Stomach cancer (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Stomach cancer is a common digestive tract cancer in some Asia areas such as Japan and China. But in the United States, the number of people diagnosed with the disease is declining in recent years. Stomach cancer is cancer that occurs in the stomach which is responsible for receiving and holding the food you eat and then helping to break down and digest it. Gastric cancer is another term for this disease. Adenocarcinoma is the most common type of stomach cancer. The disease begins on the surface of the gastric mucosa. Usual symptoms include upper abdominal pain, loss of appetite, weight loss, nausea, vomiting, etc. If not treated, the cancer invades more deeply into the muscular layer and nearby tissues. The cancer cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

What are the symptoms of stomach cancer?
Early stomach cancer does not make any symptom. When the cancer grows larger, people may notice one or more symptoms as the following:

Abdominal symptoms
 * Abdominal pain: At first the location may be upper abdominal or middle region. It is relatively mild pain or no pain may be present with life-threatening condition. With the development of the cancer, abdominal pain may be persistent.
 * Loss of appetite: Some patients endure loss of appetite without any inducement.
 * Nausea and vomiting: This is also because of the affect of the lump. It disturbs the normal functions of digest.
 * Vomiting blood: This is the result of aggressing blood vessel. Sometimes massive hemorrhage of gastrointestinal tract may happen.
 * Vague abdominal fullness: This is because of the development of the lump.
 * Premature abdominal fullness after meals: This is induced by the decreasing of gastric space with the growth of lump.
 * Abdominal lump: People can not find any lump at the beginning of the disease. When the cancer enlarge, the lump may be obvious in abdominal.

Whole body symptoms Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell his/her doctor so that problems can be diagnosed and treated as early as possible.
 * General decline in health: This is because of the consumption of the cancer.
 * Weakness or fatigue: The reason is also because the cancer wastes your energy.

Symptoms of abdominal and whole body have no specificity. Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed in the following:


 * Acute or chronic gastritis
 * gastric ulcer
 * Gastroesophageal reflux disease (GERD)
 * cholelithiasis and cholecystitis
 * Angina
 * Depression

Who is at the highest risk?
Adenocarcinoma of the stomach is a common cancer of the digestive tract worldwide, although it is uncommon in the United States. It occurs most often in men over age 40. This form of gastric cancer is very common in Japan, Chile, and Iceland.

The rate of most types of gastric adenocarcinoma in the United States has gone down over the years. Experts think the decrease may be because people are eating less salted, cured, and smoked foods.

Studies have found a number of factors that may increase the risk of stomach cancer. In recent years, scientists point out that [Helicobacter pylori] infection is the main cause of stomach cancer. HP infection and other risk factors may act together to increase the risk even more.


 * Have had a Helicobacter pylori (HP) infection
 * Have a gastric inflammation
 * Male
 * Eat lots of smoked, salted, or picked food
 * Smoke cigarettes
 * Have a family history of stomach cancer

When to seek urgent medical care?
Call your health care provider if symptoms of gastric cancer develop. If one emerges the following symptoms, seeking urgent medical care as soon as possible:


 * Severe abdominal pain: The reason of a person with stomach cancer appears severe abdominal pain is mostly because of gastric wall perforation. This is the results of cancer invade and perforation on gastric wall. A surgery will be done urgently.
 * Vomiting a lot of blood: This is the result of cancer invading the vessels of gastric wall. An abundant of blood loss may lead to shock and death.

Treatment options
It is hard to diagnose stomach cancer in its early stages. Other problems can also cause the same symptoms such as stomach discomfort and indigestion swallowing. So, if you have those symptoms, you had better go to see your doctor to do some tests. They include lab tests, image tests and endoscopy. Among them, the latter is the main test.


 * Endoscopy and biopsy: It is the main test used to diagnose stomach cancer when people have certain risk factors or when signs and symptoms suggest this disease may be present. After you are sedated (made sleepy), an endoscope which is a thin, flexible, lighted tube was passed down your throat. Then the doctor can view the lining of your esophagus, stomach, and first part of the small intestine. If abnormal areas are noted, biopsy can be obtained through the endoscope. The tissue samples will be checked by the doctors of pathology department under a microscope to see whether cancer is present or not.
 * Upper gastrointestinal series: This is an x-ray test that a person is given an injection of a medication that will temporarily slow bowel movement, so structures can be more easily seen on the x-rays. For this test, the patient drinks 16 - 20 ounces of a millkshake-like substance called barium. X-ray method called fluroscopy tracks how the barium moves through your esophagus, stomach, and small intestine. Pictures are taken in a variety of positions. The test usually takes around 3 hours or more.
 * Complete blood test: In this test, a patient with stomach cancer can be detected anemia.
 * Stool test: This test is to detect whether blood is in your digestive track. Before the test, do not eat red meat, any blood-containing food, cantaloupe, uncooked broccoli, turnip, radish, or horseradish for 3 days. You can collect stool samples in your home. You can catch the stool on plastic wrap and held in place by the toilet seat. Then put the sample in a clean container. There can be false-positive and false-negative results. Using the right collection technique, avoiding certain drugs, and observing food restrictions can reduce errors.

Patients with stomach cancer have many treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of methods. Surgical removal of the stomach (gastrectomy) is the only curative way. Radiation therapy and chemotherapy may be beneficial treatment. Recent clinical study demonstrated that chemotherapy and radiation therapy given after surgery can improve the chance of a cure. But for patients with metastasis stomach cancer, chemotherapy and/or radiation can improve symptoms and life quality but may not cure the cancer. For some patients with gastric track obstruction, a surgical bypass procedure may provide relief of symptoms. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Where to find medical care for stomach cancer?
Directions to Hospitals Treating stomach cancer

Prevention of stomach cancer
Epidemiology data show the following intervention may help to reduce your risk of gastric cancer


 * Give up smoking
 * Have a healthy, balanced diet rich in fruits and vegetables

What to expect (Outook/Prognosis)?
The prognosis varies widely. It depends on:
 * The area which the lump locates
 * The depth to which the mass invades the stomach wall
 * With or without distant metastasize

Possible Complications

 * Fluid buildup in the belly area (ascites)
 * Gastrointestinal bleeding
 * Spread of cancer to other organs or tissues
 * Weight loss