Stomach Cancer

Stomach cancer, also called gastric cancer, is cancer that occurs in the lining of the stomach. The stomach is the muscular sac located in the upper middle of your abdomen, just below your ribs. The stomach receives and holds the food you eat and then helps to break down and digest it.

Almost all gastric cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Other types of gastric cancer are gastrointestinal carcinoid tumors, gastrointestinal stromal tumors, and lymphomas.

Stomach cancer is uncommon in the United States, and the number of people diagnosed with the disease each year is declining. Stomach cancer is much more common in other areas of the world, particularly China and Japan. Stomach cancer mostly affects older people, and two-thirds of people who have it are over age 65.

Infection with bacteria called H. pylori is a common cause of stomach cancer.

Gastric cancer is often diagnosed at an advanced stage because there are no early signs or symptoms. This makes treating stomach cancer difficult, but options usually include surgery, chemotherapy, and radiation therapy.

Indigestion and stomach discomfort can be symptoms of early cancer, but other problems can cause the same symptoms.

Signs and symptoms of stomach cancer may also include:

• blood in the stool
• yellowing of the skin or eyes
• trouble swallowing
• fatigue
• feeling bloated after eating
• feeling full after eating small amounts of food
• heartburn that is severe and persistent
• indigestion that is severe and unrelenting
• nausea that is persistent and unexplained
• stomach pain
• vomiting that is persistent
• weight loss that is unintentional

The cause of most stomach cancers is unclear. There is a strong correlation between a diet high in smoked, salted, and pickled foods and stomach cancer. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined.

Infection with the H. pylori bacteria, particularly certain subtypes, is also associated with stomach cancer. The bacteria can convert substances in some foods into chemicals that cause mutations (changes) in the DNA of the cells in the stomach lining.

In general, cancer begins when an error (mutation) occurs in a cell's DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when a normal cell would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body.

Risk factors for developing stomach cancer include:

• having an H pylori infection
• having had stomach inflammation
• being male
• eating lots of salted, smoked, or pickled foods
• smoking cigarettes
• having a family history of stomach cancer

Doctors diagnose stomach cancer with a physical exam, blood and imaging tests, an endoscopy, and a biopsy. In an endoscopy, a thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can look for signs of cancer. If any suspicious areas are found, a piece of tissue can be collected for analysis (biopsy). Imaging tests used to look for stomach cancer include computerized tomography (CT) scan and a special type of X-ray exam sometimes called a barium swallow.

If you have or have had stomach cancer, you can take steps to manage the stress that accompanies the diagnosis.

• Learn about stomach cancer you have so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.

Treatment options for stomach cancer will depend on the size, type, and location of your tumor. Surgery, radiation therapy, chemotherapy, and targeted therapy may be used alone or in combination to treat soft tissue sarcoma.

Surgery. Surgery is used to remove as much of the tumor and affected lymph nodes as possible and/or relieve signs and symptoms of the cancer.

Radiation therapy. Radiation therapy involves treating cancer with high-powered beams of energy, such as X-rays or protons. You may have radiation therapy before surgery to shrink a tumor to make it easier to remove with surgery. Radiation is also used after surgery to kill any cancer cells that remain.

Chemotherapy. Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be administered by pill, through a vein (intravenously), or both methods may be used. Common chemotherapy drugs for stomach cancer include:

• 5-FU (fluorouracil), often given along with leucovorin (folinic acid)
• capecitabine (Xeloda)
• carboplatin
• cisplatin
• docetaxel (Taxotere)
• epirubicin (Ellence)
• irinotecan (Camptosar)
• oxaliplatin (Eloxatin)
• paclitaxel (Taxol)

Targeted drug treatment. Targeted drugs block specific abnormal signals present in sarcoma cells that allow them to grow. Targeted drugs used stomach cancer include:

• trastuzumab (Herceptin)
• imatinib (Gleevec)
• sunitinib (Sutent)