Stomach cancer

Ranked as the fifth most common cancer globally, stomach cancer has multiple contributing factors:

1. Pre-existing stomach conditions:

• Chronic Helicobacter pylori infection
• Persistent gastritis
• Pernicious anemia (due to poor B12 absorption)
• Gastroesophageal reflux disease (GERD)
• Intestinal metaplasia
• Gastric polyps
• Epstein-Barr virus

2. Age:

• Primarily affects individuals aged 75 and above

3. Gender:

• Higher incidence in males

4. Hereditary and genetic predisposition:

• Family history of stomach cancer (especially first-degree relatives)
• Inherited syndromes like Lynch syndrome

5. Lifestyle and environmental exposure:

• Smoking and alcohol use
• Certain professions (e.g., manual laborers, agricultural workers)
• Radiation exposure
• Frequent intake of preserved or poorly processed foods
• Obesity or being overweight

To diagnose any type of cancer, including stomach cancer, it is crucial to determine the stage of the disease. The most widely used system for staging is the TNM classification:

• T (Tumor): Describes how deeply the tumor has penetrated the layers of the stomach wall.
• N (Nodes): Indicates the number and proximity of lymph nodes involved.
• M (Metastasis): Refers to whether the cancer has spread to distant organs.

Based on these parameters, stomach cancer is categorized into the following stages:

1. Stage 0: Also known as carcinoma in situ. This stage features abnormal cells limited to the stomach lining, which could become cancerous over time.
2. Stage 1: Cancer is confined and hasn't extended beyond the muscular layer of the stomach wall.
3. Stage 2: Cancer invades deeper layers and may involve several nearby lymph nodes.
4. Stage 3: Tumor has spread through all stomach wall layers and may affect adjacent organs such as the colon or spleen.
5. Stage 4: Cancer has metastasized to distant organs like the brain, liver, or lungs. This stage is considered advanced or secondary cancer.

Diagnostic Procedures:

Medical History and Physical Exam

The doctor evaluates overall health and checks for abnormalities, including lumps or unusual physical signs. A thorough history of the patient’s health habits, past illnesses, and treatments is also recorded.

Upper Endoscopy (EGD)

This involves inserting a thin, flexible tube with a camera (endoscope) through the throat to view the esophagus, stomach, and the top of the small intestine.

Ultrasound Scans

Ultrasound uses sound waves to produce images of internal organs.

• Transabdominal ultrasound: Visualizes abdominal structures to detect irregularities.
• Endoscopic ultrasound (EUS): Performed via an endoscope to assess tumor size and depth and guide early-stage cancer removal.

Biopsy

A small tissue sample is collected and examined under a microscope to confirm the presence of cancer cells.

Imaging Tests

• Barium X-ray: The patient drinks a barium solution, which outlines the stomach on X-rays to identify abnormalities.
• Chest X-ray: Helps detect if the cancer has spread to the lungs.
• CT Scan: Provides detailed cross-sectional images after injecting a contrast dye to determine tumor position relative to surrounding tissues.
• MRI: Uses magnetic fields to generate high-resolution images and assess tumor size.
• PET or PET-CT Scan: Detects abnormal metabolic activity that may indicate cancer.

Additional Diagnostic Tools

• Laparoscopy: A camera-equipped tube is inserted into the abdomen through a small incision to examine the spread of cancer.
• ECG (Electrocardiogram): Evaluates heart health, especially before surgery or when taking cardiotoxic medications.
• HER2 Testing: After biopsy, cells may be checked for HER2 protein levels to determine if the tumor is HER2-positive.

Cancer prevention involves proactive steps to reduce the likelihood of developing the disease. Lifestyle habits, genetics, and environmental exposures all play a role in cancer risk. The following measures can help prevent stomach cancer:

Diet and Nutrition

• Eat a well-balanced diet filled with fruits, vegetables, whole grains, and lean meats.
• Limit intake of salty, smoked, or pickled foods.
• Cut down on processed meats.

Healthy Lifestyle Choices

• Stop smoking.
• Avoid excessive alcohol consumption.
• Maintain a healthy body weight.
• Stay physically active.
• Minimize contact with harmful chemicals, especially in the workplace.
• Avoid too much sun exposure, as skin cancers may occasionally metastasize to the stomach.

Medical Management and Infections

• Treat infections such as Helicobacter pylori effectively.
• Consider medications to manage precancerous conditions or to prevent the development of cancer (chemoprevention).

Routine Health Check-ups

• Regular medical screenings can help catch risk factors or early-stage cancer when it is easier to manage.

Note: Certain cancers can be prevented through vaccines, such as the BCG vaccine, which protects against infections that could lead to cancer.

Doctors to Consult

Managing stomach cancer requires a multidisciplinary approach. Specialists involved include:

• General Physician: Performs initial assessments, orders tests, and may refer to specialists.
• Gastroenterologist: Specializes in diseases of the digestive system and assists in diagnosis.
• Oncologist: Focuses on cancer diagnosis, staging, and creating treatment plans.
• Surgical Oncologist: Conducts operations for tumor removal and other surgical interventions.

The treatment plan for stomach cancer is based on the tumor’s stage, location, and size. Common treatment options include the following:

1. Surgery

Surgery plays a significant role in managing stomach cancer across all stages. Surgical methods include:

• Endoscopic Resection: This involves inserting instruments through an endoscope to remove the tumor along with a portion of the surrounding healthy stomach lining.
• Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD): These are minimally invasive procedures used to eliminate abnormal or early-stage cancerous tissues from the stomach lining using an endoscope.
• Subtotal Gastrectomy: In this surgery, a part of the stomach is removed. In some cases, the surgeon also removes a portion of the esophagus or the upper small intestine, depending on the tumor’s location. The remaining part of the stomach is then reconnected to maintain digestion.
• Total Gastrectomy: If cancer is widespread, the entire stomach is removed, along with nearby lymph nodes and possibly parts of adjacent organs like the pancreas, intestines, or esophagus.

2. Palliative Surgery for Inoperable Cancer

Even if the cancer cannot be completely removed, surgery may still be performed to manage symptoms or complications.

• Gastrojejunostomy (Gastric Bypass): This procedure connects the upper part of the stomach to the jejunum (a section of the small intestine), helping food bypass the blocked portion of the stomach.
• Stent Insertion: A stent—a hollow metal tube—is placed using an endoscope to keep a narrowed opening in the stomach open for food passage.
• Feeding Tube Insertion: When patients are unable to consume food orally, a feeding tube can be inserted into the abdomen to provide nutrients directly into the stomach or small intestine.

3. Chemotherapy

Chemotherapy uses powerful drugs to kill or inhibit the growth of cancer cells. It may be used in combination with radiation (chemoradiation) for enhanced effectiveness.

• Neoadjuvant Chemotherapy: Given before surgery to shrink the tumor, making it easier to remove and possibly more effective.
• Adjuvant Chemotherapy: Administered after surgery to destroy any residual cancer cells that may not be visible but could cause recurrence.

Common chemotherapy medications include:

• Carboplatin
• Cisplatin
• Capecitabine
• Docetaxel
• Fluorouracil
• Irinotecan
• Oxaliplatin
• Paclitaxel

4. Radiation Therapy

This treatment uses high-energy rays to destroy cancer cells and can be applied in different ways:

• Pre-surgery: Combined with chemotherapy to reduce the tumor size and make surgical removal more feasible.
• Post-surgery: Used with chemotherapy to eliminate any remaining cancer cells.
• Non-surgical cases: Helps relieve symptoms such as pain, bleeding, or difficulty swallowing.

5. Targeted Therapy and Immunotherapy

These treatments aim to block the growth and spread of cancer cells by focusing on specific molecules involved in tumor progression.

• Targeted Therapy: Attacks unique characteristics of cancer cells.
• Immunotherapy: Stimulates the body’s immune system to fight cancer more effectively.

Some commonly used drugs include:

• Ramucirumab
• Entrectinib
• Trastuzumab
• Regorafenib

As stomach cancer advances, it can result in various complications, including:

• Internal bleeding in the gastrointestinal tract
• Perforation or holes in the stomach wall
• Partial or complete blockage of the small intestine
• Loss of appetite and unintended weight loss
• Fluid accumulation in the abdominal cavity (ascites)
• Spread of cancer to distant organs like the liver, lungs, or bones (metastasis)

Several complementary therapies are considered helpful and safe when used alongside standard cancer treatments. These include:

Complementary and Integrative Approaches

1. Acupressure: Involves applying pressure or massaging specific points on the body to ease certain symptoms.
2. Acupuncture: A technique that uses very fine needles inserted at precise points on the body to relieve symptoms like mild pain and nausea.
3. Aromatherapy: Utilizes essential oils extracted from plants to improve mood and help manage symptoms such as nausea or stress.
4. Art Therapy: Encourages individuals to express their feelings and emotions through creative activities.
5. Biofeedback: Helps patients control certain physical responses, such as pain or nausea, by increasing awareness of body functions.
6. Labyrinth Walking: A meditative practice involving walking a circular path, which may offer emotional relief and stress reduction.
7. Massage Therapy: Involves the manipulation of muscles and soft tissues to reduce stress, pain, anxiety, and depression associated with cancer.
8. Meditation: A relaxation technique that involves calming the mind and body through focused attention or mindfulness.
9. Music Therapy: The use of music to encourage emotional healing and enhance overall quality of life.
10. Tai Chi: Combines gentle movements, breathing exercises, and meditation to improve physical balance, strength, and emotional well-being.
11. Yoga: Often practiced to help alleviate symptoms such as pain, fatigue, depression, and nausea, which are common in cancer patients.

While medical treatment is essential, some natural substances may provide supportive benefits. These should only be used with medical guidance:

• Turmeric (Haldi): May disrupt signals that allow cancer cells to grow and lead them to self-destruct.
• Garlic (Lehsun): Believed to slow cancer cell growth and support the body’s natural elimination process.
• Saffron (Kesar): Might restrict blood supply to cancer cells and aid in their destruction.
• Coriander (Dhaniya): Potentially enhances chemotherapy effects by reducing resistance to treatment.
• Cinnamon (Dalchini): May encourage cancer cells to self-destruct and slow tumor development.

Nutritional and Daily Care Tips:

• Eat small, well-balanced meals frequently.
• Drink enough fluids to stay hydrated.
• Follow prescribed pain management routines.
• Practice good hygiene to avoid infections.
• Ensure sufficient rest and quality sleep.

Managing a stomach cancer diagnosis and its treatment often brings emotional and psychological challenges. It is common to feel overwhelmed during this time.

Here are important considerations for individuals diagnosed with stomach cancer and their caregivers:

1. Emotional Well-Being

Cancer can lead to intense emotional experiences such as fear, sadness, or anger. Ways to manage emotional stress include:

• Gaining a clear understanding of the treatment process
• Communicating openly with loved ones
• Participating in support groups
• Starting palliative care to ease symptoms
• Seeking help with everyday challenges like finances, work, or childcare

2. Coping with Physical Side Effects

Side effects can vary depending on the stage of the disease, type and length of treatment, and overall health.

• Track any new or worsening side effects
• Keep your doctor informed of these changes
• Maintain a journal of symptoms for better communication with the healthcare team
• Address long-term or delayed side effects through continued medical care

3. Managing the Financial Impact

The cost of treatment can be overwhelming. Addressing financial concerns involves:

• Gaining clarity on treatment-related expenses
• Discussing costs with family members or care providers
• Seeking assistance from organizations that support patients with medical bills, accommodation, travel, and related expenses

4. Importance of Follow-Up Care

Even after treatment ends, routine monitoring is essential. Follow-up care usually includes:

• Medical checkups and history reviews every 3–6 months during the first 2 years
• Follow-ups every 6–12 months for the next 3–5 years
• Annual visits thereafter

Caregiver Guidance

Caregivers play a crucial role in the recovery journey. Helpful practices include:

• Providing emotional encouragement
• Understanding the treatment plan
• Assisting with symptom management and medications
• Scheduling and coordinating doctor visits
• Helping with daily hygiene and care
• Offering emotional support through compassionate communication
• Supporting with household responsibilities
• Managing insurance and billing matters