Stomach cancer

What is stomach cancer?

The stomach lies between the lower end of the gullet (oesophagus) and the beginning of the intestine. The muscles and juices of the stomach help digest food into a liquid from which nutrients can be absorbed lower in the bowel.

Although incidences of stomach cancer in the UK have been decreasing, cancers at the junction of the stomach and the oesophagus (the gastro-oesophageal junction, or GoJ) are rising and many of the symptoms, investigations and treatments are same.

Stomach cancer symptoms

As with colorectal (bowel) cancer, the embarrassment of talking about the symptoms often puts people off seeking medical help. But late diagnosis leads to a low survival rate, so the sooner it gets treated the better.

Being alert to changes in stomach and bowel symptoms, and consulting doctors about persistent problems could lead to far earlier detection. The following symptoms are common to other conditions other than stomach cancer, so it's vital to get them checked by your GP:

• Indigestion or heartburn that won't go away
• Loss of appetite
• A bloated feeling after eating
• Nausea and vomiting (including vomit that contains blood)
• Blood in bowel motions or black stools
• Weight loss
• Difficulty swallowing
• Weakness or fatigue

Unfortunately, some of the symptoms of stomach cancer can be confused with common stomach complaints, such as indigestion, heartburn, a stomach ulcer or a simple virus.

Stomach cancer causes

Causes linked to the rise in cancers of the GoJ include:

• Obesity or a poor diet, particularly one which contains a lot of salty, pickled or processed foods
• Infection with an organism called Helicobacter pylori
• Barrett's oesophagus (where abnormal cells develop in the lining of the lower oesophagus)
• Being male
• Being over 55 years old
• Pernicious anaemia (an autoimmune condition where the lining of the stomach becomes thin, less acid is produced and anaemia develops due to lack of vitamin B12), atrophic gastritis or a hereditary condition of growths in the stomach
• Smoking
• Previous surgery for peptic ulcer
• Having suffered from certain other cancers: prostate, bowel, testicular or bladder cancers for men, and breast, ovary and cervix for women
• Difficulty swallowing

A relatively high intake of vitamin C may provide some protection against stomach cancer. There's every reason to believe that a healthy diet containing plenty of fruit and vegetables appear to protect against all cancers, in particular cancers of the stomach and bowel.

Diagnosing stomach cancer

Tests are available that can help detect or rule out stomach cancer.

A faecal occult blood (FOB) test, in which a small amount of faeces is placed on a slide, checks for blood in the stool. This doesn't confirm cancer, however, but if suspicions are strong, a gastroenterologist may decide to carry out further tests. Other blood tests look for anaemia or a substance called CEA, which is present in high levels in 50 per cent of people with stomach cancer.

Further tests include x-rays of the throat and stomach, normally involving a barium meal, in which the patient swallows a solution containing a dye which shows up on x-rays. This will highlight any abnormal bumps and lumps in the digestive tract, which could be tumours.

Most commonly, a specialist may carry out endoscopy, or gastroscopy, in which a probe with a camera on the end is passed down the throat so they can see the interior of the stomach. The probe can also remove tissue samples for closer analysis. Most patients find the idea of passing a tube down their throats while conscious worrying, due to the natural gagging reflex. However, either anaesthetic is sprayed on the throat or the patient is sedated to lessen the discomfort.

Stomach cancer treatments

Treatment depends how far the cancer has spread. If tests show a stomach cancer, a CT scan will be arranged to look for spread of the cancer to other organs. If there is no sign of spread, you may go on to have a PET scan and a laparoscopy, where a flexible telescope is inserted into the abdomen under anaesthetic in order to look directly at the internal organs.

If there's no sign of the cancer spreading, most patients will be given chemotherapy for three months to reduce the size of the tumour. An operation will then be carried out to partially or totally remove the affected part of the stomach (gastrectomy).

A total gastrectomy means the throat, or oesophagus, is connected straight to the next part of the digestive tract, the duodenum. This is a major operation that not only requires recovery time but has pronounced effects on the lifestyle of the patient. Patients may have short- or long-term inability to deal with certain types of food, and may need vitamin injections to replace those which would normally be absorbed by the stomach. Very often the patient will have to eat little and often, as opposed to big meals, to prevent too much food reaching the the duodenum too quickly, which can cause pain and nausea.

Cancer can spread through the lymphatic system, so a surgeon will remove parts of that system near the stomach to check whether this has happened. If this is the case, further chemotherapy or radiotherapy may be recommended.

Recent progress in drug treatment has been made with a drug blocking a chemical produced by tumour cells that allows them to spread and invade neighbouring cells. This slows the progress of the cancer.