Stomach cancer is more rampant than people may think. The following are some of the frequently asked questions about stomach cancer.
How common is stomach cancer?
Stomach cancer is the fifth most common cancer among men and seventh among women in India. It is the second most common cause of cancer death globally, with nearly 8,00,000 cases each year. Overall the incidence of gastric cancer in India is less compared to the worldwide incidence.
Who is most vulnerable to stomach cancer?
It is most common in older people, with maximum number of cases occurring in men and women over 70 years. Few cases occur below 40 years. Topography also affects the incidence of stomach cancer. Stomach cancer in south Indian males has been reported to be more common and occurring a decade before their north Indian counterparts. The highest incidence in India is found in north-eastern India (Mizoram).
What causes stomach cancer?
The food we eat plays a major role in stomach cancer. The number of cases has dropped over the last fifty years, and a probable reason is that refrigeration of food has become common and people eat less pickled, smoked, salted, and cured foods.
What are the risk factors?
- Diet:A diet high in preserved foods is attributed to higher rates of stomach cancer
- Other diseases: It affects people with pernicious anaemia or achlorhydria (chronic atrophic gastritis)
- History of an adenomatous gastric polyp larger than 2 cm
- Infections: Helicobacter pylori, a bacterium that causes 85 per cent of stomach ulcers, is also associated with a much higher risk of stomach cancer
- Smoking and alcohol consumption
Intake of pulses, fresh fruits and vegetables help to protect us from stomach cancer.
What are the types?
Intestinal stomach cancer, more common amongst older patients and patients from ‘high-risk’ groups. Diffuse stomach cancer, found more frequently in women and people with blood group A. This type is more difficult to treat.
Is stomach cancer genetic?
A few cases of stomach cancer (about one in ten) appear to run in the family. Genetic testing is not yet possible, as it is not known which genes are involved.
What are the symptoms?
Early-stage stomach cancer rarely causes symptoms. This is one of the reasons stomach cancer is so hard to detect early. The symptoms may include
- Excessive belching
- General decline in health
- Loss of appetite
- Nausea and vomiting
- Abdominal fullness or pain
- Dark stools
- Difficulty in swallowing, especially if it increases over time
- Premature abdominal fullness after meals
- Vomiting blood
- Weight loss (unintentional)
Food poisoning, stomach ulcers and several other conditions also cause many of these symptoms, as a result of which stomach cancers are not diagnosed until they are quite advanced.
How is it diagnosed?
Normally, a procedure called endoscopy, with biopsy, is used. The patient is sedated and a thin fibre-optic tube is passed down the throat. The inside of the stomach is lit up and photographed, and thus any growths can be spotted relatively easily. Sometimes, more sophisticated endoscopes are used with which a small sample (biopsy) of the stomach lining is taken, or even an ultrasound scan from the inside of the stomach (EUS).
In some cases, a barium meal or a contrast CT-SCAN or a PET CT-SCAN is used in addition to endoscopy.
What is the treatment?
Surgery to remove the stomach (gastrectomy) is the only treatment that can cure the condition. Chemotherapy and radiation therapy after surgery may improve the chance of cure, and can improve symptoms. It may prolong survival in cases where surgery is not possible. This, however, is not likely to cure the cancer.
A surgical bypass procedure can relieve symptoms in some patients. Chemotherapy is also used to shrink the tumour before surgery, making it easier to be removed.
What surgery is done for stomach cancer?
Surgery is the mainstay for the treatment of stomach cancer.
- Endoscopic resection, in which the surgeon removes the tumour and a safe margin of stomach tissue endoscopically.
- Subtotal gastrectomy is the preferred modality in distal cancers and total or proximal gastrectomy is preferred in proximal cancers.
How effective are the treatments?
The outlook varies depending on the location and stage of the tumour. Tumours in the lower stomach are cured more often than those in the upper stomach. The chances of a cure are affected by how far the tumour invades the stomach wall and whether lymph nodes are involved when the patient is diagnosed.
A cure is not possible when the tumour has spread outside the stomach, and treatment is designed to improve symptoms.
Success rate is much higher in places such as Japan where there are national screening programmes, as the cancers are usually diagnosed early. Over 50 per cent of patients are treated successfully in Japan as of result of this.
How can we prevent stomach cancer?
The following may help reduce risk of gastric cancer:
- Avoid smoking
- Eat a healthy, balanced diet rich in fruits and vegetables
- Avoid pickled and salted foods
- Treat reflux disease with medication, if present
- An early endoscopy, if symptoms are not relieved with medication