The Stomach
The stomach
is part of the digestive
system. It is located in the upper abdomen,
under the ribs. The upper part of the stomach connects to the esophagus,
and the lower part leads into the small
intestine.
When food enters the stomach, muscles in the stomach wall create a
rippling motion that mixes and mashes the food. At the same time, juices
made by glands
in the lining of the stomach help digest the food. After about 3 hours,
the food becomes a liquid and moves into the small intestine, where
digestion continues.
The
stomach in the abdomen
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What Is Cancer?
Cancer is a group of more than 100 different diseases. They affect the
body's basic unit, the cell. Cancer occurs when cells become abnormal and
divide without control or order.
Like all other organs of the body, the stomach is made up of many types
of cells. Normally, cells divide to produce more cells only when the body
needs them. This orderly process helps keep us healthy.
If cells keep dividing when new cells are not needed, a mass of tissue
forms. This mass of extra tissue, called a growth or tumor,
can be benign
or malignant.
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Benign tumors are not cancer. They can usually be removed and,
in most cases, they do not come back. Most important, cells from benign
tumors do not spread to other parts of the body. Benign tumors are
rarely a threat to life.
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Malignant tumors are cancer. Cancer cells can invade and
damage tissues and organs near the tumor. Also, cancer cells can break
away from a malignant tumor and enter the bloodstream or lymphatic
system. This is how cancer spreads from the original (primary)
tumor to form new tumors in other parts of the body. The spread of
cancer is called metastasis.
Stomach cancer (also called gastric
cancer) can develop in any part of the stomach and may spread throughout
the stomach and to other organs. It may grow along the stomach wall into
the esophagus or small intestine.
It also may extend through the stomach wall and spread to nearby lymph
nodes and to organs such as the liver,
pancreas,
and colon.
Stomach cancer also may spread to distant organs, such as the lungs, the
lymph
nodes above the collar bone, and the ovaries.
When cancer spreads to another part of the body, the new tumor has the
same kind of abnormal cells and the same name as the primary tumor. For
example, if stomach cancer spreads to the liver, the cancer cells in the
liver are stomach cancer cells. The disease is metastatic stomach cancer
(it is not liver cancer). However, when stomach cancer spreads to an
ovary, the tumor in the ovary is called a Krukenberg
tumor. (This tumor, named for a doctor, is not a different
disease; it is metastatic stomach cancer. The cancer cells in a Krukenberg
tumor are stomach cancer cells, the same as the cancer cells in the
primary tumor.)
Stomach Cancer Symptoms
Stomach cancer can be hard to find early. Often there are no symptoms
in the early stages and, in many cases, the cancer has spread before it is
found. When symptoms do occur, they are often so vague that the person
ignores them. Stomach cancer symptoms can include the following:
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Indigestion or a burning sensation (heartburn);
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Discomfort or pain in the abdomen;
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Nausea and vomiting;
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Diarrhea or constipation;
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Bloating of the stomach after meals;
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Loss of appetite;
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Weakness and fatigue; and
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Bleeding (vomiting blood or having blood in the stool).
Any of these symptoms may be caused by cancer or by other, less serious
health problems, such as a stomach virus or an ulcer. Only a doctor can
tell the cause. People who have any of these symptoms should see their
doctor. They may be referred to a gastroenterologist,
a doctor who specializes in diagnosing and treating digestive problems.
These doctors are sometimes called gastrointestinal (or GI)
specialists.
Diagnosis
To determine if any of the above are stomach cancer symptoms, the doctor asks about the patient's
medical history, does a physical exam, and may order laboratory studies.
The patient may also have one or all of the following exams:
Fecal
occult blood test -- a check for hidden (occult) blood in the
stool. This test is done by placing a small amount of stool on a plastic
slide or on special paper. It may be tested in the doctor's office or sent
to a laboratory. This test is done because stomach cancer sometimes causes
bleeding that cannot be seen. However, noncancerous conditions also may
cause bleeding, so having blood in the stool does not necessarily mean
that a person has cancer.
Upper
GI series -- x-rays
of the esophagus and stomach (the upper gastrointestinal, or GI, tract.
The x-rays are taken after the patient drinks a barium solution, a thick,
chalky liquid. (This test is sometimes called a barium swallow.) The
barium outlines the stomach on the x-rays, helping the doctor find tumors
or other abnormal areas. During the test, the doctor may pump air into the
stomach to make small tumors easier to see.
Endoscopy
-- an exam of the esophagus and stomach using a thin, lighted tube called
a gastroscope,
which is passed through the mouth and esophagus to the stomach. The
patient's throat is sprayed with a local anesthetic
to reduce discomfort and gagging. Patients also may receive medicine to
relax them. Through the gastroscope, the doctor can look directly at the
inside of the stomach. If an abnormal area is found, the doctor can remove
some tissue through the gastroscope. Another doctor, a pathologist,
examines the tissue under a microscope to check for cancer cells. This
procedure -- removing tissue and examining it under a microscope -- is
called a biopsy.
A biopsy is the only sure way to know whether cancer cells are
present.
A patient who needs a biopsy may want to ask the doctor some of these
questions:
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How long will the procedure take? Will I be awake? Will it hurt?
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How soon will I know the results?
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If I do have cancer, who will talk with me about treatment?
When?
Staging
If the pathologist finds cancer cells in the tissue sample, the
patient's doctor needs to know the stage, or extent, of the disease. Staging
exams and tests help the doctor find out whether the cancer has spread
and, if so, what parts of the body are affected. Because stomach cancer
can spread to the liver, the pancreas, and other organs near the stomach
as well as to the lungs, the doctor may order a CT
(or CAT) scan, an ultrasound
exam, or other tests to check these areas.
Staging may not be complete until after surgery. The surgeon removes
nearby lymph nodes and may take samples of tissue from other areas in the
abdomen. All of these samples are examined by a pathologist to check for
cancer cells. Decisions about treatment after surgery depend on these
findings.
Stomach Cancer Treatment
The doctor develops a treatment plan to fit each patient's needs.
Treatment for stomach cancer depends on the size, location, and extent of
the tumor; the stage of the disease; the patient's general health; and
other factors.
Many people who have cancer want to learn all they can about the
disease and their treatment choices so they can take an active part in
decisions about their medical care. The doctor is the best person to
answer questions about their diagnosis and treatment plan.
When a person is diagnosed with cancer, shock and stress are natural
reactions. These feelings may make it difficult for people to think of
everything they want to ask the doctor. Often, it helps to make a list of
questions. Also, to help remember what the doctor says, patients may take
notes or ask whether they may use a tape recorder. Some people also want
to have a family member or friend with them when they talk to the doctor
-- to take part in the discussion, to take notes, or just to listen.
Patients should not feel the need to ask all their questions or remember
all the answers at one time. They will have other chances to ask the
doctor to explain things and to get more information.
When talking about treatment choices, the patient may want to ask about
taking part in a research study. Such studies, called clinical
trials, are designed to improve cancer treatment. More information
about clinical trials
is in the Clinical
Trials section.
These are some questions a patient may want to ask the doctor before
treatment begins:
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What is the stage of the disease?
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What are my treatment options? Which do you suggest for me? Why?
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Would a clinical trial be appropriate for me?
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What are the expected benefits of the treatment?
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What are the risks and possible side
effects of the treatment?
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What can be done about side effects?
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What can I do to take care of myself during therapy?
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How long will my treatment last?
Patients and their loved ones are naturally concerned about the
effectiveness of the treatment. Sometimes they use statistics to try to
figure out whether the patient will be cured, or how long he or she will
live. It is important to remember, however, that statistics are averages
based on large numbers of patients. They cannot be used to predict what
will happen to a particular person because no two cancer patients are
alike; treatments and responses vary greatly. Patients may want to talk
with the doctor about the chance of recovery (prognosis).
When doctors talk about surviving cancer, they may use the term remission
rather than cure. Even though many patients recover completely, doctors
use this term because the disease can return. (The return of cancer is
called a recurrence.)
Getting a Second Opinion
Treatment decisions are complex. Sometimes it is helpful for patients
to have a second opinion about the diagnosis and the treatment plan. (Some
insurance companies require a second opinion; others may pay for a second
opinion if the patient requests it.) There are several ways to find
another doctor to consult:
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The patient's doctor may be able to suggest a specialist. Specialists
who treat this disease include gastroenterologists, surgeons, medical
oncologists and radiation
oncologists.
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The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about treatment facilities, including cancer centers and other programs
supported by the National Cancer Institute.
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Patients can get the names of doctors from their local medical
society, a nearby hospital, or a medical school.
Stomach Cancer Treatment Methods
Cancer of the stomach is difficult to cure unless it is found in an
early stage (before it has begun to spread). Unfortunately, because stomach cancer symptoms in the early stages tend to be few, the disease is usually advanced when
the diagnosis is made. However, advanced stomach cancer can be treated and
the symptoms can be relieved. Treatment for stomach cancer may include
surgery,
chemotherapy,
and/or radiation
therapy. New treatment approaches such as biological
therapy and improved ways of using current methods are being
studied in clinical trials. A patient may have one form of treatment or a
combination of treatments.
Surgery is the most common treatment for stomach cancer. The
operation is called gastrectomy.
The surgeon removes part (subtotal or partial gastrectomy) or all (total
gastrectomy) of the stomach, as well as some of the tissue around the
stomach. After a subtotal gastrectomy, the doctor connects the remaining
part of the stomach to the esophagus or the small intestine. After a total
gastrectomy, the doctor connects the esophagus directly to the small
intestine. Because cancer can spread through the lymphatic system, lymph
nodes near the tumor are often removed during surgery so that the
pathologist can check them for cancer cells. If cancer cells are in the
lymph nodes, the disease may have spread to other parts of the body.
These are some questions a patient may want to ask the doctor before
surgery:
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What kind of operation will I have?
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What are the risks of this operation?
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How will I feel afterwards? If I have pain, how will you help me?
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Will I need a special diet? Who will teach me about my
diet?
Chemotherapy is the use of drugs to kill cancer cells. This type
of treatment is called systemic
therapy because the drugs enter the bloodstream and travel through
the body.
Clinical trials are in progress to find the best ways to use
chemotherapy to treat stomach cancer. Scientists are exploring the
benefits of giving chemotherapy before surgery to shrink the tumor, or as
adjuvant
therapy after surgery to destroy remaining cancer cells.
Combination treatment with chemotherapy and radiation therapy is also
under study. Doctors are testing a treatment in which anticancer drugs are
put directly into the abdomen (intraperitoneal
chemotherapy). Chemotherapy also is being studied as a treatment
for cancer that has spread, and as a way to relieve symptoms of the
disease.
Most anticancer drugs are given by injection; some are taken by mouth.
The doctor may use one drug or a combination of drugs. Chemotherapy is
given in cycles: a treatment period followed by a recovery period, then
another treatment, and so on. Usually a person receives chemotherapy as an
outpatient (at the hospital, at the doctor's office, or at home). However,
depending on which drugs are given and the patient's general health, a
short hospital stay may be needed.
These are some questions patients may want to ask about
chemotherapy:
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What is the goal of this treatment?
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What drugs will I be taking?
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Will the drugs cause side effects? What can I do about them?
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How long will I need to take this treatment?
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How will we know if the treatment is working?
Radiation therapy (also called radiotherapy) is the use of
high-energy rays to damage cancer cells and stop them from growing. Like
surgery, it is local
therapy; the radiation can affect cancer cells only in the treated
area. Radiation therapy is sometimes given after surgery to destroy cancer
cells that may remain in the area. Researchers are conducting clinical
trials to find out whether it is helpful to give radiation therapy during
surgery (intraoperative
radiation therapy). Radiation therapy may also be used to relieve
pain or blockage.
The patient goes to the hospital or clinic each day for radiation
therapy. Usually treatments are given 5 days a week for 5 to 6 weeks.
These are some questions a patient may want ask the doctor before
receiving radiation therapy:
-
What is the goal of this treatment?
-
How will the radiation be given?
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When will the treatment begin? When will it end?
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Will I have side effects? What can I do about them?
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How will we know if the radiation therapy is working?
Biological therapy (also called immunotherapy) is a form of
treatment that helps the body's immune system attack and destroy cancer
cells; it may also help the body recover from some of the side effects of
treatment. In clinical trials, doctors are studying biological therapy in
combination with other treatments to try to prevent a recurrence of
stomach cancer. In another use of biological therapy, patients who have
low blood cell counts during or after chemotherapy may receive colony-stimulating
factors to help restore the blood cell levels. Patients may need
to stay in the hospital while receiving some types of biological
therapy.
Clinical Trials
Many patients with stomach cancer are treated in clinical trials
(treatment studies). Doctors conduct clinical trials to find out whether a
new approach is both safe and effective and to answer scientific
questions. Patients who take part in these studies are often the first to
receive treatments that have shown promise in laboratory research. In
clinical trials, some patients may receive the new treatment while others
receive the standard approach. In this way, doctors can compare different
therapies. Patients who take part in a trial make an important
contribution to medical science and may have the first chance to benefit
from improved treatment methods. Researchers also use clinical trials to
look for ways to reduce the side effects of treatment and to improve the
quality of patients' lives.
Many clinical trials for people with stomach cancer are under way.
Patients who are interested in taking part in a trial should talk with
their doctor.
One way to learn about clinical trials is through PDQ, a computer database developed by
the National Cancer Institute. PDQ contains information about cancer
treatment and about clinical trials. The Cancer Information Service can
provide PDQ information to doctors, patients, and the public.
Side Effects of Treatment
It is hard to limit the effects of therapy so that only cancer cells
are removed or destroyed. Because healthy cells and tissues also may be
damaged, treatment can cause unpleasant side effects.
The side effects of cancer treatment are different for each person, and
they may even be different from one treatment to the next. Doctors try to
plan treatment in ways that keep side effects to a minimum; they can help
with any problems that occur. For this reason, it is very important to let
the doctor know about any problems during or after treatment.
Surgery
Gastrectomy is major surgery. For a period of time after the surgery,
the person's activities are limited to allow healing to take place. For
the first few days after surgery, the patient is fed intravenously
(through a vein). Within several days, most patients are ready for
liquids, followed by soft, then solid, foods. Those who have had their
entire stomach removed cannot absorb vitamin B12, which is
necessary for healthy blood and nerves, so they need regular injections of
this vitamin. Patients may have temporary or permanent difficulty
digesting certain foods, and they may need to change their diet. Some
gastrectomy patients will need to follow a special diet for a few weeks or
months, while others will need to do so permanently. The doctor or a
dietitian (a nutrition specialist) will explain any necessary dietary
changes.
Some gastrectomy patients have cramps, nausea, diarrhea, and dizziness
shortly after eating because food and liquid enter the small intestine too
quickly. This group of symptoms is called the dumping syndrome. Foods
containing high amounts of sugar often make stomach cancer symptoms worse. The dumping
syndrome can be treated by changing the patient's diet. Doctors
often advise patients to eat several small meals throughout the day, to
avoid foods that contain sugar, and to eat foods high in protein. To
reduce the amount of fluid that enters the small intestine, patients are
usually encouraged not to drink at mealtimes. Medicine also can help
control the dumping syndrome. The symptoms usually disappear in 3 to 12
months, but they may be permanent.
Following gastrectomy, bile in the small intestine may back up into the
remaining part of the stomach or into the esophagus, causing the symptoms
of an upset stomach. The patient's doctor may prescribe medicine or
suggest over-the-counter products to control such symptoms.
Chemotherapy
The side effects of chemotherapy depend mainly on the drugs the patient
receives. As with any other type of treatment, side effects also vary from
person to person. In general, anticancer drugs affect cells that divide
rapidly. These include blood cells, which fight infection, help the blood
to clot, or carry oxygen to all parts of the body. When blood cells are
affected by anticancer drugs, patients are more likely to get infections,
may bruise or bleed easily, and may have less energy. Cells in hair roots
and cells that line the digestive tract also divide rapidly. As a result
of chemotherapy, patients may have side effects such as loss of appetite,
nausea, vomiting, hair loss, or mouth sores. For some patients, the doctor
may prescribe medicine to help with side effects, especially with nausea
and vomiting. These effects usually go away gradually during the recovery
period between treatments or after the treatments stop.
Radiation Therapy
Patients who receive radiation to the abdomen may have nausea,
vomiting, and diarrhea. The doctor can prescribe medicine or suggest
dietary changes to relieve these problems. The skin in the treated area
may become red, dry, tender, and itchy. Patients should avoid wearing
clothes that rub; loose-fitting cotton clothes are usually best. It is
important for patients to take good care of their skin during treatment,
but they should not use lotions or creams without the doctor's
advice.
Patients are likely to become very tired during radiation therapy,
especially in the later weeks of treatment. Resting is important, but
doctors usually advise patients to try to stay as active as they
can.
Biological Therapy
The side effects of biological therapy vary with the type of treatment.
Some cause flu-like symptoms, such as chills, fever, weakness, nausea,
vomiting, and diarrhea. Patients sometimes get a rash, and they may bruise
or bleed easily. These problems may be severe, and patients may need to
stay in the hospital during treatment.
Nutrition for Cancer Patients
It is sometimes difficult for patients who have been treated for
stomach cancer to eat well. Cancer often causes loss of appetite, and
people may not feel like eating when they are uncomfortable or tired. It
is hard for patients to eat when they have nausea, vomiting, mouth sores,
or the dumping syndrome. Patients who have had stomach surgery are likely
to feel full after eating only a small amount of food. For some patients,
the taste of food changes. Still, good nutrition is important. Eating well
means getting enough calories and protein to help prevent weight loss,
regain strength, and rebuild normal tissues.
Doctors, nurses, and dietitians can offer advice for healthy eating
during and after cancer treatment.
Support for Cancer Patients
Living with a serious disease is not easy. Cancer patients and those
who care about them face many problems and challenges. Coping with these
problems is often easier when people have helpful information and support
services.
Cancer patients may worry about holding their job, caring for their
family, or keeping up with their daily activities. Concerns about tests,
treatments, hospital stays, and medical bills are common. Doctors, nurses,
and other members of the health care team can answer questions about
treatment, working, or other activities. Meeting with a social worker,
counselor, or member of the clergy also can be helpful for patients who
want to talk about their feelings or discuss their concerns about the
future or about personal relationships.
Friends and relatives can be very supportive. Also, it helps many
patients to discuss their concerns with others who have cancer. Cancer
patients often get together in support groups, where they can share what
they have learned about coping with cancer and the effects of treatment.
It is important to keep in mind, however, that each patient is different.
Treatments and ways of dealing with cancer that work for one person may
not be right for another -- even if they both have the same kind of
cancer. It is always a good idea to discuss the advice of friends and
family members with the doctor.
Often, a social worker at the hospital or clinic can suggest groups
that can help with rehabilitation, emotional support, financial aid,
transportation, or home care. For example, the American Cancer Society has
many services for cancer patients and their families. Local offices of the
American Cancer Society are listed in the white pages of the telephone
directory. The Cancer Information Service also has information on local
resources.
Causes of Stomach Cancer
The stomach cancer rate in the United States and the number of deaths
from this disease have gone down dramatically over the past 60 years.
Still, stomach cancer is a serious disease, and scientists all over the
world are trying to learn more about what causes this disease and how to
prevent it. At this time, doctors cannot explain why one person gets
stomach cancer and another does not. They do know, however, that stomach
cancer is not contagious; no one can "catch" cancer from another
person.
Researchers have learned that some people are more likely than others
to develop stomach cancer. The disease is found most often in people over
age 55. It affects men twice as often as women, and is more common in
black people than in white people. Also, stomach cancer is more common in
some parts of the world -- such as Japan, Korea, parts of Eastern Europe,
and Latin America -- than in the United States. People in these areas eat
many foods that are preserved by drying, smoking, salting, or pickling.
Scientists believe that eating foods preserved in these ways may play a
role in the development of stomach cancer. On the other hand, fresh foods
(especially fresh fruits and vegetables and properly frozen or
refrigerated fresh foods) may protect against this disease.
Stomach ulcers do not appear to increase a person's risk (chance) of
getting stomach cancer. However, some studies suggest that a type of
bacteria, Helicobacter
pylori, which may cause stomach inflammation and ulcers, may be an
important risk
factor for this disease. Also, research shows that people who have
had stomach surgery or have pernicious
anemia, achlorhydria,
or gastric
atrophy (which generally result in lower than normal amounts of
digestive juices) have an increased risk of stomach cancer.
Exposure to certain dusts and fumes in the workplace has been linked to
a higher than average risk of stomach cancer. Also, some scientists
believe smoking may increase stomach cancer risk.
People who think they might be at risk for stomach cancer should
discuss this concern with their doctor. The doctor can suggest an
appropriate schedule of checkups so that, if cancer appears, it can be
detected as early as possible.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
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