Gastric Cancer, Gastric Adenocarcinoma, and Stomach Cancer

This process happens slowly. Stomach cancer tends to develop over many years. Stomach cancer is directly linked to tumors in the stomach. However, there are some factors that might increase your risk of developing these cancerous cells. These risk factors include certain diseases and conditions, such as:. While your personal medical history can impact your risk of developing stomach cancer, certain lifestyle factors can also play a role. You may be more likely to get stomach cancer if you:. According to the NCI , there are typically no early signs or symptoms of stomach cancer.

To make a diagnosis, your doctor will first perform a physical exam to check for any abnormalities. They may also order a blood test, including a test for the presence of H. More diagnostic tests will need to be done if your doctor believes that you show signs of stomach cancer. Diagnostic tests specifically look for suspected tumors and other abnormalities in the stomach and esophagus.

These tests may include:. Your exact treatment plan will depend on the origin and stage of the cancer.

Age and overall health can also play a role. Aside from treating cancer cells in the stomach, the goal of treatment is to prevent the cells from spreading. Stomach cancer, when left untreated, may spread to the:. However, you can lower your risk of developing all cancers by:.

In some cases, doctors may even prescribe medications that can help lower the risk of stomach cancer. This is usually done for people who have other diseases that may contribute to the cancer. You may also want to consider getting an early screening test. This test can be helpful in detecting stomach cancer.

Your doctor may use one of the following screening tests to check for signs of stomach cancer:. Your chances of recovery are better if the diagnosis is made in the early stages. According to the NCI , around 30 percent of all people with stomach cancer survive at least five years after being diagnosed.

The majority of these survivors have a localized diagnosis. This means that the stomach was the original source of the cancer. When the origin is unknown, it can be difficult to diagnose and stage the cancer. This makes the cancer harder to treat. If your cancer is more advanced, you may want to consider participating in a clinical trial. Clinical trials help determine whether a new medical procedure, device, or other treatment is effective for treating certain diseases and conditions. You can see if there are any clinical trials of treatments for stomach cancer on the NCI website. The website also has resources to help you and your loved ones cope with a stomach cancer diagnosis and its subsequent treatment.

We asked several people who are living with cancer to tell us what they wish someone had told them before they started to receive treatment. It is connected to the mouth and throat by the esophagus.

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The stomach contains acid and is quite muscular. Due to the motion of the stomach and the acid, quite a bit of digestion takes place in the stomach. The partially digested food is then emptied into the small intestine so that absorption of the nutrients from food can take place. The definition of a tumor is a mass of quickly and abnormally growing cells. Tumors can be either benign or malignant. Benign tumors have uncontrolled cell growth, but without any invasion into normal tissues and without any spread. A malignant tumor is called cancer when these tumor cells gain the ability to invade tissues and spread locally as well as to distant parts of the body.

In this sense, gastric cancer occurs when cells in the lining of the stomach grow uncontrollably and form tumors that can invade normal tissues and spread to other parts of the body. Cancers are described by the types of cells from which they arise. Since this lining has glands, the cancer that comes from it is called adenocarcinoma. Although there are other cancers that can arise in the stomach lymphomas-from lymph tissue, leiomyosarcoma-from muscle tissue, squamous cell carcinoma-from lining without glands , the vast majority of gastric cancers are adenocarcinomas.

What Is Stomach Cancer?

Hence, these are the most commonly studied. In the United States, in , there were an estimated 26, gastric cancers diagnosed. Interestingly, its incidence has drastically decreased since Although it is presumed that this is due to some sort of dietary or environmental factor s , the exact reason behind this decrease is not known. One theory is that the advent of refrigeration led to decreased use of nitrites, "smoking" of foods, and other such forms of food preservation.

Gastric cancer is approximately twice as common in men and more common in African Americans than Caucasians. It is rare to see gastric cancer before the age of 40, and its incidence increases with age. Although gastric cancer has greatly decreased in the United States, on a worldwide scale its incidence is still high, and it is the fourth most common cancer in the world.

Interestingly, first generation immigrants from these countries have a decreased incidence of stomach cancer after moving to the United States, but it is still higher than the general American population. However, the incidence greatly declines in second and third generation Japanese and Chinese immigrants to the United States, pointing to the fact that there does not appear to be an inherently genetic component in Eastern Asians' risk to develop gastric cancer, but rather an environmental component.

As mentioned above, diets heavily salted, smoked, or pickled are associated with an increased risk of disease, while diets rich in fruits, vegetables, and dietary fiber are associated with a decreased risk of gastric cancer. The incidence of gastric cancers also increases with decreasing socioeconomic status, likely due to a number of social, occupational, and cultural factors. Tobacco use has also been associated with an increase in gastric cancers. There are some genetic diseases such as hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, and Peutz Jeghers syndrome which all predispose to gastric cancer.

It also appears that people with blood type A are at increased risk for gastric cancer for an unknown reason. Hereditary diffuse gastric cancer HDGC is an inherited genetic abnormality that is associated with an increased risk of developing gastric cancer. It is not known how many families carry the CDH1 mutation. Families that have had several cases of gastric cancer, particularly if they are the diffuse type, should consider genetic testing and screening options. Studies have also linked infection with Helicobacter pylori with gastric cancer.

However, the exact role of H. It is theorized that H. It is believed that this process of atrophy can lead to gastric cancer. Pernicious anemia, an autoimmune disease where the stomach does not produce stomach acid, has also been linked to gastric cancer. Drugs which cause a decrease in stomach acid production have not been linked to an increased risk of gastric cancer.

It should be noted that, although these risk factors are listed above, the majority of gastric cancers develop without any one obvious predisposing cause. In other words, there is no extremely strong cause effect relationship with any risk factor, in contrast, for example, to that between smoking and lung cancer. Because there is no one risk factor directly associated with gastric cancer, there is no strict lifestyle change that can greatly decrease a person's risk of developing gastric cancer.

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However, eating a "Western" type diet, without heavily smoked or salted foods and rich in fruits and vegetables will likely decrease a person's risk. Also, smoking cessation will likely decrease gastric cancer risk though smoking should be stopped for numerous other health reasons. Some have advocated the consumption of foods with high level of antioxidants and vitamin C to prevent gastric cancers, though this has not been definitively proven.

Pylori actually reduces the risk of gastric cancer remains controversial. The decision to treat H. There are no established programs for primary prevention of gastric cancer in the United States. There are no plans to initiate a screening program in the United States, simply because the incidence of gastric cancer is fairly low, and thus the yield from gastric cancer screening would be far too low to approach cost-effectiveness.

Gastric Adenocarcinoma

A few populations may be exceptions e. Currently, screening for H. Pylori is not recommended for areas with a relatively low incidence of gastric cancer, such as in the United States. In Japan, where gastric cancer is much more prevalent, screening programs have been successful and in place for more than 50 years. These tests include double-contrast barium radiographs so-call "upper GIs" or "barium swallows" and upper endoscopies.

An upper endoscopy or an "EGD" is a test done using a camera at the end of a long tube that is placed down the patient's throat, into the stomach, by the gastroenterologist. The physician performing the EGD is able to directly visualize the stomach. Many abnormalities can be detected with an EGD-most importantly, ulcers and cancers.

Patients are sedated during the procedure, so discomfort is kept to a minimum. More recently, studies have verified the use of a blood test that could be used to screen for gastric cancer. However, this is still in the early stage of testing and needs to be verified.

The symptoms of gastric cancer are often nonspecific, and the majority of people will unfortunately present with advanced disease. The vast majority of gastric cancer patients present with vague complaints such as upper abdominal discomfort or indigestion, loss of appetite, occasional vomiting, belching, or decreased ability to eat a large meal. Additional symptoms are unexplained weight loss, fatigue and weakness, with or without anemia. Again, these symptoms are vague.

These symptoms are often the exact symptoms that patients experience when they have peptic ulcer disease or gastritis. Therefore, patients may be treated for benign diseases, such as ulcers, before the cancer diagnosis is made. This is not incorrect management, as gastritis and peptic ulcer disease are much more common than gastric cancer. However, if symptoms persist or do not respond to treatment, further evaluation should be done.

Other symptoms, such as vomiting blood or problems with swallowing, are less common, but should be investigated without delay. Advanced disease can present with palpable lymph nodes able to be felt by the healthcare provider with masses in the area of the belly button, the underarms, or the clavicle. People with advanced disease may also present with abdominal swelling. Upper EGD, is routinely used for the initial diagnosis and staging of patients with gastric cancer.

Many times, ultrasound during endoscopy is used to attempt to identify how deep into the wall of the stomach the cancer has penetrated. In addition, ultrasound can identify spread to lymph nodes in many cases. Depth of wall invasion and presence of lymph node spread are two very important components of treatment, as the surgeon uses this information to determine if surgery is a treatment option. Other procedures are needed to determine the stage of the disease.

CT scans "CAT scans" of the abdomen and chest are done, not only to rule out spread to distant organs, like the liver and lungs, but also to determine the spread to lymph nodes close to the stomach that could not be identified by ultrasound. Laparoscopy is a surgical procedure that involves puncturing the abdominal cavity with a fiber optic camera and directly viewing the organs and tissues in the area of the stomach, the entire abdominal cavity, and the lining of the abdomen omentum and peritoneum.

Other, more routine tests done before treatment include blood screening tests, to insure that overall blood counts are within normal limits, to check for anemia and that a patient's liver and kidneys are functioning properly. All of these tests are important to determine the extent of the disease, which allows the disease to be staged. The stage provides a guideline for the optimal treatment of the gastric cancer. Before the staging systems are introduced, here is some background on how cancers grow and spread, and therefore become more advanced in stage.

Cancers cause problems because they spread and can disrupt the functioning of normal organs.

Stomach cancer

One way gastric cancer can spread is by local extension to invade through the stomach wall and into adjacent structures. These surrounding structures include the soft tissues and fat surrounding the stomach as well as other organs such as the spleen, pancreas, large intestine, small intestine, liver, and large blood vessels. Gastric cancer can also spread by accessing the lymphatic system. The lymphatic circulation is a complete circulation system in the body somewhat like the blood circulatory system that drains into various lymph nodes.

When cancer cells access this lymphatic circulation, they can travel to lymph nodes and start new sites of cancer. This is called lymphatic spread. Gastric cancers have a propensity to undergo lymphatic spread because there are many small lymphatic vessels contained within the stomach wall.

The first lymph nodes that cancer cells spread to are the "perigastric" nodes along the sides of the stomach itself. They can then spread to lymph nodes adjacent to the liver, spleen, pancreas, and aorta. Gastric cancers can also spread through the bloodstream. Cancer cells gain access to distant organs via the bloodstream and the tumors that arise from these cells are called metastases. Because of the stomach's blood supply, the most common organ it spreads to is the liver, though tumors can also spread to the lung or other organs less commonly.

A fourth way gastric cancer can spread is throughout the entire abdomen, the so-called peritoneal cavity. Although rare, once cancer cells grow outside of the stomach itself, there is nothing stopping cells from spreading to any surface in the entire abdominal cavity. The staging of a cancer basically describes how much it has grown before the diagnosis is made, documenting the extent of disease. Unfortunately, gastric cancer often presents as a more advanced disease because of lack of early diagnosis, due mainly to the vague associated symptoms. The TNM system is used to describe many types of cancers.

Though complicated, this staging system help physicians determine the extent of the cancer, and therefore make treatment decisions regarding a patient's cancer. The stage of cancer, or extent of disease, is based on information gathered through various tests done as the diagnosis and work-up of the cancer is being performed. It has three components: T-describing the extent of the "primary" tumor the tumor in the stomach itself ; N-describing the spread to the lymph nodes; M-describing the spread to other organs i. Currently, all curative treatments for gastric cancer involve surgery surgical resection of the cancer.

The smallest amount of surgery that is possible while still taking out all of the cancer is what is normally performed. Generally, tumors that are localized to the part of the stomach closest to the esophagus proximal stomach are treated with a gastrectomy removal of the entire stomach. A partial gastrectomy is the removal of only a portion of the stomach, in contrast to a total gastrectomy, which is done when the tumor is larger. Partial gastrectomies may be appropriate for those tumors located further from the esophagus, in the distal portion of the stomach.

For partial gastrectomy, the surgical margin around the gastric cancer needs to be 5 cm, i. Disease involving the entire stomach is also an indication for a total gastrectomy. The surgeon removes the cancer with an adequate margin of healthy tissue and the surrounding lymph nodes. How extensive of a lymph node dissection to perform is controversial, with contradictory data from the United States compared with Japan. However, it is import that an experienced surgeon performs the dissection as it is a difficult surgery.