach cancer. This is probably because people who do not have access to refrigeration often rely on salt to preserve their food.
Limit your intake of salt and salty foods. Also, limit the amount of salt you use in your recipes and add less salt to your food at the table. Find out more about ways to eat less salt.
The following have been linked to stomach cancer in some way, but there is not enough evidence to say that they are risks. We need to do more research.
Vegetables and fruits
Smoked, treated or processed meats
Grilled or barbecued meats
Gastroesophageal reflux disease (GERP)
Contact with lead in the workplace
Diagnose stomach cancer
The diagnostic process for stomach cancer usually begins with a visit to your family doctor. Your doctor will ask you about your symptoms and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for stomach cancer or other health problems.
The diagnostic process can seem long and overwhelming. It’s okay to worry, but try to remember that other medical conditions can cause stomach cancer-like symptoms. It is important that the healthcare team rule out any other possible cause of the condition before making a diagnosis of stomach cancer.
The following tests are commonly used to rule out or confirm a diagnosis of stomach cancer. Many tests that can diagnose cancer are also used to determine the stage, that is, the extent of progression of the disease. Your doctor may also order other tests to assess your general health and to help plan your treatment.
Medical history and physical examination
A medical history is a history of symptoms, risk factors, and any medical events and conditions a person has had in the past. When checking your medical history, your doctor will ask you questions about your history of:
symptoms that may indicate the presence of stomach cancer
H. pylori infection (Helicobacter pylori)
stomach problems such as gastric polyps, chronic inflammation of the stomach (gastritis) or pernicious anemia
Your doctor may also ask you about your family history of:
- stomach cancer
- risk factors for stomach cancer
- other cancers
- genetic disorders
The physical exam allows the doctor to look for any signs of stomach cancer. During the physical examination, the doctor may:
- feel your abdomen to check for swollen organs, lumps, or fluid
- examines the lymph nodes in your armpits and those above your collarbones
- perform a digital rectal exam to check for lumps in the pelvis
Complete blood count (CBC)
The complete blood count (CBC) is used to assess the quantity and quality of white blood cells, red blood cells and platelets. It is used to check for anemia due to chronic (long-term) bleeding in the stomach.
Blood biochemical analyzes
A blood chemistry test measures the level of certain chemicals in the blood. It helps assess the functioning of certain organs and can detect abnormalities. Blood chemistry tests used to diagnose and determine the stage of stomach cancer include the following.
Blood urea nitrogen and creatinine levels can be measured to check kidney function. High levels could indicate that the cancer has spread to the ureters or kidneys.
Lacticodehydrogenase, alkaline phosphatase, transaminase, and bilirubin levels can also be measured to check liver function. High levels could indicate that the cancer has spread to the liver.
Upper gastrointestinal endoscopy
Upper gastrointestinal endoscopy examines the upper digestive tract, including the esophagus, stomach, and the upper segment of the small intestine (duodenum). With this procedure, the doctor can observe the interior of these organs using a flexible tube with a lumen and a lens at one end (endoscope). Upper gastrointestinal endoscopy is sometimes called esophagogastroduodenoscopy (OGD) because it examines all of these organs. It can also be called gastroscopy when looking only at the stomach. Before the procedure, you will probably be given some medicine that will make you drowsy.
Upper gastrointestinal endoscopy is the most common test done to diagnose stomach cancer. It is used for:
check for bleeding, inflammation (gastritis), ulcers, polyps or tumors in the stomach
take tissue samples that will be examined in the laboratory (biopsy)
An ultrasound can be done with an endoscope (endoscopic ultrasound, or EE) to see how deep the tumor has grown in the stomach wall and surrounding tissue. Endoscopy can also be used to see if the cancer has spread to the surrounding lymph nodes.
For performing endoscopy (EE), an endoscope with an ultrasound probe at the end is used. In an ultrasound, high-frequency sound waves are used to produce images of body structures. This technique provides detailed information about the location, size and depth of the tumor (how far the tumor has grown in the stomach wall) and helps to know if the cancer has spread. lymph nodes or surrounding tissue. An endoscopic ultrasound is often done at the same time as an upper gastrointestinal endoscopy.
Endoscopy can also be used during a biopsy to guide a needle (endoscopic-guided needle biopsy) to collect samples to examine cancer in the stomach wall outside the stomach. or in the surrounding lymph nodes.
A biopsy involves removing tissue or cells from the body for analysis in the laboratory. The laboratory report confirms or not the presence of cancer cells in the sample and provides information on the type of cancer cells present (for example, adenocarcinoma).
Endoscopic biopsy – During an upper gastrointestinal endoscopy, tissue is removed with a special instrument placed over an endoscope.
Endoscopic-guided needle biopsy – Tissue is removed using a needle that is guided by endoscopic ultrasound (EE). Endoscopic ultrasound-guided needle biopsy examines cancer deep in the stomach wall, outside the stomach, or in surrounding lymph nodes.
Laparoscopic biopsy – A laparoscopic biopsy is usually done after a diagnosis of stomach cancer. This biopsy is taken during a laparoscopy to check if the cancer has spread outside the stomach, for example into the peritoneum or into lymph nodes. In a laparoscopic biopsy, tissue is removed with a special instrument placed on a thin, flexible tube with a lumen (called a laparoscope).
Ose-gastro-duodenal transit (TOGD)
During an esophageal-duodenal transit, X-rays are used to look for a tumor in the esophagus, stomach and the upper segment of the small intestine (duodenum). This test is not often used as it has been replaced by upper gastrointestinal endoscopy.
Determination of tumor markers
Tumor markers are substances found in the blood that can signal the presence of stomach cancer. Tumor marker assay is usually done to assess response to cancer treatment. It can also be used to diagnose stomach cancer.
In the case of stomach cancer, the following tumor markers can be assayed:
The HER2 gene (human epidermal growth factor receptor 2) can undergo a change (mutation). If it does, it can promote the growth of a tumor (oncogene). The HER2 status test is done to find out how much HER2 is produced by a tumor. Stomach tumors that contain the HER2 gene are said to be HER2 positive. This information will help doctors make a treatment plan.
Higher than normal levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) or tumor antigen 125 (CA 125) may signal the presence of cancer of the cell.
Computed tomography (CT scan)
In a computed tomography (CT) scan, special x-ray machines are used to produce 3-dimensional and cross-sectional images of the body’s organs, tissues, bones and blood vessels. A computer assembles the photos into detailed images. This is the most common test done to determine the stage of stomach cancer. CT is used to:
- find out if the cancer has spread to other tissues and organs, such as lymph nodes or the liver
- check to see if cancer has spread to the ovaries (in women)
- find out if the lining of the stomach has thickened
- guide a biopsy needle into an area of the body where cancer may have spread
A dye (contrast medium) may be given orally, intravenously (injected into a vein), or both before a CT scan. This dye helps the doctor see the structures of the body better. When the dye is given as a drink (by mouth, or by mouth), it lines the esophagus, stomach and small intestine. This allows the doctor to examine the lining of the upper gastrointestinal tract for any abnormal areas. If you’ve ever had an allergic reaction to a dye, talk to your doctor or a member of the radiology department.
CT is more effective at staging advanced stomach cancer than it is at detecting early stage gastric tumors.
In an x-ray, low doses of radiation are used to produce images of the body’s structures on film. It is used to find out if the cancer has spread to the lungs. A chest x-ray is unlikely if you have had a previous CT scan of your chest.
Laparoscopy is surgery in which a laparoscope (a type of endoscope) is used to examine internal organs or remove them through several small incisions made in the skin. The laparoscope has a camera at its end, which transmits live video to a television. Laparoscopy may be used to determine the stage of stomach cancer and to help doctors plan treatment. Laparoscopy is used for:
- examine the outside of the stomach (serosa) and surrounding lymph nodes for cancer
- check for cancer that a CT scan or ultrasound would not have detected in other parts of the abdomen, such as the peritoneum or liver
- perform a biopsy (laparoscopic biopsy)
- removing fluid from the abdomen (peritoneal lavage) to check for the presence of cancer cells
Laparoscopy can be combined with an ultrasound to try to determine if there is cancer in hidden areas.
Positron Emission Tomography (PET scan)
In a positron emission tomography (PET) scan, radioactive materials called radiopharmaceuticals are used to detect changes in the metabolic activity of body tissues. A computer analyzes patterns of radioactivity distribution and produces 3-dimensional, color images of the region being examined.
A PET is used to determine if the cancer has spread outside of the stomach. It is sometimes done at the same time as a CT (PET / CT).
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radio waves to produce cross-sectional images of the body’s organs, tissues, bones, and blood vessels. A computer assembles the images into 3-dimensional snapshots.
MRIs are used to check for cancer in the stomach or to determine if the cancer has spread outside the stomach.
In an ultrasound, high-frequency sound waves are used to produce images of body structures. It is used:
- to find out how deep the cancer has grown in the stomach wall and whether the cancer has spread to lymph
- nodes or surrounding tissue (in conjunction with endoscopy)
- to guide a needle during a biopsy
- to check if the cancer has spread to the liver (ultrasound of the liver)
Grades and histological classification of stomach cancer
To determine the grade of stomach cancer, the pathologist examines a small amount of tissue taken from the stomach under a microscope. The pathologist assigns a grade of 1 to 4 to stomach cancer. The lower the number, the lower the rank.
The grade is the description of the differentiation of cancer cells. Differentiation is defined by the appearance and behavior of cancer cells compared to normal cells.
Low-grade cancer cells are well differentiated. They look and behave very much like normal cells. They tend to grow slowly and are less likely to spread.
High-grade cancer cells are poorly differentiated or undifferentiated. Their appearance and behavior are less normal, or more abnormal. They tend to grow faster and are more likely to spread.
Knowing the grade gives your healthcare team an idea of how quickly cancer can grow and how likely it is to spread. It helps him plan your treatment. The grade can also help the healthcare team predict how you might respond to treatment.
Histological classification of stomach cancer
There are several classification systems for stomach cancer around the world. We mainly use 2 systems.
Lauren’s classification is based on the appearance and behavior of gastric tissue when viewed under a microscope. This system is the one most often used to describe what and how adenocarcinoma, the most common type of stomach cancer, looks and behaves.
Lauren’s classification divides adenocarcinoma of the stomach into 2 main types:
- intestinal type – Tumor cells are well differentiated, grow slowly, and tend to form glands. This type is seen more often in men than in women and it affects older people more often.
- diffuse type – Tumor cells are poorly differentiated, behave aggressively, and tend to disperse throughout the stomach (rather than forming glands). This type spreads to other parts of the body (metastasizes) much faster than intestinal-type tumors. It affects both men and women and tends to occur in people younger than the intestinal type.
Lauren’s classification also includes a so-called mixed type of adenocarcinoma, made up of the intestinal and diffuse types.
The World Health Organization (WHO) classification is more detailed than Lauren’s classification. The WHO classification divides stomach cancer into 5 main types:
- Tubular adenocarcinoma – This type is made up of small branching tubes (tubules) of different sizes.
- Papillary adenocarcinoma – This tumor grows outside the stomach wall and has glove-like growths that point inside the stomach cavity. These cells usually look and behave greatly like normal cells.
- Mucinous adenocarcinoma – There is a lot of mucin (the main component of mucus) outside of cancer cells.
- Independent cell carcinomas (including kitten ring cell carcinoma and others) – These cancer cells are grouped together in clusters.
- Mixed carcinoma – It is a mixture of different types of adenocarcinoma of the stomach.
Stages of stomach cancer
Staging describes or categorizes cancer based on how much cancer is in the body and where it was initially diagnosed. This is often referred to as the extent of cancer. Information from tests is used to find out how big the tumor is, what parts of the organ have cancer, if the cancer has spread from where it started and where it has spread. Your healthcare team uses the stage to plan your treatment and predict the outcome (your prognosis).
The most commonly used staging system for stomach cancer is the TNM classification. In stomach cancer, there are 5 stages, stage 0 followed by stages 1 to 4. For stages 1 to 4, the Roman numerals I, II, III and IV are often used. But in order to make the text clearer, we will use the Arabic numerals 1, 2, 3 and 4. In general, the higher the stage number, the more cancer has spread. Talk to your doctor if you have questions about staging.
When doctors describe the stage, they can use the words local, regional, or distant. Local means the cancer is only in the stomach and has not spread to other parts of the body. Regional means near or around the stomach. Distant means in a part of the body farther from the stomach.
The stomach is made up of different layers of tissue. The stage often depends on the layer in which the tumor is growing.
Stage 0 (carcinoma in situ)
The tumor is only found inside the epithelium of the inner lining (lining) of the stomach. Doctors describe it as high grade dysplasia, which is a precancerous condition.
The tumor has grown into the connective tissue layer of the lining, the muscle layer of the lining, or the connective tissue layer that surrounds the lining (submucosa).
One of the following applies:
The tumor has invaded the connective tissue layer or the muscular layer of the mucosa or the submucosa. The cancer has also spread to 1 or 2 lymph nodes near the stomach.
The tumor has grown into the thick layer of muscle in the stomach called the muscularis.
One of the following applies:
The tumor has invaded the connective tissue layer or the muscular layer of the mucosa or the submucosa. The cancer has also spread to 3 to 6 lymph nodes near the stomach.
The tumor has invaded the muscularis. The cancer has also spread to 1 or 2 lymph nodes near the stomach.
The tumor has grown in the area between the muscularis and the outer lining of the stomach called the serosa. This region is called the subserosa.
One of the following applies:
The tumor has invaded the connective tissue layer or the muscular layer of the mucosa or the submucosa. The cancer has also spread to 7 to 15 lymph nodes near the stomach.
The tumor has invaded the muscularis. The cancer has also spread to 3 to 6 lymph nodes near the stomach.
The tumor has invaded the subserosa. The cancer has also spread to 1 or 2 lymph nodes near the stomach.
The tumor has passed through the serosa.
One of the following applies:
The tumor has invaded the muscularis. The cancer has also spread to 7 to 15 lymph nodes near the stomach.
The tumor has invaded the subserosa. The cancer has also spread to 3 to 6 lymph nodes near the stomach.
The tumor has passed through the serosa. The cancer has also spread to 1 to 6 lymph nodes near the stomach.
The tumor has grown into nearby areas or organs, such as the spleen, colon, small intestine, liver, diaphragm or abdominal wall.
One of the following applies:
The tumor has grown into the connective tissue layer or muscle layer of the lining, submucosa, or muscle tissue. The cancer has also spread to at least 16 lymph nodes near the stomach.
The tumor has invaded the subserosa or it has crossed the serosa. The cancer has also spread to 7 to 15 lymph nodes near the stomach.
The tumor has grown to nearby areas or organs. The cancer has also spread to 1 to 6 lymph nodes near the stomach.
One of the following applies:
The tumor has invaded the subserosa or it has crossed the serosa. The cancer has also spread to at least 16 lymph nodes near the stomach.
The tumor has grown to nearby areas or organs. The cancer has also spread to at least 7 lymph nodes near the stomach.
Cancer has spread to other parts of the body (distant metastasis), such as the lungs, bones, peritoneum or omentum. It is also called metastatic stomach cancer.
Recurrence of stomach cancer
If stomach cancer comes back, the cancer comes back after treatment. If it reappears where it first started, it is called a local recurrence. If it reappears in tissues or lymph nodes near where it first started, it is called a regional recurrence. It can also reappear in another part of the body: this is called a recurrence or distant metastasis.
Esophagogastric junction cancers
The point of contact between the esophagus and the stomach is called the esophagogastric (OG) junction. Sometimes it is difficult for a doctor to tell if the cancer started in the lower part of the esophagus or in the upper part of the stomach when the cancer is in the OG junction. Cancers of the OG junction are staged and treated as cancer of the esophagus or cancer of the stomach depending on the location of the tumor.
If stomach cancer spreads
Cancer cells can spread from the stomach to other parts of the body. This spread is called metastasis.
Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If stomach cancer spreads, it can spread to the following structures:
- small intestine
- mesentery (folds of tissue that hold the abdominal organs in place)
- abdominal wall
- adrenal glands;
- lymph nodes in the abdomen or around or above the left collarbone (Troisier’s or Virchow’s lymph nodes)
- ovaries (Krukenberg tumor)
- area around the navel (Sister Mary Joseph’s ganglion)
- womb / uterus
- pelvic region around the rectum (Blumer’s plate)
Prognosis and survival for stomach cancer
If you have stomach cancer, you may be wondering about your prognosis. A prognosis is the act by which the doctor best assesses how cancer will affect a person and how they will respond to treatment. The prognosis and survival depend on many factors. Only a doctor who is familiar with your medical history, the type, stage and characteristics of the cancer you have, the treatments chosen and the response to treatment can look at all of this data together with survival statistics to come to a conclusion. prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor takes into account when making a prognosis. A predictor factor influences how cancer responds to a certain treatment. We often discuss prognostic and predictive factors together. They both play a role in choosing the treatment plan and in establishing the prognosis.
The following are prognostic factors for stomach cancer
The most important prognostic factor is the stage of stomach cancer. When stomach cancer is detected at an early stage, the prognosis is better.
The 2 most important prognostic indicators of the stage are the tumor and the lymph nodes. A tumor that has not spread beyond the wall of the stomach has a better prognosis than a tumor that has passed through the wall. The number of lymph nodes the cancer has spread to affects the prognosis. If the cancer has spread to 3 or more lymph nodes, the prognosis is less favorable than if it has spread to 2 or less nodes. If the cancer has spread to 7 or more lymph nodes, the prognosis is even less favorable.
Cancer cells found in peritoneal lavage
If cancer cells are seen in peritoneal washings done during surgery, the prognosis is less favorable.
The prognosis for cancer that has not invaded the blood vessels and lymphatic vessels (lymphovascular invasion) is typically better than that for cancer that has spread to the blood vessels.
Intestinal-type tumors have a better prognosis than diffuse tumors. Adenocarcinoma usually has a better prognosis than adenosquamous carcinoma.
Location of the tumor
Tumors found in the lower part of the stomach have a better prognosis than tumors seen in the upper part of the stomach.
If stomach cancer can be completely removed by surgery (resection), the prognosis is better than if it cannot be removed entirely.
When the tumors are HER2 positive, the prognosis is poorer.
People with a high functional index (Karnofsky index greater than or equal to 70) have a better prognosis than those with a low functional index.
Treatments for stomach cancer
If you have stomach cancer, your healthcare team will make a treatment plan just for you. This plan will be based on your condition and cancer-specific information. When your healthcare team decides what treatments to offer you for stomach cancer, they take the following into consideration:
- the stage of cancer
- the location of the tumor in the stomach
- your HER2 status (ERBB2)
- your overall health
You may be offered the following treatments for stomach cancer
Surgery is often done to treat stomach cancer. The type of surgery you will have depends mostly on the size and location of the tumor.
Endoscopic mucosal resection may be done to treat early stage stomach cancer.
An exploratory laparoscopy is sometimes done to see if the cancer has spread from the stomach to other parts of the abdomen, such as the liver or pancreas.
A limited resection is surgery in which part of the gastric wall including the tumor is removed as well as a margin of healthy tissue around the tumor. It is used to treat stomach cancer at an early stage.
Gastrectomy is the most common surgery for stomach cancer. Gastrectomy is the surgical removal of the stomach, in whole or in part, through an incision made in the abdomen.
A lymph node dissection is often done at the same time as a gastrectomy to remove the lymph nodes surrounding the stomach.
Palliative surgery may be done to relieve symptoms of advanced stomach cancer, such as bleeding, pain, or difficulty feeding. Palliative surgery may include gastric bypass (to ensure that the passage of food or fluids bypass a gastric tumor that blocks the stomach or esophagus), placement of a stent or tube feeding or endoscopic tumor removal (laser surgery done using an endoscope).
Chemotherapy can be used to treat stomach cancer of any stage. Chemotherapy is sometimes given at the same time as radiation therapy (chemoradiotherapy).
Radiation therapy can be used to treat stomach cancer of any stage. The most common type of radiation therapy given is external beam radiation therapy. Radiation therapy can also be given at the same time as chemotherapy (chemoradiotherapy).
Trastuzumab (Herceptin) and ramucirumab (Cyramza) are targeted drugs used to treat advanced, metastatic or recurrent stomach cancer.
If you cannot or do not want to be treated for cancer
You may want to consider care that aims to make you feel better rather than treating the cancer itself, perhaps because cancer treatments no longer work and are no longer likely to improve your condition. condition or that their side effects are difficult to tolerate. There may also be other reasons why you cannot or do not want to be treated for cancer.
Discuss it with members of your health care team. They can help you choose advanced cancer care and treatment.
Follow-up after treatment is an important part of caring for people with cancer. You will need to have regular follow-up visits, especially during the first 2 years after treatment. These visits allow the healthcare team to monitor your progress and to know how you are recovering from treatment.
A few clinical trials in stomach cancer are underway in certain countries and are accepting participants. Clinical trials aim to find new and better methods of cancer prevention, detection and treatment.
Follow-up after treatment for stomach cancer
Follow-up after treatment is an important part of caring for people with cancer. In the case of stomach cancer, cancer specialists (such as oncologists, surgeons and radiation therapists) and the family doctor often share this responsibility. Your healthcare team will discuss with you to decide which follow-up meets your needs.
Don’t wait until your next scheduled appointment to report any new symptoms and any symptoms that don’t go away. Tell your healthcare team if you experience:
- pain or increased pain already present
- difficulty eating or swallowing
- swelling of the abdomen
- weight loss
The risk of stomach cancer coming back (recurring) is higher within 2 years of treatment, so close monitoring should be done during this time.
Planning of follow-up visits
Follow-up visits after treatment for stomach cancer usually take place:
- 3 months after initial treatment
- every 3 to 6 months for the first 2 years
- every 6 to 12 months for the next 3 years
- each subsequent year
Progress of follow-up visits
During a follow-up visit, your healthcare team will usually ask you about the side effects of treatment and how well you are coping. If you’ve had surgery to remove your stomach, you might also be asked if you’re eating well. You will probably also meet a nutritionist.
The doctor may also do a physical exam, including an exam of the abdomen.
Examinations are often ordered as part of the follow-up. We could order:
- an endoscopy to make sure the endoscopic cancer has not come back
- a vitamin B12 level test to see if you need to have vitamin B12 injections (if part or all of your
- stomach has been removed and it can no longer absorb vitamin B12)
- blood tests, including a complete blood count and blood chemistry tests
- imaging tests such as computed tomography (CT) or x-rays
If there is a recurrence, your healthcare team will assess you to determine the best treatment options.
Supportive care for stomach cancer
- Self-esteem and body image
- Blockage in the stomach
- Nutritional disorders
- Gastroesophageal reflux
- Dumping syndrome
Supportive care empowers people with the physical, practical, emotional and spiritual barriers of stomach cancer. It is an important component of the care of people with this disease. There are many programs and services that meet the needs and improve the quality of life of these people and their loved ones, especially after treatment is over.
Recovery from stomach cancer and coping with life after treatment is different from person to person. They vary depending on the extent of the disease, the type of treatment given and many other factors. The end of cancer treatment can lead to mixed emotions. Even if treatment is finished, there may be other issues to work out, such as coping with long-term side effects. A person who has been treated for stomach cancer may be concerned about the following things.
Self-esteem and body image
Self-esteem refers to how a person feels about himself or sees himself. Body image refers to a person’s perception of their own body. Stomach cancer and its treatments can affect a person’s self-esteem and body image, often because they can affect the body, for example:
- hair loss
- skin changes
- change in body weight
- need a feeding tube
Some of these changes may be temporary, while others may last a long time or be permanent.
Blockage in the stomach
Late stage stomach cancer can sometimes grow so much that it blocks the stomach, preventing food from passing from the esophagus to the stomach or from the stomach to the small intestine. Different options exist to deal with such a blockage:
- placement of a stent to bypass the tumor and allow the passage of food
- radiation therapy to reduce the size of the tumor and clear a blockage
- laser surgery to shrink the tumor and clear a blockage
People with stomach cancer often have nutritional problems, either because of the cancer itself or its treatment. Nutritional disorders include:
- weight loss
- feeling full after drinking or eating
- not getting enough vitamins and minerals
- The healthcare team, which includes a registered dietitian, can help you continue to eat well during treatment and deal with any side effects.
Gastroesophageal reflux disease (GERD) refers to the ascent of stomach contents (including stomach acid) or bile into the esophagus (reflux). GERD can be a side effect of stomach surgery. The signs and signs and symptoms of GERD include heartburn, burping (belching), and discomfort in the chest or abdomen. Here are some ways to relieve GERD:
- change your diet to avoid spicy foods, acidic foods, alcohol and carbonated drinks
- sit up straight after eating and drinking
- keep your head and shoulders elevated when lying down or sleeping
- take antacids, respecting what the healthcare team has prescribed
Pain associated with stomach cancer can be related to the surgery, the location of the tumor, and the effect the tumor has on other structures (such as tissues, organs, nerves, and blood vessels). surrounding blood) as the cancer grows or spreads.
Pain relief goes a long way in improving the quality of life for a person with stomach cancer. Pain relievers are commonly used to relieve pain. There are many types of pain medication. Your doctor will decide which type and dose is best for you.
Sometimes surgery can be done to treat pain caused by a blockage in the stomach. Surgery may include placing a stent to bypass the blockage.
Radiation therapy may also be used only to help control the pain. Pain is sometimes caused by a tumor pressing on a nerve or other organ. Such treatment can help reduce the size of the tumor and thus relieve pain.
There are other physical, psychological and complementary treatments to relieve pain, for example massage therapy, methods of relaxation and deep breathing.
Many people with stomach cancer experience extreme weariness, or fatigue. Fatigue can be caused by the cancer itself or its treatment. It can also be made worse by difficulty eating and poor nutrition. It can be difficult to cope with the disease when you feel very tired and have little energy, especially after treatments or if the cancer is at an advanced stage.
Dumping syndrome occurs when food passes too quickly from the stomach to the small intestine. This can happen after surgery for stomach cancer where part or all of this organ has been removed. Hunting syndrome can lead to nausea and vomiting, diarrhea, sweating, and body redness after eating. These symptoms usually improve over time.
The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition. Thank you.
Photo explanations: The anatomy of human stomach.
Fundus is a medical term from Latin which means the part that is farthest from the entrance area of an organ.
The pyloric sphincter is a small piece of smooth visceral muscle that functions as a valve and regulates the flow of partially digested food.