Stomach Cancer

Stomach cancer can occur in different forms depending on where it starts and how it grows. Common types include:

• Adenocarcinoma (most common): Cancer starting in the glandular cells of the stomach lining.
• Lymphoma: Cancer that begins in the immune system cells (lymphocytes) of the stomach wall.
• Gastrointestinal stromal tumour (GIST): A rare cancer that develops from special nerve-related cells in the stomach wall.
• Carcinoid tumour: Cancer that starts in hormone-producing cells of the stomach.

Stomach cancer can be silent in early stages. Symptoms may appear once the disease progresses, and can sometimes mimic other digestive issues, including:

• Bloated feeling
• Loss of appetite
• Unexplained weight loss
• Blood in stools or vomit
• Nausea or vomiting
• Feeling full after a small snack

The exact cause is not yet known. However, some common causes of stomach cancer include:

• Genetics: Cancer occurs due to DNA mutations in the cells of the stomach
• Infections: Certain bacteria and viruses, such as Helicobacter pylori (a common stomach infection) and Epstein–Barr virus
• Diet and lifestyle: High-fat diet, high salt diet (including pickles), obesity, less consumption of fruits and vegetables, and alcohol and tobacco consumption
• Gastritis (inflammation of the stomach) and gastrointestinal reflux disease (hyperacidity)

Doctors may use a combination of imaging, lab tests, and procedures to diagnose stomach cancer:

• Endoscopy: A flexible tube with a camera is inserted through the mouth to view the stomach lining.
• CT scan: Cross-sectional imaging to detect tumour size and spread.
• Biopsy: Tissue samples taken during endoscopy and examined under a microscope.
• Barium swallow test: X-ray imaging after drinking a special liquid to highlight abnormalities in the stomach.
• Biomarker tests: Blood tests that check for tumour markers, such as CEA and CA 19-9.

Treatment for stomach cancer depends on the stage of cancer. Options include:

• Surgery (primary treatment):
  • Total gastrectomy: Involves the complete removal of the stomach along with the lymph nodes and omentum, sometimes including parts of the intestines, pancreas, spleen, and oesophagus. The remaining parts are attached (usually the end of the oesophagus to the remaining small intestine). This is performed when the cancer is in the upper part of the stomach.
  • Subtotal (partial) gastrectomy: Involves the removal of only a part of the stomach. It is often recommended when the cancer is in the lower part only or upper part of the stomach.
  • Palliative surgery: In cases of advanced cancer and unresectable stomach cancer, to prevent the blockage of the stomach by the tumour and to prevent bleeding or relieve symptoms or complications. This includes subtotal gastrectomy as well. The goal is not to cure cancer but to relieve symptoms.
• Endoscopic procedures (minimally invasive for early cases or symptom relief):
  • Endoscopic resection: Used in early-stage cancers, when the chances of cancer spreading to the lymph nodes are minimal. This procedure involves an endoscope to remove the tumour and the surrounding parts of the stomach.
  • Endoscopic tumour ablation: An endoscope is used to guide a laser beam to eliminate parts of the tumour in patients on whom surgery cannot be done. This is performed to relieve blockage and stop bleeding without any surgery.
  • Gastric bypass (gastrojejunostomy): Sometimes, the tumours are large enough to block the food from leaving the lower part of the stomach. An option to help prevent or treat this blockage of food passage is to bypass the lower part of the stomach.
  • Stent placement: A stent is placed using an endoscope to prevent the blockage at the opening or end of the stomach for free passage of food.
• Other therapies:
  • Chemotherapy: Medicines used to shrink tumours before surgery or kill remaining cancer cells after surgery.
  • Targeted therapy and immunotherapy: Advanced drugs that attack cancer cells more precisely than standard chemotherapy.

You should consult a doctor if you experience persistent digestive symptoms such as unexplained weight loss, prolonged bloating, loss of appetite, vomiting blood, or black/tarry stools. Early diagnosis significantly improves treatment outcomes

While not all stomach cancers can be prevented, risk can be reduced by:

• Eating a healthy diet rich in fresh fruits and vegetables
• Reducing salt-rich, smoked, and processed foods
• Avoiding smoking and limiting alcohol intake
• Regular health check-ups, especially if you have a family history of stomach cancer

For diagnosis and treatment of stomach cancer, patients may need to consult:

• Gastroenterologist (specialist in digestive system diseases) for evaluation and endoscopic procedures.
• Oncologist (cancer specialist) for chemotherapy, targeted therapy, and overall cancer management.
• Surgical oncologist or gastrointestinal surgeon for operations such as gastrectomy.