Stomach/Gastric Cancer

What are Stomach Cancer?

The stomach is an organ that holds food and in it, digestion is started. It lies between the esophagus and the small intestine

Stomach cancer forms slowly over a period of time. It usually starts as a pre-cancerous stage as a small lump, or redness (inflammation) or ulcer. All these usually have minimal symptoms until it is too late
Once the cancer grows and spreads, then the symptoms are more obvious. Symptoms to look out for are upper abdominal pain, reflux or heartburn, vomiting blood, black stools and a lump in the tummy

What are the symptoms of stomach cancer?

Gastric (stomach) cancer can often remain asymptomatic for a long time, especially in the early stages. As such, it usually presents late. The usual symptoms are pain and discomfort in the upper abdomen. It can also cause early satiety (fullness after a small meal), vomiting, loss of weight and loss of appetite. Occasionally it presents as an emergency with severe pain from perforation or bleeding (vomiting of blood or passage of black stools due to altered blood).Early stage stomach cancer rarely causes symptoms, making early detection very difficult. Stomach cancer may or may not present with vague gastrointestinal symptoms. These symptoms can also be associated with other gastrointestinal illnesses, however, and should be discussed with a doctor who can perform tests to determine the cause of the symptoms

Signs and symptoms of stomach cancer can include:
• Indigestion, heartburn or ulcer-type symptoms
• Difficulty swallowing
• Abdominal pain or vague discomfort in the abdomen, usually above the navel
• Nausea and vomiting and/or bloating after meals
• Vomiting blood, or blood in the stool
• Diarrhea or constipation
• Loss of appetite
• Unexplained weight loss
• Weakness and fatigue
• Sense of fullness after eating small amounts of food (also called early satiety)
• Symptoms may mimic other conditions, such as GERD, gastritis or peptic ulcer

Signs and symptoms should not be ignored. Most of these symptoms may be caused by things other than stomach cancer. They may also occur with other types of cancer. People who have any of these symptoms, especially if they don’t go away or get worse, should see their doctor to determine the cause and be treated.

What is the treatment for stomach cancers?

In the pre-cancerous stage, the cancer can be revered ad prevented with diet and lifestyle changes and medication .Once cancer forms , only surgery can treat it .In the early cancer stage, it will need chemotherapy together with surgery and chances of cure is very low. Usually the whole stomach is removed during surgery (depending on how large the cancer has grown and which part of the stomach it is. The best way to diagnose cancer of the stomach is a gastroscopy .Using the scope, a sample of tissue, or biopsy can be taken. This is done when suspicious lumps or redness or ulcers are seen. It can also be used to test for the Helicobacter Pylori which, if left untreated, can cause ulcers or even cancers.

Regular gastroscopy, regular meals low in acidic foods and a low stress, healthy lifestyle of exercise, no smoking or alcohol consumption may reduce the chance of developing cancer

What are the treatment options available for Stomach Cancer?

After staging is completed we can decide on the most effective treatment for that particular cancer. A tumor that is confined to the stomach is suitable for potentially curative surgery. It is possible that there is spread to the surrounding lymph nodes but this can also be resected at the same time. We believe that radical resection of the regional lymph nodes by systematic dissection decreases the risk of recurrence and offers a better chance for cure. This operation was devised by the Japanese. They have the highest rates of gastric cancer in the world but they show far better treatment results using this approach when compared to Western surgeons.

In the Western type operation, only the lymph nodes next to the stomach (Group 1) are removed. In the Japanese type operation, we routinely remove the Group 2 lymph nodes, and occasionally, even the Group 3 and 4 lymph nodes. The spleen and left adrenal gland may also need to be removed depending on their proximity to the cancer. The pancreas and colon are not resected unless they are directly invaded by the cancer. The Japanese type of radical surgery is technically demanding and requires 3 to 4 hours to complete. Nevertheless, if the surgeon is skilled the operation is safe (mortality about 1%) and worthwhile as there is a better chance for cure.

What happens to the stomach after surgery?

Depending on the location of the cancer, either the whole stomach (Total Gastrectomy) or part of the stomach (Partial Gastrectomy or Subtotal Gastrectomy), needs to be removed. The cut end of the esophagus or remaining stomach is re-connected to the small intestine. This anastomosis takes about a week to heal after surgery. The patient is slowly re-introduced to fluids, soft diet and finally solid diet. Once fully recovered, normal meals can be consumed although in reduced amounts. This is easily compensated with frequent, small meals. No dietary restriction is required.

In the long term, some types of nutritional problems may develop after gastric surgery. It is therefore important that the patient is closely followed up. Nutritional supplements may be required, including Vitamin B12 injections, other oral B vitamins and iron tablets.

What are the success rates after surgery?

We usually measure the outcome of surgery for cancer by the 5 year survival rates (percentage of patients considered cured after a follow up of 5 years). This depends greatly on the stage of the cancer. We can determine the stage accurately only after a complete examination of the tissue by the pathologist. If a Japanese type Radical Gastrectomy with Systematic Lymph Node Clearance is performed the 5 year survival rates are: 90% (stage I), 70% (stage II), 50% (stage IIIa), 30% (stage IIIb) and 10% (stage IV). In contrast, if the patient only had a Western type operation, the 5 year survival rates are much lower: 60% (stage I), 30% (stage II), 15% (stage IIIa), 10% (stage IIIb) and 3% (stage IV).

What about chemotherapy and radiotherapy?

There is now good data from clinical trials to show that chemotherapy in combination with radiotherapy after potentially curative surgery can improve the chances of long term survival. This combination therapy is given as soon as the patient has recovered fully from surgery. The rationale of treatment is that even if there is no visible residual cancer after a complete resection, there may be microscopic cancer cells circulating in the blood stream or elsewhere which cannot be detected by any test. The best treatment for this would be giving the combination therapy before these microscopic cells grow to become visible recurrences.

In some patients where the tumour is very large, we may also choose to give the chemotherapy and radiotherapy before surgery to shrink the tumour. This would improve the chances of a complete resection. Chemotherapy and radiotherapy can also be given for relief of symptoms (palliation), in patients with widespread disease not suitable for surgery