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Gastric Cancer

The stomach lies on the left side of the upper abdomen. When we eat, food passes down the food pipe (esophagus) into the stomach. It makes acid and some chemicals (enzymes) that help to digest food. The muscles in the wall of the stomach tighten (contract) to mix the food and force it to pass into the first part of the small intestine (duodenum).

Cancer is a disease in which cells grow uncontrollably and do not die when they should. These cancer cells can travel and have the ability to spread to other parts of the body.

Stomach cancer is also called gastric cancer.

Types of stomach cancer include:

  • Adenocarcinoma: This is the most common type arising from a cell that is on the inside lining of the stomach (the mucosa).

  • Gastrointestinal stromal tumours: These types of tumours are less common and originate in the interstitial cells in the wall of the stomach.

  • Gastrointestinal neuroendocrine tumours: These arise from cells in the stomach lining which make hormones.

  • Lymphomas: These arise from the lymphatic tissue within the wall of the stomach.

What Causes Stomach Cancer?

The exact cause of stomach cancer is not known, but studies say that something damages or alters certain genes in the cell. This makes the cell abnormal and they start multiplying uncontrollably. 

Nonetheless, certain risk factors increase the chance of stomach cancer. 

  • Ageing - Stomach cancer is more common in older adults, usually people 50 years old.

  • Pernicious anaemia - which causes a lack of vitamin B12, can slightly increase your risk of stomach cancer.

  • Diet is probably a factor- Countries such as Japan, where people eat a lot of salt, pickled and smoked foods have a high rate of stomach cancer. Having a lot of fruit and green vegetables can reduce the risk of stomach cancer.

  • Gender -  Stomach cancer is more common in men than it is in women.

  • Family history - For some cases, it may run in the family. 

  • Blood group A - People of blood group A have a slightly higher risk.

  • Smokers are at more risk of getting stomach cancer.

  • Long-term infection of the stomach lining with a germ (bacterium) known as Helicobacter pylori (H. pylori) maximizes the risk of stomach cancer. 

  • If the part of your stomach was removed in the past due to any problem. For instance, to treat stomach cancer or any other condition.

Stomach Cancer Symptoms

When a stomach (gastric) cancer is in its initial stage and is small, it usually causes no symptoms. Some patients do not become symptomatic until later stages of cancer while many others have mild non-specific symptoms that are ignored for a long time.

  • Discomfort or pain or in the upper abdomen, usually after eating. 

  • Indigestion. 

  • Feeling sick and being off food. 

  • A sense of fullness after eating.

  • Vomiting

  • Weight loss and/or loss of appetite.

  • You may have blood in your stools (faeces). This usually presents as black faeces (known as melaena) or dark blood rather than bright red bleeding - which is more unusual with stomach cancer and implies very severe bleeding in the stomach or bowel.

  • Jaundice (yellowing of eyes and skin).

  • Ascites (build-up of fluid in the abdomen).

(Note: People who have the above symptoms may not necessarily be having cancer. However, they need further tests to find out the cause for their symptoms, cancer being one of them.)

If you have signs and symptoms that worry you, make an appointment with the best hospital for stomach cancer in Delhi.

How Is Stomach Cancer Diagnosed?

  • Health History and Physical Examination - A history of the patient's health habits and past illnesses and treatments will be taken. The doctor will examine for general signs of health or lumps or anything else that seems abnormal. 

  • Blood tests are usually to assess general health or for tumor markers

  • Upper GI Endoscopy- If a doctor suspects that you may have stomach (gastric) cancer, he or she may advise upper GI endoscopy. An endoscope is a thin, flexible, telescope that is passed through the mouth, into the food pipe (oesophagus) and down towards the stomach and the first part of the small intestine (the duodenum). The endoscope contains fibre-optic channels which allow light to shine down so the doctor can see inside your stomach and duodenum.

  • Biopsy – to confirm the diagnosis. During endoscopy, if anything abnormal is seen, then a small sample of tissue is removed from that abnormal area -this procedure is called a biopsy. The sample is then examined under the microscope to look for abnormal cells and for confirmation of diagnosis. It can take a few days for the biopsy results.

Extent And Spread Of Gastric Cancer

We need investigations to find out the extent of cancer in the body. The information gathered from these determines the stage of the disease which is important to know in order to plan treatment.

The tests and procedures may be used in the staging process include:

  • Endoscopic ultrasound (EUS): At the end of the endoscope a probe is used to bounce high-energy and strong sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues known as a sonogram. This procedure is also called endosonography.

  • CT scan (CAT scan): It is a procedure that is used to make a series of detailed pictures of areas inside the body, such as the chest, abdomen, or pelvis, the pictures can be taken from different angles. The computer that made pictures is linked to an x-ray machine. A dye may be injected into a vein and/or swallowed to help the organs or tissues show up more clearly. It is also called computed tomography, computerized tomography, or computerized axial tomography.

  • PET scan (positron emission tomography scan): A small amount of radioactive glucose is injected into a vein of your hand. The PET scanner rotates around the body and takes pictures of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and absorb more glucose than normal cells. A PET scan and CT scan may be done at the same time known as PET-CT and give more information than either of the tests done alone.

  • MRI (magnetic resonance imaging) with gadolinium: It is a procedure that uses a magnetic field and radio waves to create a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein to serve as a contrast just like in a CT scan. The gadolinium collects within cancer and can be seen as bright areas on the scan. This procedure is also called nuclear magnetic resonance imaging (NMRI). The advantage of MRI is that it is free of radiation. However, it is used less in the assessment of stomach cancer

  • Diagnostic Laparoscopy: It’s a surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small 1 cm incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to inspect and perform procedures such as taking tissue samples to be checked under a microscope for signs of cancer. A solution may be washed over the surface of the organs in the stomach and then removed to collect cells. These cells are also viewed under a microscope to check for signs of cancer.

How Stomach Cancer Is Treated?

The treatment advised for each case depends on the size and stage of cancer and the general health of the patient. 

You should also discuss with your surgeon the aims of treatment. For example:

  • Treatment may aim to cure cancer. Some stomach or gastric cancers can be cured, particularly if they can be diagnosed in the early stages of the disease. 

  • Treatment may aim to control cancer. If a cure is not realistic, with treatment it is often possible to control the growth of the cancer and prevent it from spreading to other areas of the body.

  • Treatment may aim to ease symptoms. In patients with advanced cancer when a cure is not possible, treatments may be used to reduce the symptoms like pain, bleeding or obstruction.

Surgery

Removing the tumour may be curative if the cancer is in the early stage. Surgery can be done through an open approach or laparoscopic/robotic approach (in selected patient groups). The following types of surgery may be used to treat cancer:

  • Subtotal gastrectomy: Removal of the part of the stomach that contains cancer with an adequate margin of the normal stomach, nearby lymph nodes, and parts of other tissues and organs near the tumor, if involved by tumor. The spleen may be removed. 

  • Total gastrectomy: Removal of the entire stomach, nearby lymph nodes, and parts of the esophagus and other tissues near the tumor. The spleen may be removed. The esophagus (food pipe) is reconnected to the small intestine so the patient can continue to eat.

If the tumor is blocking the stomach but cancer cannot be completely removed by standard surgery, the following procedures may be used:

  • Endoluminal stent placement: It is an endoscopy procedure where a stent is inserted (a thin, expandable tube) GI tract in order to keep a passage open. For tumors blocking the passage into or out of the stomach, a procedure may be performed to place a stent from the esophagus to the stomach or from the stomach to the small intestine to allow the patient to eat and swallow normally.

  • Endoluminal laser therapy: In this procedure an endoscope (a thin, lighted tube) with a laser attached is inserted into the body. A laser is an intense beam of light that can be used as a knife to make way through the obstructing tumor.

  • Gastrojejunostomy: The part of the stomach above the cancer is connected to the jejunum (a part of the small intestine) to allow food to pass from the stomach into the small intestine.

Endoscopic mucosal resection

Endoscopic mucosal resection is a procedure that uses an endoscope to remove very early-stage cancer and precancerous growths from the lining of the digestive tract without surgery. 

Chemotherapy

Chemotherapy uses medicines to control the growth of cancer cells, either by destroying the cells or by stopping them from dividing. Chemotherapy drugs can be taken by mouth or injected into a vein or muscle, then these drugs enter the bloodstream and can reach cancer cells throughout the body.

When chemotherapy is used in addition to surgery it is called adjuvant chemotherapy. For example, post-surgery, you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour but were not detected on routine investigations. Sometimes, chemotherapy is required to be given before surgery, to shrink a large tumour and take care of circulating cancer cells in order to achieve better results from surgery - this is known as neoadjuvant chemotherapy.

Radiation therapy

Radiation therapy uses strong and high-energy x-rays or other types of radiation to destroy the cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to deliver radiation toward the area of the body affected with cancer.

For radiation therapy in Delhi to treat stomach cancer, consult the nearest cancer hospital.

Chemoradiation

Chemoradiation therapy combined chemotherapy and radiation therapy to increase the effects of treatment. Chemoradiation given after surgery, to lower the risk that cancer will come back, is called adjuvant therapy. Chemoradiation given before surgery to shrink the tumor is known as neoadjuvant therapy.

For chemotherapy in Delhi to treat stomach cancer, consult the Manipal hospital. They have cancer experts with wide experience in the diagnosis and treatment of virtually every kind of cancer.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific targets on cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy but they also have their side effects. Monoclonal antibodies and multikinase inhibitors are types of targeted therapy used to treat gastric cancer. Currently, they are used in more advanced stages of gastric cancer but studies are ongoing to test if they may also be beneficial in relatively earlier stages.

Manipal hospital is the best stomach cancer hospital in India that brings the expertise of several specialists, including surgeons, pathologists, oncologists, radiation therapists, and nurses, to bear in customizing treatment for each patient so that you can get the care you need right away.

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