What is stomach cancer?
Stomach cancer occurs when normal cells of the stomach transform into cancerous cells. The term stomach cancer, or gastric cancer, usually refers to adenocarcinoma of the stomach. It is important not to confuse stomach cancer with cancers of the colon, liver, pancreas, or small intestine because they have different symptoms, different outcomes, and different treatments.
Cancers of the stomach can occur throughout the lining of the stomach, from the point where the esophagus and stomach meet (the gastroesophegeal junction, or GEJ) all the way to the pylorus where the stomach empties into the duodenum.
There are two major types of stomach cancer. The most common type of stomach cancer is called an adenocarcinoma, or gland forming cancer. This type of stomach cancer arises from the functional cells of the stomach and is responsible for about 90% of all stomach cancers. Adenocarcinoma of the stomach is classified in two ways: intestinal type or diffuseâ€”type stomach cancer. This is also known as the Lauren’s classification.
Intestinal gastric cancer tends to grow as tumors within the stomach wall from gland forming cancer cells. Diffuse stomach cancers grow within the wall as discohesive cells infiltrating throughout.
Another type of stomach cancer is called gastrointestinal stomach tumor (GIST) and occurs from the stromal, or supporting, cells of the stomach.
GIST tumors are rare tumors that develop from the cells in the wall of the stomach. These cells are called interstitial cells of Cajal. Interstitial cells of Cajal are rare cells that are normally found within the wall of the stomach within the stroma. Their normal function is unknown. GIST tumors can be benign or malignant. These cancers can be found anywhere in the gastrointestinal tract, but they often, in as many as 70% of patients, occur in the stomach.
Other, less common tumors that can be found in the stomach include lymphoma and carcinoid tumors. Gastric lymphoma is a cancer of the immune system cells found in the stomach. They usually account for 4% of all stomach cancers.
Prognosis and treatment will depend on whether it is an aggressive lymphoma or an indolent, or slow-growing, lymphoma. One type of lymphoma is a MALT lymphoma, Mucosa Associated Lymphoid is Tissue lymphoma. This lymphoma is caused by immune cells that line the intestines. Carcinoid tumors are tumors of hormone-producing cells of the stomach. These tumors generally do not metastasize. Approximately 3% of all stomach cancers are carcinoid tumors.
What causes of stomach cancer?
For the vast majority of patients, stomach cancer is caused by random genetic events, which is “doctor-speak” for bad luck. Essentially, a mutation occurs in DNA of a stomach cells that lines the inside of the stomach. This mutation is not caught by the cell’s repair machinery, and after many replications and more mutations, eventually the first cancer cell develops, which then leads to the cancer itself. This cancer cell carries with it basic properties of cancer— that continuously growing and producing more cancer cells and avoiding programmed cell death.
There are associations linked to the development of stomach cancer as well. For example, about 10% of 15% of all stomach cancers are inherited. There is also an association between stomach cancer and a bacterial infection of the stomach called Helicobacter pylori. H. Pylori infection causes inflammation, and the stomach cells are damaged by cells of the immune system. It is not known exactly why this condition progresses to cancer, but it may be related to the irritation caused by chronic inflammation.
Obesity, chronic heartburn, and tobacco and alcohol use are other characteristics associated with the development of stomach cancer. It is important to realize that not all patients with these characteristics will indeed develop the disease. Eating fruits and vegetables reduces the risk of developing stomach cancer.
A stomach ulcer is not, by itself, associated with a high risk of stomach cancer. However, it may be an indicator that other risk factors for stomach cancer exist, such as infection with H. pylori or reflux disease, as these are also risk factors for stomach ulcers. The majority of patients with gastric ulcers do not go on to develop stomach cancer.
Symptoms of stomach cancer/clinical features of carcinoma stomach
- Very often patients would have vague symptoms -early satiety, flatulence, discomfort, pain upper abdomen. Some following features are :
S- silent: growth is silent but manifests secondary in the liver, ascites, Virchow’s node, rectovesical deposits, umbilical nodule(sister Mary Joseph’s nodule), left axillary nodes (Irish nodes).
O- Obstruction at pylorus (pyloric antrum) with features of vomiting with/without blood. VGP can also be present. Obstruction at cardio esophageal junction, producing Dysphagia
L- Lump in the abdomen which is hard and irregular. Clinically, stomach
Mass is differentiated from liver mass.
I- Insidious in onset- Anaemia, anorexia, and asthenia of short duration.
D- Dyspepsia in a man over the age of 40, carcinoma stomach should be ruled out. Early gastric cancer presents as dyspepsia.
Diagnosis of stomach cancer
Early diagnosis can be achieved if early warning signals such as bleeding are caught. If you are over fifty, an annual fecal blood test can discover any are internal bleeding. If a colonoscopy then proves negative, and upper endoscopic investigation should be done. Most of this bleeding will be caused by gastritis or an ulcer, but it also may be caused by cancer.
Once cancer is identified, it is staged by scanning the body with CT or ultrasound. This will guide treatment and determine if the cancer has spread, and if so, where. Staging cannot be complete until after surgery, when nearby lymph nodes and organs can be tested.
Treatment and prevention
Surgery is the most common treatment for stomach cancer. Depending on the stage of the cancer, a doctor can choose between two different types of surgery. Partial gastrectomy is recommended when the cancer is till localized. Parts of the stomach are removed, and part of the esophagus or the small intestine and nearby tissues may also be removed. The entire stomach is removed in total gastrectomy. During surgery, a feeding tube is connected to a patient’s small intestine.
Chemotherapy drugs are injected into the bloodstreams: these chemicals kill cancer cells. Chemotherapy is often used after surgery to prevent the cancer from recurring. The side effects of chemotherapy vary, but the most common side effects include tiredness, losing hair, lack of appetite, nausea and vomiting, diarrhea, and mouth and lip sores.
Radiation therapy, using high energy X-rays to kill the cancer cells, targets only the area where cancer grows. External radiation, in which the radiation is from a machine outside the body, is normally performed in the hospital or clinic. Radiation therapy may cause stomach or intestinal pain. Patients may suffer from nausea, diarrhea, and tiredness, as well as skin discomfort in the treated area.
Homeopathic treatment of stomach cancer – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to manage stomach cancer but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to manage stomach cancer symptoms that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of stomach cancer:
Kreosote, Lycopodium, Conium, Condurango, Carbolic Acid, Arsenic Album, Hydrastis Can, Bismuth, Phosphorous, Carbo Animalis, Baryta Carb, Sulphur, Cadmium Sulph, Nux Vomica, Belladonna.
Manish A. Shah, Natasha Pinheiro, Brinda M. Shah- 100 Questioons and Answers about Gastric Cancer -2007: 7&9
Paul F. Miskovitz, Marian Betancourt- The doctor’s guide to gastrointestinal health: preventing and treating acid; 2005; – 95
Marshall Cavendish Corporation- Disease And Disorders, Volume 1 2007:169