Stomach cancer

Symptoms Of Stomach Cancer 

The symptoms are generally based on the stage of cancer. They include:

1. Early stage symptoms

• Indigestion and stomach discomfort
• Bloating
• Mild nausea
• Loss of appetite
• Acidity

2. Advanced stage symptoms

• Vomiting
• Weight loss for no known reason
• Trouble swallowing
• Feeling full even after eating small amounts of food
• Stomach pain
• Blood in stools
• Jaundice (yellowing of eyes and skin)
• Ascites (build-up of fluid in the abdomen)
• Anemia
• Enlargement of the liver

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Causes Of Stomach Cancer

• Stomach cancer develops when a genetic mutation (inherited or acquired) occurs in the DNA of stomach cells. 
• DNA is the genetic code that instructs cells on when to grow and when to die. 
• As a result of the mutation, abnormal cells in the stomach begin to grow and divide uncontrollably.
  
  

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Risk Factors For Stomach Cancer

Stomach cancer is the 5th most common cancer. It is a multifactorial disease associated with several risk factors, which include: 

1. Stomach conditions

• H.Pylori infection

• Chronic gastritis (swelling and inflammation of the stomach)

• Pernicious anemia (decrease in red blood cells when the body can't absorb enough vitamin B12)

• GERD (stomach acid backing up into the food pipe)

• Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines)

• Gastric polyps (growths of noncancerous cells in the stomach)

• Epstein-Barr virus infection

2. Age  

Stomach cancer is more common in the elderly. Half of all stomach cancers occur in people aged 75 and above.

3. Gender

 Men are more likely than women to develop stomach cancer.

4. Genetic factors

• People who have first-degree relatives with stomach cancer (parents, siblings, or children) are more likely to develop the disease.
• A family history of genetic syndromes such as Lynch syndrome (an inherited genetic disorder that increases the risk of colorectal cancer, stomach cancer, and other cancers) is likely to increase the risk of stomach cancer.

5. Environmental factors

• Alcohol and tobacco use.
  
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• Occupation ( manual workers and farmers, have a higher risk of gastric cancer) 
• Radiation exposure
• Eating improperly prepared or processed foods in excess
• Being overweight or obese
  
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Diagnosis Of Stomach cancer

To arrive at the diagnosis of any kind of cancer, it is important to understand its staging. The most common way of staging stomach cancer is the TNM staging system, where:

1. T stands for Tumor and how many layers of the stomach wall the tumor has penetrated

2. N stands for Lymph Nodes and how many lymph nodes have cancer spread to. It also looks at where the lymph nodes are affected and how close to the original tumor.

3. M stands for metastasis ie. spread to other parts of the body

Depending on this the cancer is divided into 4 stages. These are: 

1. Stage 0: Also known as carcinoma in situ. This stage is distinguished by abnormal cells in the stomach lining. The cells can become malignant (cancerous) in the future.

2. Stage 1: Cancer hasn’t spread beyond the thick muscle in the stomach wall.

3. Stage 2: The cancer has spread to deeper layers of the stomach and may have spread to a number of nearby lymph nodes.

4. Stage 3: The cancerous cells are present in all the layers of the stomach as well as in some of the adjacent organs like the spleen or colon. 

5. Stage 4: Cancer has spread to distant organs in the body like the liver, lungs, brain etc. This is referred to as advanced, metastatic, or secondary cancer.

The diagnosis consists of the following:

1. Medical history and physical examination

It entails examining the body to check general signs of health, including looking for signs of disease, such as lumps or anything else that appears unusual. A history of the patient's health habits, as well as previous illnesses and treatments is taken.

2. Upper endoscopy

• Also known as esophagogastroduodenoscopy (EGD).

• The doctor will insert an endoscope, which is a thin, flexible, lighted tube with a small video camera on the end, down your throat during this test.

• This allows the doctor to examine the lining of your esophagus, stomach, and the first part of your small intestine. 
  
  

3. Ultrasound

An ultrasound uses sound waves to create a picture of the internal organs. There are 2 types of ultrasound devices:

• Transabdominal ultrasound: It is the ultrasound to see inside the abdomen and check for abnormalities.

• Endoscopic ultrasound EUS: It is an ultrasound done with the help of an endoscope. This is to help find out the size of the cancer and whether it has spread. It can be used to help remove very early-stage cancers without the need for more extensive surgery. 
  
  

4. Biopsy

A biopsy is the removal of a small amount of tissue for examination under a microscope. It can make a definite diagnosis for most cancers. 

5. Imaging Tests

• X-Ray: A barium meal X-ray or barium swallow involves drinking a chalky liquid containing a substance called barium, which makes your stomach show up on an X-ray. It can reveal abnormalities in the shape, position, narrowing, or obstruction of the stomach that may be indicative of stomach cancer.
  
  
• Chest X-ray: This can also be done to check if the cancer has spread to the lungs.
  
  
• Computed tomography (CT or CAT) scan: CT scans involve taking pictures of the stomach at specific times after the intravenous (IV) injection of contrast medium. It can help diagnose the position of a tumor about nearby organs and blood ves
  
  
• Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed images of the body and to measure the tumor’s size.
  
  
• Positron emission tomography (PET) scan or PET-CT scan: A PET scan is usually combined with a CT scan or MRI scan to detect and visualize abnormal metabolic activity.
  
  

6. Other tests

• Laparoscopy: A laparoscopy is a minor procedure in which a laparoscope (a thin, flexible tube with a small video camera on the end) is inserted through a small cut in the belly. It is used by doctors to determine whether stomach cancer has spread.
  
  
• Electrocardiogram (ECG): It may be performed if surgery is planned or if you are taking medicines that can affect the heart.
  
  
• HER2 testing: The cancer cells may be tested after biopsy to see if they have too much of a growth-promoting protein called HER2. Cancers with increased levels of HER2 are called HER2-positive.
  
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Prevention Of Stomach Cancer

Cancer prevention is an action taken to lower the chance of getting cancer. Many things in our genes, our lifestyle, and the environment around us may increase or decrease our risk of getting cancer. Some of the ways to prevent stomach cancer include:

1. Diet and nutrition

• Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins

• Reduce consumption of heavily salted, pickled, and smoked foods.

• Reduce intake of processed meats.
  
  

2. Lifestyle choices

• Quit smoking.

• Avoid or limit alcohol consumption.

• Maintain a healthy weight.

• Engage in regular physical activity, which supports overall health.

• Minimize exposure to carcinogens in the workplace.

• Protect your skin from excessive sun exposure to prevent skin cancer, which can sometimes metastasize to the stomach.
  
  

3. Infections and medical Interventions

• Treat and manage Helicobacter pylori infections.

• Take medicines to treat a precancerous condition or to keep cancer from starting (chemoprevention).
  
  

4. Health Monitoring

• Maintain routine health check-ups for early detection and management of risk factors.

Note: You can prevent certain types of cancer with vaccines. Like BCG vaccines, cancer vaccines protect our body from viruses that can cause diseases that can develop into cancer. 
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Doctor To Visit

Cancer requires comprehensive care. Doctors that take care of patients with stomach cancer and help in diagnosing and formulating a treatment plan are:

• General physician
• Gastroenterologist
• Oncologist
• Surgical oncologist

A general physician can do a detailed clinical examination, suggest tests and refer to a specialist in case they are suspecting stomach cancer.

A gastroenterologist and oncologist assist with diagnosing, staging, and creating personalized treatment plans for stomach cancer.

A surgical oncologist performs surgeries for diagnosis, tumor removal, and symptom relief.

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Treatment Of Stomach cancer

Treatment for stomach cancer depends on the size, location, and stage of the tumor. It includes:

1. Surgery

Surgery is a common treatment for all stages of gastric cancer. The following types of surgery may be used:

• Endoscopic resection: In an endoscopic resection, surgical tools can be passed through the endoscope to remove the tumor and part of the normal stomach wall around it.

• Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD): These are minimally invasive procedures where abnormal tissues or early-stage tumors are removed from the stomach lining using an endoscope.

• Subtotal gastrectomy: In this procedure, only a portion of the stomach is removed, sometimes in conjunction with a portion of the food pipe (in a proximal gastrectomy) or the first part of the small intestine (in a distal gastrectomy). The remaining stomach section is then reattached. 

• Total gastrectomy: This surgery is performed if the cancer has spread throughout the stomach. The entire stomach, as well as nearby lymph nodes, as well as parts of the esophagus, intestines, pancreas, and other nearby organs, are removed. 
  
  

2. Palliative surgery for unresectable cancer

For people with unresectable stomach cancer, surgery can often still be used to help control cancer or to help prevent or relieve symptoms or complications.

• Gastric bypass (gastrojejunostomy): This is accomplished by connecting a section of the small intestine (the jejunum) to the upper part of the stomach, allowing food to exit the stomach via the new connection.

• Stent placement: Using an endoscope to place a stent (a hollow metal tube) in the opening aids in keeping the passage open and allows food to pass through.

• Feeding tube placement: Some people with stomach cancer are unable to eat or drink enough to obtain adequate nutrition. A feeding tube can be inserted through the skin of the abdomen and into the distal part of the stomach or the small intestine via a minor operation.
  
  

3. Chemotherapy

Chemotherapy employs anti-cancer drugs that may help shrink the cancer or slow its growth, relieving symptoms and extending lives. Also, chemo can help the radiation work better which is known as chemoradiation. 

• Adjuvant treatment: In this treatment, chemo is given before surgery for stomach cancer. It often shrinks the tumor and possibly makes surgery easier. It may also help patients live longer lives by preventing cancer from returning.

• Neoadjuvant treatment: It is administered after surgery to remove the cancer. The goal of adjuvant chemotherapy is to kill any remaining cancer cells that are too small to see. This can help prevent the cancer from returning.
  
  

The most often used drugs for stomach cancer are:

• Carboplatin
• Cisplatin
• Capecitabine
• Docetaxel 
• Fluorouracil
• Irinotecan 
• Oxaliplatin 
• Paclitaxel 

4. Radiotherapy

Radiation therapy resembles an X-ray procedure, but the radiation used is more potent, and it can be applied in various ways to aid in the treatment of stomach cancer.

• Before surgery: For some earlier-stage cancers, radiation can be used in conjunction with chemotherapy (chemo) before surgery to shrink cancer and make it easier to remove.

• After surgery: Radiation therapy can be used in conjunction with chemotherapy to try to kill any cancer cells that were not removed during surgery.

• For cancers that can't be removed by surgery: Radiation therapy may be used to help slow the growth of cancer and alleviate symptoms such as pain, bleeding, or eating difficulties.
  
  

5. Targeted drugs and immunotherapy

• These drugs in stomach cancer treatment focus on specific traits of cancer cells to hinder their growth and enhance the effectiveness of therapy. 

• Some medicines help the body's defense system fight against cancer, known as immunotherapy.
  
  Examples of targeted drugs include:

• Ramucirumab
• Entrectinib
• Trastuzumab 
• Regorafenib 
  
  

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Home Care For Stomach Cancer

Certain spices may offer supportive benefits from stomach cancer, but they should not replace conventional medical treatment. Always consult your doctor before starting anything new.  These include:

Turmeric (Haldi): May help slow cancer cells from growing and make them self-destruct by disrupting their signals.

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Garlic (Lehsun): Can slow cancer cells from multiplying and help the body eliminate them through natural processes.

Saffron (Kesar): May prevent tumor growth by reducing blood supply to cancer cells and promoting their destruction.

Coriander (Dhaniya): May reduce cancer resistance to chemotherapy and enhance treatment effectiveness.

Cinnamon (Dalchini): May help slow tumor growth by inducing cancer cell self-destruction.

Dietary considerations

• Focus on a balanced diet with small, frequent meals

• Drink plenty of fluids to stay hydrated

• Follow prescribed pain medications and communicate any discomfort to your doctor

• Maintain good personal hygiene to prevent infections

• Get adequate rest and sleep.

Diagnosis and treatment of stomach cancer diagnosis can lead to chronic stress. With so much to care for, one often finds it hard to cope with situations beyond control.

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Complications Of Stomach cancer

If stomach cancer progresses to advanced stages, then it may lead to many complications like:

• Gastrointestinal bleeding

• Gastric perforation (holes in the stomach)

• Small bowel obstruction (partial or full obstruction of the small intestine)

• Loss of appetite and weight loss

• Ascites (causing fluid build-up in the abdomen)

• Metastases (cancer can spread to distant organs like lungs, liver, or bones)

Alternative Therapies For Stomach cancer

Here are examples of complementary methods that some people have found helpful and safe when used along with standard medical treatment. They include:

Complementary and integrated methods

1. Acupressure: The application of pressure to or rubbing of specific areas of the body to alleviate symptoms.

2. Acupuncture: A technique in which very thin needles are inserted into the body to treat a variety of symptoms, including mild pain and nausea.

3. Aromatherapy: The use of fragrant substances distilled from plants, known as essential oils, to alter mood or alleviate symptoms such as stress or nausea.

4. Art therapy: Using creative activities to assist people in expressing their emotions.

5. Biofeedback: It can assist in managing symptoms like nausea and pain in stomach cancer patients by teaching them how to control certain bodily functions.

6. Labyrinth walking: A meditative walk through a circular pathway that leads to the center and back out. It can provide relaxation and stress reduction, aiding emotional well-being for individuals dealing with stomach cancer.

7. Massage therapy: Massage therapy entails manipulating, rubbing, and kneading the muscles and other soft tissues of the body. Reduces stress, anxiety, depression, and pain in individuals dealing with cancer.

8. Meditation: A mind-body process in which a person relaxes the body and calms the mind through concentration or reflection.

9. Music therapy: Using music to promote healing and improve one's quality of life.

10. Tai chi: A mind-body system that improves health and well-being through movement, meditation, and breathing. It has been shown to help some people improve their strength and balance alleviating cancer symptoms.

11. Yoga: People with cancer frequently experience a variety of symptoms and side effects, including depression, pain, nausea, fatigue, and others. Yoga can help cancer patients deal with these and other issues.

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Living With Stomach Cancer

Things that the caregiver and the individuals with stomach cancer should take into consideration include:

1. Managing the emotions

Individuals with cancer may feel turmoil of emotions such as sadness, anxiety, or anger, or difficulty in managing the stress level. Tips that can help help:

• Get all the information needed to go about with the treatment

• Talk to the loved ones

• Join support groups

• Start palliative care to get relief from other symptoms

• Take help in coping with practical issues like financial expenses, childcare, and work issues.

2. Surviving the physical side effects

Changes to the physical health depend on several factors including cancer’s stage, the length and dose of treatment, and the patient’s general health. Things to keep in mind are:

• Keep a note about any new side effects or changes in existing side effects

• Inform your doctor about the side effects so that they can potentially keep any side effects from worsening

• Keep track of the side effects so it is easier to explain any changes to the healthcare team

• Get treatment for long-term side effects and late effects as it is important to survive to post the completion of treatment 

3. Supervising the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. This can be managed by:

• Understanding the cost of the treatment

• Talking about financial concerns with family members or the healthcare team

• Getting support from organizations that help with treatment, housing, travel, and other cancer-related costs.
  
  

4. Getting follow-up care

Post the completion of the treatment, the doctors will still want to watch you closely. It’s very important to go to all of the follow-up appointments that include medical history and physical exam every 3 to 6 months for 1 to 2 years, every 6 to 12 months for 3 to 5 years, and annually thereafter.

Tips for caregivers

There are numerous resources available for the patient and their family, battling stomach cancer. Tips that the caregivers can follow to help the patient in difficult times include:

• Encouraging and providing mental support to the patient
• Understanding the course of treatment
• Helping the patient manage their symptoms and side effects
• Coordinating their medical appointments and giving medications on time
• Assisting the patient in maintaining personal care and hygiene
• Talking with empathy and a positive attitude toward the patient
• Helping the patients with household chores
• Handling insurance and billing issues for them

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