Stomach Cancer

Stomach Cancer: Overview

Stomach cancer (also known as gastric cancer or carcinoma of the stomach) is one of the most common cancers, affecting roughly twice as many men as women.  More than 8 out of 10 cases are diagnosed in people over the age of 60.  The success of treatment depends on how early the diagnosis is made.

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Most stomach cancers form a tumor or an ulcer in the inner lining of the stomach.  Less commonly, the cancer spreads along the stomach wall without forming a discrete lump.  This is known as a diffuse tumor.

Incidence; Causes and Development; Contributing Risk Factors

There is wide variation from country to country in the numbers of people affected.  Less industrialized countries generally have the highest rates.  Poorer people in Western countries are also more likely to be affected than the better-off.

The exact causes of stomach cancer are not yet fully understood.

In addition to affecting more men than women, and occurring most in older people (the cancer is uncommon in people under 50) other factors that appear to increase the risk of stomach cancer include:

  • Helicobacter pylori (H.  pylori) infection – these bacteria live in the stomach lining of many people, usually without any symptoms.  It causes inflammation of the stomach lining (gastritis), ulcers and also increases the risk of stomach cancer.
  • Pernicious anemia – this affects the lining of the stomach.
  • Diet – a diet high in salt and foods that are smoked or cured may increase the risk of stomach cancer.  In particular, certain food preservative chemicals known as nitrosamines, which are found meats such as bacon and ham, may lead to an increased risk of stomach cancer.  In contrast, a diet rich in antioxidant vitamins (A, C and E), available in fresh fruit and vegetables, is thought to be protective against stomach cancer.
  • Family history – some people inherit an increased risk of developing stomach cancer.
  • Type A blood group – people who have this blood group are at higher risk.
  • Smoking – certain types of stomach cancer are four times more likely in smokers than non-smokers.
  • Atrophic gastritis – people who have a stomach disorder called atrophic gastritis, where the lining of the stomach wastes away, are at higher risk.

Signs and Symptoms

Early stomach cancer can have very mild symptoms, similar to indigestion symptoms.  This includes feeling full after eating only a small meal, heartburn, stomach pain, nausea, vomiting and difficulty swallowing.

As the cancer advances, there may be additional symptoms such as:

  • Unexplained or sudden weight loss.
  • Vomiting blood (it may have the appearance of coffee grounds).  See a doctor if vomiting persists for more than a few days, or if it contains blood.
  • Passing blood in the stools.  This is not usually fresh, red blood, but dark blood.
  • The blood loss (through vomiting or passing out via stools) may go unnoticed, but over a period of time, can cause anemia.
  • Persistent abdominal pain.

Diagnosis and Tests

If suspected, a doctor should order further investigation.  This includes the following:

The process of investigating how far the cancer has spread is known as staging.  It is based on how deeply the tumor has invaded the stomach wall, whether or not the nearby lymph glands are affected, and whether the cancer has spread to other organs such as the liver or lungs.  The stage a cancer is at helps to determine what treatment is possible and what the likely outcome will be.

Laboratory Findings:

  • Gastroscopic biopsy and cytology – essential for diagnosis
  • Hypochromic, microcytic anemia due to chronic blood loss
  • Occult blood in stool
  • Blood in gastric contents
  • Gastric analysis – 50% of patients have no gastric acid, even following stimulation; 50% have normal or decreased gastric acid
  • Increased serum gastrin due to hypochlorhydria.

Prognosis; Seek medical attention if...

If discovered early, stomach cancer can be contained within the stomach lining or stomach wall.  However, cancer cells can also invade neighboring organs, and break away and travel to distant parts of the body via the blood stream and lymph channels.

In general, the further that stomach cancer has spread from the original site, the less likely it is that the condition will be cured.  This is why recognizing the signs, early diagnosis and treatment are crucial.

It is important to seek medical advice if any symptoms persist despite alterations to lifestyle, such as stopping smoking and eating more healthily, or if they start in someone aged 40 or over.

Conditions that suggest Stomach Cancer:

Digestion

Symptoms - Cancer

Risk factors for Stomach Cancer:

Addictions

Cigarette Smoke Damage

About 20% of the mortality from stomach cancer is attributable to smoking.  There is approximately a 50% increase in the risk of stomach cancer in smokers compared to never-smokers.

Digestion

Atrophic Gastritis

Gastric cancer is 5 to 10 times more likely in those with chronic atrophic gastritis; the same increased incidence is also found in first-degree relatives of patients with gastric cancer and pernicious anemia.

Infections

Helicobacter Pylori Infection

Helicobacter Pylori infection leads to a significantly increased risk of stomach cancer.  About 550,000 new cases of stomach cancer each year are attributable to Helicobacter pylori, the same bacterium that causes ulcers.

Supplements and Medications

Counter-indicators
Frequent/regular aspirin use

Several studies have noted a reduction in the risk of esophageal, gastric and biliary cancers among regular aspirin users.  A 2012 study showed that those who used aspirin daily had a 40% lower risk of death from stomach cancer.  [JNCI J Natl Cancer Inst (2012) 104 (16): pp1208-1217]

Symptoms - Cancer

Symptoms - Food - Intake

(High) processed meat consumption

Nitrates and nitrites, such as those in hot dogs, lunch meats, and other cured meats, increase food levels of nitrates, which can lead to the formation of carcinogenic nitrosamines in the stomach.

Processed meats are often salted or smoked, or nitrites may be added to them, in order to prolong their shelf-life.  It may be the case that these treatments increase the risk of developing stomach cancer, but previous studies have given contradictory results.

Said Susanna Larsson, research student at The Institute of Environmental Medicine at Karolinska Institutet in Sweden, "We decided to carry out a meta-analysis.  This is an analysis in which we collated all research into processed meats and stomach cancer that we could find".

They found 15 studies, covering 4,704 subjects in the period 1966 to 2006, and the results are unequivocal: the risk of developing stomach cancer increases by between 15% and 38% when consumption of processed meat products increases by 30gm (approximately a half-portion) per day.

["Processed Meat Consumption and Stomach Cancer Risk: A Meta-Analysis"; Susanna C.  Larsson, Nicola Orsini and Alicja Wolk; Journal of the National Cancer Institute, Volym 98, Nummer 15, Augusti 2006]

Symptoms - Food - Preferences

(Partial) vegetarian diet or omnivorous diet

An October, 2001 study by Yale School of Medicine researchers has found that a diet high in cholesterol, animal protein and vitamin B12 is linked to increased risk of a specific type of esophageal and stomach cancer, known as adenocarcinoma of the esophagus and gastric cardia, cases of which increased by 300% between the mid-1970s and 2000.

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Stomach Cancer suggests the following may be present:

Addictions

Cigarette Smoke Damage

About 20% of the mortality from stomach cancer is attributable to smoking.  There is approximately a 50% increase in the risk of stomach cancer in smokers compared to never-smokers.

Tumors, Malignant

Stomach Cancer can lead to:

Digestion

Recommendations for Stomach Cancer:

Drug

Chemotherapy

Chemotherapy may be used after surgery to try to reduce the chances of the cancer coming back.  The additional treatment is known as adjuvant chemotherapy.

Environmental

Radiation Therapy (Radio Therapy)

Radiotherapy is not usually used to try and cure stomach cancer, but is sometimes used to relieve symptoms if cancer has spread outside the stomach.

Surgery/Invasive

Surgery

The only way to cure stomach cancer is to find it early and remove the tumor through surgery.  If it has not spread outside the stomach, then an operation to remove either the whole stomach or just the affected part of it may be done.  In advanced cases, surgery will not cure the cancer but may be needed to treat symptoms such as vomiting, pain or bleeding.

Preventive measures against Stomach Cancer:

Botanical

Green Tea

Regular and substantial consumption of green tea may provide protective effect against this type of cancer.

Diet

Increased Fruit/Vegetable Consumption

Eating a diet rich in fruit and vegetables (which contain antioxidant vitamins) will reduce the risk of stomach problems, including cancer.

Alcohol Avoidance

Reducing alcohol intake will reduce the risk of stomach cancer.

Plant-Based Nutrition

An October, 2001 study by Yale School of Medicine researchers has found that a diet high in cholesterol, animal protein and vitamin B12 is linked to increased risk of a specific type of esophageal and stomach cancer, known as adenocarcinoma of the esophagus and gastric cardia, that has been increasing rapidly.  The number of cases increased by 300% between the mid-1970s and 2000, according to lead author Susan Mayne, associate professor in the Department of Epidemiology and Public Health at Yale School of Medicine, and associate director of the Yale Cancer Center.

The researchers found that plant-based nutrients such as dietary fiber, dietary beta-carotene, folic acid, vitamin C and vitamin B6 were associated with lower risk of these kinds of cancers.

"We found that many animal-based nutrients found in foods of animal origin are strongly associated with risk of developing these types of cancers and we were able to identify nutrients that presumably would be protective," said Mayne.  "We also found that regular users of vitamin C supplements were at significantly lower risk of stomach cancer."

"Our results suggest that prevention strategies for these cancers should emphasize increased consumption of plant foods, decreased consumption of foods of animal origin with the possible exception of dairy products, and control of obesity."

Processed Foods Avoidance

Watch out for cured/smoked foods.  Foods such as pickles, ham and bacon should be consumed less.  The high rate of stomach cancer in Japan has been traced to the large amount of smoked fish in the Japanese diet.  Also, Asians who eat a traditional diet – with lots of salt-cured, pickled and smoked foods – have a high rate of stomach and esophageal cancer.  Use herbs and spices to season foods instead.

Weight Loss

During analysis of the data from a Yale study (see link between Increased Risk of Stomach Cancer and treatment Vegetarian/Vegan Diet) the research team found that obesity is strongly linked with risk of these cancers.  "The increase in the prevalence of obesity in the United States certainly contributes to the time trends... Our results suggest that prevention strategies for these cancers should emphasize increased consumption of plant foods, decreased consumption of foods of animal origin with the possible exception of dairy products, and control of obesity."

Increased Fish Consumption

Study subjects who ate two or more servings of fish weekly had a much lower risk for esophageal, stomach, colon, rectum, and pancreatic cancers than those who avoided fish.  In fact, the rates of these types of cancer were 30 to 50 percent lower among fish eaters.  High fish consumption was also associated with lower risks for cancers of the larynx (30 percent lower risk), endometrial cancer (20 percent lower risk), and ovarian cancer (30 percent lower risk).

Spicy Foods Avoidance

Researchers at Yale University School of Medicine discovered an increased rate of stomach cancer among those who consumed one or more chili peppers a day, compared to those who did not.

Habits

Tobacco Avoidance

Non-smokers have a significantly lower risk of developing stomach cancer.

Mineral

Vitamins

Vitamin C (Ascorbic Acid)

Vitamin C supplementation may help reduce the risk to the development of gastric cancer by increasing ascorbate levels within the stomach and decreasing mucosal DNA damage.

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