Gastric cancer is a malignancy of the stomach. It is also referred to as stomach cancer. The stomach is an organ that is part of the digestive system it connects the esophagus and the small intestine.
Eighty-five percent of gastric cancer diagnoses are present in the lining or mucosa of the stomach. These tumors are referred to adenocarcinomas, or tumors that are in glandular tissues. Forty percent of gastric cancers are found in the lower part of the stomach which is the pylorus. Forty percent of gastric cancers grow in the middle part of the stomach and fifteen percent develop in the upper part, called the cardia. In ten percent to of diagnosed patients the cancer is in more than one part of the stomach.
In the beginning stages of gastric cancer, there are no symptoms. The symptoms are only present when the disease is advanced and they are blood in stool, bloating after eating especially, abdominal pain or distress, fatigue, gastrointestinal bleeding, weight loss, nausea, vomiting, loss of appetite, heartburn diarrhea or constipation.
Diagnosis for gastric cancer is determined from a medical history, physical exam, and laboratory tests. In some cases a tumor can be felt with the hands, during a physical exam. This could be indicative of advanced gastric cancer. Tests for this disease are a fecal occult blood test, upper GI series known as barium swallow, gasrtroscopy, complete blood count (CBC) and imaging test (CT Scan, X-ray).
A fecal occult blood test detects microscopic blood in the stool, indicative of gastrointestinal cancers (stomach, colon, etc). An upper GI series involves the patient swallowing a tracer of barium suspension and then a series of x-rays are taken. A double-contrast barium enema involves blowing air into the esophagus and stomach to ensure that the barium suspension coats the organs more completely for a better image. A gastroscopy is a procedure in which an endoscope (a thin tube with a light and camera) is slipped down the throat into the stomach. Small instruments can be snaked through the endoscope to perform a biopsy of the suspected tissue in the stomach. This procedure is performed why the patient is awake. A local anesthesia is used to ease any uncomfortable sensations in the esophagus and sedatives can be administered for relaxation.
Staging is an important part of diagnosis. Medical imaging is used to determine if the gastric cancer has spread to other parts of the body. After a diagnosis is made, the disease is staged to help determine treatment and predict prognosis.
There are six stages for gastric cancer. Staging evaluates the tumor and where and how it has spread through out the body. Here are the six stages for gastric cancer.
Stage 0: the cancer is just beginning to alter the inner stomach.
Stage I: the cancer is beginning to grow to the outer layer of the stomach. Lymph nodes may be involved.
Stage II: the cancer has grown farther into the stomach wall or distant lymph nodes may be involved.
Stage III the cancer has grown through all the tissues of the stomach wall and distant lymph nodes may be involved.
Stage IV the disease has affected nearby organs and has metastasized to other parts of the body.
Recurrent a cancer free patient has developed cancer again.
Gastric cancer treatment is based on the location, size and extent of the tumor, the age and health of the patient and the stage of the cancer. Treatment goal in early stage gastric cancer is a total cure of the disease. When the disease is advanced and cure is improbable the goal of treatment is restoring as much quality of life possible and pain management. This type of treatment is called palliative treatment.
Removing the tumor is the only curative treatment, known as resection. Chemotherapy and radiation may be used after surgery as an adjuvant treatment. Chemotherapy and radiation have also been used in palliative treatment.
Surgery for gastric cancer depends on the degree of the disease. A tumor smaller than 3 cm, that is not affecting the innermost layer or submucosa of the stomach lining will be removed. The surgery involves removing just the tumor and surrounding tissues.
A procedure called a gastrectomy is the most common surgery for gastric cancer. Gastrectomy removes the entire stomach or a part of the stomach, referred to as total and partial or subtotal respectively. Nearby tissues that are affected may be removed as well. In a majority of patients lymph nodes are removed as well. Another procedure, depending on the location of the tumor is an esophagogastrectomy removes the upper part of the stomach and a section of the esophagus.
When the stomach is removed the esophagus is attached to the small intestine, which is called an anastomosis. Gastrectomy involves a large incision, which means that post-op recovery involves pain, weakness, fatigue and poor appetite. The recovery time will depend on the health, mentally and physically of the patient, stage of the cancer, type of surgery and the age of the patient.
Surgery can have complications such as, blood clots, bowel obstruction, inflammation of the gall bladder, pneumonia and a failure of the anastomosis to heal.
When a large part of or the entire stomach is removed, permanent dietary changes are non-negotiable. Patients will need to eat small meals frequently, reduce sugar intake, not drink will meals and eat more fat and protein. If only a small section is removed, most patients can return to normal, previous eating habits.
Dumping syndrome can occur in patients who have had a gastrectomy. Symptoms of dumping syndrome may be a few or all of these: pain, headache, dizziness, flushing, weakness and sweating. Some long term complications of a gastrectomy are pernicious anemia which is a vitamin B-12 deficiency, esophagitis, osteoporosis and decreased immunity.
Chemotherapy is the administration of powerful drugs to kill cancer cells. This treatment can be used after surgery to kill any remaining cancer cells and prevent a recurrence. Chemotherapy can be taken orally or administered via IV. Treatment is most often given as an outpatient. The drugs in chemotherapy are strong and side effects can be severe, such as fatigue, hair loss, diarrhea, suppressed immune system, loss of appetite, anemia, depression and nausea or vomiting.
Radiation therapy is the application of high energy x-rays to destroy cancer cells in a specific area. This treatment is often used after surgery to destroy residual cancer cells. Some times radiation can be administered during surgery. Side effects are fatigue, inflammation and skin irritation.
Treatment for gastric cancer requires a lot of follow-up care. Tests and physical exams are performed on a regular basis to determine the state of remission or advancement of the disease. Patients will also have their diet monitored for healthy eating and behaviors.
The prognosis of gastric cancer varies with the stage of the cancer. A metastasized cancer has the poorest prognosis with 80% of cases resulting, unfortunately in fatality. In the United States the five year survival rate for cancer is 5 to 15%.
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