What is Stomach Cancer?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant: Benign tumors are not cancer:

• Benign tumors are rarely life-threatening.
  
  
• Most benign tumors can be removed. They usually do not grow back.
  
  
• Cells from benign tumors do not invade the tissues around them.
  
  
• Cells from benign tumors do not spread to other parts of the body.
  

• Malignant tumors are generally more serious than benign tumors. They may be life- threatening.
  
  
• Malignant tumors often can be removed. But sometimes they grow back.
  
  
• Cells from malignant tumors can invade and damage nearby tissues and organs.
  
  
• Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original tumor and entering the bloodstream or the lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
  

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if stomach cancer spreads to the liver, the cancer cells in the liver are actually stomach cancer cells. The disease is metastatic stomach cancer, not liver cancer. For that reason, it is treated as stomach cancer, not liver cancer.
                                 
What are the risk factors?

No one knows the exact causes of stomach cancer. Doctors often cannot explain why one person develops this disease and another does not.

Research has shown that people with certain risk factors are more likely than others to develop stomach cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for stomach cancer:

• Age: Most people with this disease are 72 or older.
  
  
• Sex: Men are more likely than women to develop stomach cancer.
  
  
• Race: Stomach cancer is more common in Asian, Pacific Islander, Hispanic, and African Americans than in non-Hispanic white Americans.
  
  
• Diet: Studies suggest that people who eat a diet high in foods that are smoked, salted, or pickled may be at increased risk for stomach cancer. On the other hand, eating fresh fruits and vegetables may protect against this disease.
  
  
• Helicobacter pylori infection: H. pylori is a type of bacteria that commonly lives in the stomach. H. pylori infection increases the risk of stomach inflammation and stomach ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer. Although infection increases the risk, cancer is not contagious. You cannot catch stomach cancer from another person who has it.
  
  
• Smoking: People who smoke are more likely to develop stomach cancer than people who do not smoke.
  
• Certain health problems: Conditions that cause inflammation or other problems in the stomach may increase the risk of stomach cancer:
  
  
  • Stomach surgery
    
    
  • Chronic gastritis (long-term inflammation of the stomach lining)
    
    
  • Pernicious anemia<(a blood disease that affects the stomach)
    
    
• Family history: A rare type of stomach cancer runs in some families.
  
  

Most people who have known risk factors do not develop stomach cancer. For example, many people have H. pylori in their stomach but never develop cancer. On the other hand, people who do develop the disease sometimes have no known risk factors.

If you think you may be at risk, you should talk with our doctor. Oour doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

What are the symptoms of Stomach Cancer?

Early stomach cancer often does not cause clear symptoms. As the cancer grows, the most common symptoms are:

• Discomfort in the stomach area
  
  
• Feeling full or bloated after a small meal
  
  
• Nausea and vomiting
  
  
• Weight loss
  

Most often, these symptoms are not due to cancer. Other health problems, such as an ulcer or infection, can cause the same symptoms. Anyone with these symptoms should tell our doctor so that problems can be found and treated as early as possible.

What is the diagnosis for Stomach Cancer?

If you have a symptom that suggests stomach cancer, your doctor must find out whether it is really due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems.

The doctor asks about your personal and family health history. You may have blood or other lab tests. You also may have:

• Physical exam: The doctor checks your abdomen for fluid, swelling, or other changes. The doctor also feels for swollen lymph nodes. Your skin and eyes are checked to see if they seem yellow.
  
  
• Upper GI series: The doctor orders x-rays of your esophagus and stomach. The x-rays are taken after you drink a barium solution. The solution makes your stomach show up more clearly on the x-rays.
  
  
• Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into your stomach. The doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.
  
  
• Biopsy: The doctor uses an endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.
  

To plan the best treatment, our doctor needs to know the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Stomach cancer can spread to the lymph nodes, liver, pancreas, and other organs. The doctor may order tests to check these areas:

• Blood tests: The lab does a complete blood count to check for anemia. Blood tests also show how well your liver is working.
  
  
• Chest x-ray: An x-ray machine takes pictures of your lungs. The doctor can then study these pictures on film. Tumors in your lungs can show up on the x-ray.
  
  
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive an injection of dye. The dye makes abnormal areas easier to see. Tumors in your liver, pancreas, or elsewhere in the body can show up on a CT scan.
  
  
• Endoscopic ultrasound: The doctor passes a thin, lighted tube (endoscope) down your throat. A probe at the end of the tube sends out sound waves that you cannot hear. The waves bounce off tissues in your stomach and other organs.
  
  
• Laparoscopy: A surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. The surgeon may remove lymph nodes or take tissue samples for biopsy.
  

Sometimes staging is not complete until after surgery to remove the tumor and nearby lymph nodes.

These are the stages of stomach cancer:

• Stage 0: The cancer is found only in the inner layer of the stomach. It is carcinoma in situ.
  
  
• Stage I is one of the following:
  The tumor has invaded only the submucosa. Cancer cells may be found in up to 6 lymph nodes. Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.
  
  
• Stage II is one of the following:
  The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes. Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes. Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other organs.
  
  
• Stage III is one of the following:
  The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes. Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes. Or, the tumor has invaded nearby organs, such as the liver or spleen. Cancer cells have not spread to lymph nodes or to distant organs.
  
  
• Stage IV is one of the following:
  Cancer cells have spread to more than 15 lymph nodes. Or, the tumor has invaded nearby organs and at least 1 lymph node. Or, cancer cells have spread to distant organs.
  
  
• Recurrent cancer: The cancer has come back (recurred) after a period of time when it could not be detected. It may recur in the stomach or in another part of the body.
  

How is Stomach Cancer treated?

The choice of treatment depends mainly on the size and place of the tumor, the stage of disease, and your general health. Treatment for stomach cancer may involve surgery, chemotherapy, or radiation therapy. Many people have more than one type of treatment.

Our doctor can describe your treatment choices and the expected results. Wer can work together to develop a treatment plan that meets your needs.

Cancer treatment is either local therapy or systemic therapy:

• Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy cancer in or near the stomach. When stomach cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
  
  
• Systemic therapy: Chemotherapy is systemic therapy. The drug enters the bloodstream and destroys or controls cancer throughout the body.
  

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Before treatment starts, our health care team will explain possible side effects and suggest ways to help you manage them. NCI provides helpful booklets about cancer treatments and coping with side effects. These include Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer Patients.

Surgery is the most common treatment for stomach cancer. The type of surgery depends on the extent of the cancer. There are two main types of stomach cancer surgery:

• Partial (subtotal) gastrectomy: The surgeon removes the part of the stomach with cancer. The surgeon also may remove part of the esophagus or part of the small intestine. Nearby lymph nodes and other tissues may be removed.
  
  
• Total gastrectomy: The doctor removes the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, and other tissues near the tumor. The spleen also may be removed. The surgeon then connects the esophagus directly to the small intestine. The surgeon makes a new "stomach" out of tissue from the intestine.
  

It is natural to be concerned about eating after surgery for stomach cancer. During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal.

The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with our doctor or nurse. After surgery, our doctor can adjust the plan if you need more pain relief.

Many people who have stomach surgery feel tired or weak for a while. The surgery also can cause constipation or diarrhea. These symptoms usually can be controlled with diet changes and medicine. Your health care team will watch for signs of bleeding, infection, or other problems that may require treatment.

Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body. Most people who receive chemotherapy have it after surgery. Radiation therapy may be given along with chemotherapy.

Anticancer drugs for stomach cancer are usually injected into a blood vessel. But some drugs may be given by mouth. You may have your treatment in a clinic at the hospital, at the doctor's office, or at home. Some people may need to stay in the hospital during treatment.

The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

• Blood cells: These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.
  
  
• Cells in hair roots: Chemotherapy drugs can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
  
  
• Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. The drugs used for stomach cancer also may cause a skin rash or itching. Your health care team can suggest ways to control many of these side effects.
  

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

The radiation comes from a large machine outside the body. Treatments are usually 5 days a week for several weeks.

Side effects depend mainly on the dose of radiation and the part of your body that is treated. Radiation therapy to the abdomen may cause pain in the stomach or the intestine. You may have nausea and diarrhea. Also, your skin in the treated area may become red, dry, and tender.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, our doctor can usually treat and control them. Also, side effects usually go away after treatment ends.

What nutrional care should I undertake during treatment?

It is important to eat well during and after cancer treatment. You need the right amount of calories, protein, vitamins, and minerals. Eating well may help you feel better and have more energy.

Eating well can be hard. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. You also may have side effects of treatment such as poor appetite, nausea, vomiting, or diarrhea.

Our registered dietitian can suggest ways to deal with these problems. Some people with stomach cancer are helped by receiving nutrition by a feeding tube or by injection into a blood vessel. Some are helped by nutritional beverage products.

Nutrition after stomach surgery

Weight loss after surgery for stomach cancer is common. You may need to change the types of food you eat. Our registered dietitian can help you plan a diet that will give you the nutrition you need.

Another common problem after stomach surgery is dumping syndrome. This problem occurs when food or liquid enters the small intestine too fast. It can cause cramps, nausea, bloating, diarrhea, and dizziness. Eating smaller meals can help prevent dumping syndrome. Also, you may wish to cut down on very sweet foods and drinks, such as cookies, candy, soda, and juices. A registered dietitian can suggest foods to try. Also, your health care team may suggest medicine to control the symptoms.

You may need to take daily supplements of vitamins and minerals, such as calcium. You also may need injections of vitamin B12.