Stomach Cancer:  From cause to treatment

Stomach Cancer

Stomach cancer, medically known as gastric cancer, is a formidable adversary that demands our attention. This silent predator often lurks unnoticed until it reaches advanced stages. Let's embark on a journey to understand the intricacies of stomach cancer, exploring its various types and shedding light on the mysteries that surround this disease.

Stomach cancer originates in the lining of the stomach, often evolving slowly over the years. As cells divide and multiply uncontrollably, a tumor forms, posing a serious threat to one's health.

Stomach cancer is the fifth most common cancer worldwide and the fourth most common cause of cancer death
Stomach cancer is more common in developing countries than in developed countries.

Types of Stomach Cancer:

1. Adenocarcinoma:

This is the most prevalent type, accounting for the majority of stomach cancer cases. Arising from the cells that form the stomach lining, adenocarcinoma manifests in various subtypes, each with its unique characteristics and challenges.

The most common type of stomach cancer is adenocarcinoma, which accounts for about 95% of cases

2. Lymphoma:

Stomach lymphoma, although rare, is a type of cancer that begins in the immune system cells within the stomach wall. Understanding its distinct features is crucial for tailored treatment approaches.

3. Gastrointestinal Stromal Tumor (GIST):

GIST is a rare type of stomach cancer that originates in the connective tissues of the stomach. Unlike adenocarcinoma, GIST requires specialized diagnostic and treatment strategies.

4. Carcinoid Tumor:

These tumors are slow-growing and may develop in the stomach's hormone-producing cells. Unraveling the nuances of carcinoid tumors is essential for a comprehensive understanding of stomach cancer diversity.

5. Sarcoma:

Stomach sarcomas are uncommon, originating in the mesenchymal tissues. Exploring the challenges associated with sarcomas provides insights into the less-traveled pathways of stomach cancer.

Symptoms and Signs:

• Early Symptoms:
  • Indigestion and mild discomfort after eating
  • Persistent stomach pain
  • Unexplained weight loss
  • Mild nausea and vomiting
  • Feeling bloated after meals
• Advanced Symptoms:
  • Severe abdominal pain
  • Vomiting blood or material that looks like coffee grounds
  • Difficulty swallowing
  • Fatigue and weakness
  • Jaundice (yellowing of the skin and eyes)
• Common Signs:
  • Persistent, unexplained stomach pain
  • Feeling full even after small meals
  • Significant and unexplained weight loss
  • Blood in the stool
  • Changes in bowel habits

Causes of Stomach Cancer:

• Helicobacter pylori Infection:
  • Bacterial infection linked to the development of stomach ulcers and an increased risk of stomach cancer
• Smoking:
  • Tobacco smoke contains carcinogens that increase the risk of stomach cancer
• Diet and Nutrition:
  • High consumption of smoked, salted, or pickled foods
  • Low intake of fruits and vegetables
  • Nitrate-rich foods may contribute to risk
• Genetic Factors:
  • Family history of stomach cancer
  • Inherited genetic conditions, such as hereditary diffuse gastric cancer (HDGC) and Lynch syndrome

.Diagnosis:

1. Imaging Tests:
   • CT Scan (Computed Tomography):
     • Detailed cross-sectional images of the stomach and surrounding areas.
     • Helps in identifying the location, size, and extent of the tumor.
   • MRI (Magnetic Resonance Imaging):
     • Provides high-resolution images of soft tissues.
     • Useful for evaluating the stomach wall and nearby structures.
2. Endoscopy and Biopsy:
   • Upper Endoscopy (Esophagogastroduodenoscopy, EGD):
     • A flexible tube with a camera is passed through the mouth to examine the stomach lining.
     • Allows for direct visualization of abnormalities and collection of tissue samples.
   • Biopsy:
     • Removal of a small tissue sample for laboratory analysis.
     • Determines the type of cancer cells and helps in planning appropriate treatment.
3. Blood Tests:
   • Tumor Marker Tests:
     • Measurement of certain substances in the blood that may be elevated in stomach cancer.
     • Examples include carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA 19-9).
   • Complete Blood Count (CBC):
     • Assess changes in blood cell counts, which can indicate the presence of cancer.
4. Staging of Cancer:
   1. TNM Staging System:
      • Tumor (T): Describes the size and depth of the primary tumor.
      • Lymph Nodes (N): Indicates whether cancer has spread to nearby lymph nodes.
      • Metastasis (M): Indicates whether cancer has spread to distant organs.
   2. Stage 0 (Carcinoma in Situ):
      • Cancer is limited to the inner lining of the stomach.
   3. Stages I to III:
      • Gradual progression based on tumor size, lymph node involvement, and local spread.
   4. Stage IV:
      • Cancer has spread to distant organs or lymph nodes.

Treatment:

1. Surgery:
   • Gastrectomy:
     • Removal of part or all of the stomach depending on the extent of cancer.
     • Lymph nodes may also be removed.
   • Subtotal Gastrectomy:
     • Removal of part of the stomach, often the lower portion.
   • Total Gastrectomy:
     • Removal of the entire stomach, and sometimes nearby organs like the spleen or parts of the esophagus.
   • Lymph Node Dissection:
     • Removal of nearby lymph nodes to check for cancer spread.
2. Chemotherapy:
   • Systemic Treatment:
     • Drugs circulate through the bloodstream to reach cancer cells throughout the body.
     • Used to shrink tumors before surgery, kill remaining cancer cells after surgery, or treat advanced cancer.
   • Combination Chemotherapy:
     • Using multiple drugs to enhance effectiveness and minimize resistance.
3. Radiation Therapy:
   • External Beam Radiation:
     • Precisely targeted radiation from outside the body to destroy cancer cells.
     • Often used after surgery to kill remaining cancer cells or as palliative treatment for advanced cases.
   • Internal Radiation (Brachytherapy):
     • Radioactive material placed directly inside or very close to the tumor.
4. Targeted Therapy:
   • Herceptin (Trastuzumab):
     • Targets cancer cells with specific proteins, like HER2-positive stomach cancer.
   • Ramucirumab:
     • Blocks blood vessel growth to the tumor, inhibiting its growth.
   • Imatinib (Gleevec):
     • Specifically used for Gastrointestinal Stromal Tumors (GISTs).
5. Immunotherapy:
   • Checkpoint Inhibitors:
     • Boosts the body's immune system to recognize and attack cancer cells.
     • Nivolumab and Pembrolizumab are examples.
   • Adoptive Cell Transfer:
     • Uses the patient's own immune cells, often modified in a lab, to target and kill cancer cells.

Risk Factors:

• Family History:
  • Increased risk if close relatives have had stomach cancer.
• Previous Stomach Surgery:
  • Removal of part or all of the stomach may increase the risk.
• Pernicious Anemia:
  • Chronic condition affecting the stomach lining, linked to higher stomach cancer risk.
• Smoking and Alcohol Consumption:
  • Smoking and excessive alcohol intake are associated with an elevated risk of stomach cancer.'

Complications:

• Metastasis:
  • Spread of cancer cells to other parts of the body, often leading to more advanced and challenging stages.
• Obstruction of the Stomach:
  • Tumors can obstruct the normal passage of food through the stomach, causing pain and nausea.
• Bleeding:
  • Cancerous lesions may lead to internal bleeding, resulting in symptoms like black stools or vomiting blood.

Prevention:

• Healthy Lifestyle Choices:
  • Maintain a balanced diet rich in fruits and vegetables.
  • Regular exercise to promote overall health.
• Helicobacter pylori Prevention:
  • Treatment of H. pylori infections, which may involve antibiotics and acid-reducing medications.
• Dietary Considerations:
  • Limit intake of smoked, salted, or pickled foods.
  • Increase consumption of fresh fruits and vegetables.
  • Be mindful of dietary nitrates, which may contribute to risk.

Stomach cancer, with its diverse challenges from diagnosis to treatment, is a story of resilience and hope. From understanding its complexities to embracing preventative measures, it is a narrative of human strength facing uncertainty with courage and science pushing towards a future where stomach cancer is not just treatable but preventable.