Stomach cancer (gastric cancer) – symptoms, treatment

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Stomach cancer is a malignant tumor that can come in various forms. It is manifested by frequent vomiting, blood in the stool, weight loss. Medical statistics on stomach cancer raise high hopes among doctors, as its incidence has been systematically decreasing for several years.

Unfortunately, gastric cancer is still the fifth most common cancer in men, and seventh in women. When causes of death are combined, stomach cancer is the third cause of death in men and the fifth in women.

Unfortunately, stomach cancers are usually detected late in their advancement, when treatment is difficult or sometimes even impossible. It is therefore important to pay attention to some disturbing symptoms that may make us suspect a cancer. It is worth remembering that, as in all cancers, early detection gives very high hopes for cure, survival and the comfort of the patient’s functioning.

Stomach cancer causes

It is not fully known what mechanisms cause gastric cancer, but the causes of its formation are believed to be caused by several factors, the most common of which are the type of diet and the occurrence of the so-called precancerous conditions.

An increase in the number of cases has been proven with a diet based on eating large amounts of canned, smoked and salted products (they have a high content of nitrites), and thus often eating less fresh vegetables and fruits. Smoking is another significant risk factor. Another cause that increases the risk of stomach cancer is infection with bacteria Helicobacter pylori, which causes chronic inflammation of the gastric mucosa, and this in turn remodeling (i.e. metaplasia), and later dysplasia of the epithelium, which is the lined stomach. A similar carcinogenic mechanism occurs in patients with partial gastric resection, pernicious anemia or (very rarely) with peptic ulcer disease.

Different faces of stomach cancer

Approx. 95 percent malignant tumors of the stomach are adenocarcinomas, i.e. tumors that originate from the cells of the glandular epithelium of the stomach. The remaining 5 percent. are lymphomas, sarcomas, carcinoids or stromal tumors. Clinically, these neoplasms are classified according to the so-called Lauren’s classification into two types: diffuse and intestinal. This is an important division, as these groups differ in prognosis, occurrence and the basis for the development of the disease.

1. The intestinal type develops on the basis of the already mentioned precancerous lesions, it is characterized by a more frequent occurrence in men and a better prognosis. It is located circumferentially. It is called an epidemic type because it appears in areas where this cancer is common.
2. Diffuse type is produced on an unchanged mucosa, and the prognosis is worse. It is more common in women, usually young, in the part of the stomach closer to the esophagus. An interesting fact is that it happens more often in people with blood type A and is more common in families.

Symptoms of stomach cancer

Symptoms of stomach cancer are primarily abdominal pain located in the epigastrium, i.e. above the line connecting the lower edges of the ribs. They most often occur after meals, but disappear on an empty stomach. It is also characteristic that they do not decrease after frequent use of antacids, which patients willingly take with heartburn or stomach ulcers. Disturbing symptoms also include unplanned weight loss, lack of appetite and nausea, vomiting, sometimes difficulty swallowing (dysphagia) or a feeling of disgust with eating meat. Stool disorders in the form of tarry stools (black) may appear as a consequence of gastrointestinal bleeding. Anemia is also a common symptom, i.e. anemia, which is also caused by bleeding from the tumor. Some people with stomach cancer also experience pale skin and conjunctivitis, sleepiness and unreasonable fatigue.

Stomach cancer diagnosis

If a doctor suspects that a patient has stomach cancer, they will usually refer them to X-rays of the upper digestive tract. The test is performed after drinking, before the contrast test, which makes it possible to visualize the contours of the stomach walls and the image of the mucosa. It is, however, a preliminary examination, as we can only make a full diagnosis and detailed histopathological diagnosis after performing an endoscopic examination (gastroscopy) and collecting samples for examination from the stomach walls. The examination is painless, although patients often find it unpleasant, and consists in introducing a thin tube through the esophagus into the stomach, at the end of which a camera is installed.

The doctor may also order other specialized tests to confirm the diagnosis or provide data to assess the stage of the cancer. Complementary diagnostic methods include ultrasound (ultrasound) and abdominal tomography (KT) or nuclear magnetic resonance (NMR).

Treatment of stomach cancer

For stomach cancer, treatment begins with removing all of the stomach. Depending on the stage of the tumor, it is possible to perform a subtotal resection which involves excision of at least 4/5 of the organ. The operation is combined with a regional lymphadenectomy, which means removing the surrounding lymph nodes. After surgery, the surgeon restores the continuity of the gastrointestinal tract so that food can be moved into the intestine despite the absence of the stomach. Then he performs an esophageal-intestinal anastomosis and shapes a pouch that replaces the stomach.

When the stage of the cancer does not allow for surgery, palliative treatment is applied, i.e. procedures aimed at improving the patient’s quality of life. The purpose of these surgeries is to prevent bleeding and gastrointestinal obstruction. The most common procedures are the prosthesis of the gastric inlet, i.e. its initial part, or the gastrointestinal anastomosis, which allows food to bypass the pylorus (connects the stomach with the intestine).

Chemotherapy is used, but as an adjuvant treatment before surgery, to reduce the weight of the tumor. In inoperable tumors, chemotherapy is part of palliative treatment.

The latest generation of drugs are increasingly being used to treat stomach cancer. They are molecularly targeted drugs and have a completely different mechanism of action than the chemotherapy used so far. Generally speaking, these drugs are aimed at a specific place in the cell and are designed to stop the neoplastic process in it. They can be administered in tablets or by injection. Molecularly targeted drugs have been available for several years and new ones are constantly being developed. Doctors are also increasingly using herceptin, a drug that has proven itself in the treatment of breast cancer patients. Unfortunately, not all patients can use targeted therapy. The reason is not only the high price (a monthly treatment costs from several to several thousand zlotys), but most of all knowledge about cancer. These drugs do not work for all patients.

Prognosis in gastric cancer

The prognosis of gastric cancer, as well as of other cancers, depends on the stage at which it was diagnosed. The five-year survival rate is assessed. And so it is for individual stages of disease advancement: I – 90%, II – 60-70%, III – 30%, IV – 5%.

Other stomach tumors

1. Gastric lymphoma is quite rare (about 4% of cases). Lymphoma occurs only in the stomach (called primary lymphoma) or comes from another site (systemic lymphoma). Older people usually suffer from them, and more often they are men. Neoplasms with a lower degree of malignancy, and at the same time a good prognosis, among which the dominant lymphoma of the MALT system ( mucosa associated lymphoid tissue – lymphatic tissue associated with the mucosa), constitute the majority (about 80%). Symptoms are very similar to those of stomach cancer, but more common are general reactions of the body, such as increased temperature, weight loss, sweating, and enlarged lymph nodes. The treatment of gastric lymphoma is different from that of stomach cancer, as it is based on radiochemotherapy. The goal of the therapy is also to remove the bacterial infection Helicobacter pyloriwhich may be responsible for the development of MALT lymphoma.
2. Stromal tumor (GIST- ang. gastrointestinal stroma tumor– gastrointestinal stromal tumor) An interesting, for scientists, gastric cancer is a stromal tumor, which is a rare type of sarcoma, i.e. a tumor of mesenchymal origin. They are very rare, accounting for about 0,2% of all gastrointestinal cancers. Only 1/5 becomes malignant. It occurs mainly in the elderly. It is important that these tumors are not limited to the stomach, although this location is the most common, but they are characteristic of the entire gastrointestinal tract (small intestine, large intestine, esophagus, mesentery or mesentery). The cause of cancer is believed to be a mutation of one of the genes (the c-kit gene). Patients undergo surgical treatment. In non-operative cases, a drug called imatinib is used, which blocks the activity of the tyrosine kinase, the mutation of which is responsible for the development of the disease.

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