Stomach Cancer: About Stomach Cancer

This form of cancer begins when abnormal cells begin to grow in the stomach, the organ where food is digested. The stomach should not be confused with the abdomen, the lower part of the body between the chest and the pelvic area.

Cancers that occur in the abdomen affect the colon (large intestine), liver, pancreas, or small intestine. These cancers have different symptoms and different treatments.

After being chewed, food enters the esophagus, a tube in the throat, then passes through the esophageal sphincter, a ring-like muscle that opens into the stomach. After food is broken down by digestive juices, it passes out of the stomach, through the pyloric sphincter, another muscle, and enters the intestines.

a. Classification

Over 90 percent of gastric cancers are adenocarcinomas, an abnormal growth of the inner lining of the stomach wall. Adenocarcinomas of the stomach often have distinct properties based on the location of the tumor.

  • Proximal stomach cancer affects the first part of the stomach and may extends into the area where it meets the esophagus (this is called GE junction cancer). Risk factors for this type of cancer include obesity and gastroesophageal reflux disease.
  • Non-cardia stomach cancer affects any other part of the stomach, and may develop from prolonged periods of inflammation and irritation. These tumors are often associated with chronic infection with Helicobacter pylori bacteria.
  • Diffuse stomach cancer grows within the stomach wall as scattered cells without forming a distinct tumor. This may have a genetic cause.

The treatment of gastric cancers depends on which type of cancer and on whether the tumor is confined to the stomach or if it has spread to distant sites.

Other cancers of the stomach include

  • Gastrointestinal stomal tumors (GISTS), abnormal growths in the connective tissues of the stomach wall.
  • Lymphoma, an uncontrolled growth of immune cells of the stomach.
  • Carcinoid tumors, cancers of the hormone-producing cells of the stomach. These often stimulate production of gastric acid, a substance that helps the body to digest food.

b. Risk Factors

Worldwide, some 989,000 patients are diagnosed with gastric cancer each year, with higher rates in East Asia, Eastern Europe, South America, and the Middle East. Gastric cancer is more common in some areas of the world than others and overall is the 4th leading cancer in the world and the 2nd leading cancer killer, and the 14th most common cancer in the United States.

In Japan and Korea, where the incidence of gastric cancer is much higher screening is a national health policy that has improved gastric cancer-free survival, where greater than 50 percent of patients are diagnosed at earlier stages. In the United States the incidence of gastric cancer is highest in the Asian American population and South Americans, followed by Black, Hispanic, and White Americans.

The following factors influence the risk of developing stomach cancer:

  • Helicobacter Pylori: Left untreated this infection leads to chronic inflammation of the inner layer of the stomach. In some cases, this develops into precancerous lesions which may become cancerous.
  • Diet: Eating lots of highly preserved foods, such as smoked fish, salted meats, and pickled vegetables, has been shown to increase a person's chances of developing stomach cancer. A diet including a substantial amount of fresh fruits and vegetables (especially those high in beta-carotene and vitamin C) has been shown to reduce the risk of gastric and other cancers.
  • Gender/Age: Stomach cancer is more common in men than in women and is most commonly diagnosed in people over the age of 65.
  • Smoking and Alcohol Use: Both smoking tobacco and excessive alcohol consumption have been linked to increased risk of developing stomach cancer.
  • Previous Stomach Surgery: Removal of part of the stomach for ulcer, previous removal of stomach polyps.
  • History of pernicious anemia
  • Persistent abdominal symptoms for past three months
  • Family cancer syndromes, such as hereditary nonpolyopsis colorectal cancer (HNPCC) and Li Fraumeni Syndrome, as well as hereditary diffuse gastric cancer.
  • Family history of stomach cancer
  • Family history of breast cancer: People carrying mutations of the inherited genes BRCA1 and BRCA2 may also have a higher rate of stomach cancer. Mutations in a gene called E-cadherin can be associated with both gastric cancers and lobular breast cancers.

c. Symptoms

Symptoms of earlier stage gastric cancers are usually vague and may include minor stomach aches and indigestion. Other warning signs include

• Dark stools
• Difficulty swallowing, which becomes worse over time
• Excessive burping
• General decline in health
• Loss of appetite or feeling full early after starting to eat
• Nausea
• Vomiting blood
• Weakness or fatigue
• Unexplained weight loss

d. Diagnosis

As is the case with all types of cancer, prevention is the most effective method to ensure long-term cancer-free survival. Successful treatment and long-term survival is associated with earlier diagnosis and proper treatment.

Early Detection of Stomach Cancer The doctors at Columbia University Medical Center are dedicated to the early detection and curative treatment of patients with gastric cancer. If you or someone you know have any of the risk factors listed below or have abdominal symptoms for the past three months, please contact the Center for Global Excellence in Gastric Cancer Care at 212.305.0374 for a consultation to assess your risk of having or developing gastric cancer.

Patients who come to our Gastric Cancer Center will be evaluated as follows:

  • A thorough evaluation of medical history including determination of exposure to risk factors.
  • Review of all relevant exams previously performed.
  • Complete physical exam.

A suspected diagnosis of gastric cancer is evaluated by an upper endoscopy, called anesophagogastroduodenscopy (EGD) performed by a specially trained gastroenterologist. While the patient is under sedation, a small tube with a light and camera is inserted into the mouth and directed into the stomach. The doctors then examine the inner lining of the stomach for any abnormal areas. Suspicious tissue is biopsied and evaluated for presence or absence of cancer or precancerous conditions.

Endoscopic Ultrasound (EUS) is sometimes performed as well to determine the depth of the ulceration or tumor and is an important part of determining the extent of any lesion. This test uses sound waves to create images of the stomach.

If you are confirmed to have gastric cancer, other diagnostic tools may be used to determine the extent of your cancer:

  • CT Scan A computed tomography or CT scan creates a series of pictures of the body from many angles. It can detect enlarged lymph nodes, which may signal more advanced prostate cancer, infection, or a benign mass.
  • PET scan (positron emission tomography). A PET scan is another way to find malignant cells in the body. A small amount of radioactive glucose (sugar) is injected into the patient’s vein. The scanner rotates around the body and takes pictures of where the glucose is being used. Malignant cells take up more glucose than normal cells do.