Stomach Cancer

Adenocarcinoma of the stomach often begins at a site where the stomach lining is inflamed. Helicobacter pylori infection Helicobacter pylori Infection Helicobacter pylori (H. pylori) infection is a bacterial infection that causes stomach inflammation ( gastritis), peptic ulcer disease, and certain types of stomach cancer. The... read more is a risk factor for some stomach cancers. People who have certain gene mutations are also at risk as are people who have autoimmune atrophic gastritis Causes .

Stomach polyps may become cancerous (malignant) and are thus removed. Adenocarcinoma of the stomach is particularly likely to develop if the polyps consist of glandular cells, if the polyps are larger than ¾ inch (2 centimeters), or if several polyps exist.

Hereditary diffuse gastric cancer is a rare inherited disorder that increases a person's risk of developing stomach cancer. It is caused by a mutation in a certain gene. Affected people usually develop stomach cancer at an early age (average age 38). Affected women are also at high risk of developing cancer of the milk-producing glands (lobular breast cancer). People who have had stomach cancer, lobular breast cancer, or both or who have multiple family members who have had these cancers should receive genetic counseling and testing, especially if they were diagnosed before age 50.

Certain dietary factors were once thought to play a role in the development of adenocarcinoma of the stomach. These factors included a high intake of salt, a high intake of carbohydrates, a high intake of preservatives called nitrates (often present in smoked foods), and a low intake of fruit and green leafy vegetables. Although none of these factors has proved to be a cause, a direct link between the consumption of processed meat and stomach cancer has been reported.

Smoking is a risk factor for stomach cancer. People who smoke may not respond as well to treatment.

In the early stages, symptoms of stomach cancer are vague and easily ignored. Early symptoms may mimic those of peptic ulcer disease Peptic Ulcer Disease A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. Peptic ulcers can result from infection with Helicobacter... read more , with burning abdominal pain. Therefore, peptic ulcer symptoms that do not resolve with treatment may indicate stomach cancer. The person may notice a feeling of fullness after a small meal (early satiety).

People may begin to feel full after eating sooner than they normally do. They may have weight loss or weakness caused by difficulty eating or by an inability to absorb some vitamins and minerals. Anemia, characterized by fatigue, weakness, and light-headedness, may result from very gradual bleeding that causes no other symptoms, from malabsorption of vitamin B12 (a vitamin needed for red blood cell formation), or from malabsorption of iron (a mineral needed for red blood cell formation) due to a lack of stomach acid. Uncommonly, a person may vomit large amounts of blood (hematemesis) or pass black tarry stools (melena). When adenocarcinoma is advanced, a doctor may be able to feel a mass when pressing on the abdomen.

Even in the early stages, a small adenocarcinoma may spread (metastasize) to distant sites. The spread of the tumor may cause liver enlargement, a yellowish discoloration of the skin and the whites of the eyes (jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more ), fluid accumulation and swelling in the abdominal cavity (ascites Ascites Ascites is the accumulation of protein-containing (ascitic) fluid within the abdomen. Many disorders can cause ascites, but the most common is high blood pressure in the veins that bring blood... read more ), and swollen lymph nodes. The spreading cancer also may weaken bones, leading to bone fractures.

Endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more (an examination in which a flexible tube is used to visualize the inside of the digestive tract) is the best diagnostic procedure. It allows a doctor to view the stomach directly, to check for Helicobacter pylori, and to remove tissue samples for examination under a microscope (biopsy). Barium x-rays are used less often because they rarely reveal small early-stage cancers and do not allow for biopsy.

If cancer is found, people usually have a CT scan Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT) and magnetic resonance imaging (MRI) scans are good tests for assessing the size and location of abdominal organs. Additionally, cancerous (malignant) or noncancerous... read more of the chest and abdomen to determine the extent to which the tumor has spread to other organs. If the CT scan does not show the tumor has spread, doctors usually do an endoscopic ultrasound Ultrasound Scanning (Ultrasonography) of the Abdomen Ultrasound scanning uses sound waves to produce pictures of internal organs (see also Ultrasonography). An ultrasound scan can show the size and shape of many organs, such as the liver and pancreas... read more (which shows the lining of the digestive tract more clearly because the probe is placed on the tip of the endoscope) to determine the depth of the tumor and the involvement of nearby lymph nodes.

Basic blood tests are done including complete blood count, electrolytes, liver blood tests, and carcinoembryonic antigen level.

Fewer than 5 to 15% of people with adenocarcinoma of the stomach survive longer than 5 years. The cancer tends to spread early to other sites.

The prognosis is good if the cancer has not penetrated the stomach wall too deeply. In such cases, up to 80% of people may survive for 5 years. However, in the United States, the results of surgery are often poor, because most people have extensive cancer by the time a diagnosis is made. In Japan, where stomach cancer is very common, mass public health screening programs help to detect it early so that a cure is more likely.

If the cancer has not spread beyond the stomach, surgery is usually done to try to cure it. Removal of the entire tumor before it has spread offers the only hope of cure. Most or all of the stomach and nearby lymph nodes are removed.

If the cancer has spread beyond the stomach, surgery cannot cure the condition, but it is sometimes used to relieve symptoms. For example, if the passage of food is obstructed at the far end of the stomach, a bypass operation, in which an alternate connection is made between the stomach and the small intestine, allows food to pass. This connection relieves the symptoms of obstruction—pain and vomiting—at least for a while.

Chemotherapy plus radiation therapy ( see Combination Cancer Therapy Combination Cancer Therapy Cancer drugs are most effective when given in combination. The rationale for combination therapy is to use drugs that work by different mechanisms, thereby decreasing the likelihood that resistant... read more ) may help relieve symptoms as well but does little to help people survive longer than 5 years. In recent years, chemotherapy has been combined with trastuzumab and ramucirumab to treat people who have advanced cancer.

Immunotherapy Immunotherapy for Cancer Immunotherapy is used to stimulate the body's immune system against cancer. These treatments target specific genetic characteristics of the tumor cells. The genetic characteristics of tumors... read more drugs, such as pembrolizumab, which help the immune system fight the cancer, may be given to people who have stomach cancer that is advanced or has spread (metastasized) and is PD-L1–positive. This therapy enhances the immune system’s ability to fight cancer. Nivolumab is another immunotherapy drug that is available outside of the United States.