Gastric Cancer

Gastric Cancer: Symptoms, Causes, Types, Diagnosis, and Treatments

Gastric cancer, also known as stomach cancer, is a significant global health concern due to its often late diagnosis and poor prognosis. This comprehensive article aims to provide a deep understanding of gastric-cancer, discussing its symptoms, causes, various types, diagnostic methods, and available treatments. Whether you’re a patient, caregiver, or healthcare enthusiast, this guide offers valuable insights into managing and understanding this complex disease.

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What is Gastric Cancer?

Gastric cancer refers to malignant tumors originating from the lining of the stomach. It generally starts in the mucosal cells, which are the inner lining of the stomach wall. Gastric-cancer can grow slowly over time and may spread to other parts of the digestive system or distant organs, such as the liver, lungs, and lymph nodes.

Global Impact and Epidemiology

According to the World Health Organization (WHO), gastric-cancer ranks as the fifth most common cancer worldwide and the third leading cause of cancer-related deaths. It is particularly prevalent in East Asia, Eastern Europe, and parts of Central and South America. Despite advances in medical science, the survival rate remains low because many patients are diagnosed at advanced stages.

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Symptoms of Gastric Cancer

Early-stage gastric cancer rarely presents obvious symptoms, which contributes to delayed diagnosis. However, as the disease progresses, symptoms become more apparent.

Common Symptoms Include:

• Persistent indigestion or heartburn: Discomfort or burning sensation in the upper abdomen.
• Abdominal pain or discomfort: Often vague, located in the upper stomach region.
• Nausea and vomiting: Sometimes vomiting blood or material resembling coffee grounds.
• Loss of appetite: Reduced desire to eat, which can lead to weight loss.
• Unintentional weight loss: Noticeable drop in body weight without trying.
• Feeling full quickly: Early satiety after eating small amounts of food.
• Swelling or fluid buildup: Ascites or swelling in the abdomen may occur in advanced stages.
• Fatigue: General tiredness due to anemia or poor nutritional status.
• Blood in stool: Black or tarry stools, indicating gastrointestinal bleeding.
• Difficulty swallowing (dysphagia): If the tumor is near the stomach’s entrance.

When to See a Doctor?

If you experience persistent stomach discomfort, unexplained weight loss, or symptoms like vomiting blood, it is essential to consult a healthcare professional promptly. Early detection significantly improves treatment outcomes.

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Causes and Risk Factors of Gastric Cancer

The exact cause of gastric cancer remains unclear, but multiple factors contribute to its development.

1. Helicobacter pylori Infection

Infection with Helicobacter pylori (H. pylori), a bacteria that colonizes the stomach lining, is the strongest known risk factor. This infection causes chronic inflammation (gastritis) and can lead to changes in stomach cells, increasing cancer risk over time.

2. Diet and Lifestyle

• High salt intake: Diets rich in salty and smoked foods increase the risk.
• Low consumption of fruits and vegetables: Deficiency in antioxidants and vitamins may contribute.
• Smoking: Tobacco use doubles the risk of gastric cancer.
• Alcohol consumption: Heavy drinking is also linked to higher risk.

3. Genetic Factors

A family history of gastric cancer increases susceptibility. Certain inherited syndromes like hereditary diffuse gastric cancer (HDGC) and mutations in genes such as CDH1 also raise risk.

4. Chronic Gastric Conditions

• Chronic atrophic gastritis
• Pernicious anemia
• Intestinal metaplasia (precancerous condition)
• Gastric polyps

5. Other Risk Factors

• Older age (most cases occur after 50)
• Male gender (higher incidence in men)
• Previous stomach surgery for benign conditions

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Types of Gastric Cancer

Gastric cancer is not a single disease but comprises several types, mainly classified based on cell origin and tumor location.

1. Adenocarcinoma

This is the most common type, accounting for about 90-95% of cases. It arises from the glandular cells lining the stomach.

• Intestinal type: Forms gland-like structures and is linked to environmental factors and precancerous conditions.
• Diffuse type: Characterized by scattered cancer cells that invade the stomach wall, often associated with genetic mutations.

2. Lymphoma

This type originates from immune cells (lymphocytes) in the stomach. Though rare, it is associated with H. pylori infection and may respond well to antibiotics in early stages.

3. Gastrointestinal Stromal Tumor (GIST)

GIST arises from the interstitial cells of Cajal in the stomach wall. It is a distinct tumor type with different treatment protocols.

4. Other Rare Types

• Squamous cell carcinoma
• Neuroendocrine tumors
• Leiomyosarcoma

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Diagnosis of Gastric Cancer

Early detection and accurate diagnosis are crucial for effective management. Several diagnostic tools are used.

1. Medical History and Physical Examination

Initial assessment includes evaluating symptoms, risk factors, and physical signs such as abdominal tenderness or masses.

2. Endoscopy (Esophagogastroduodenoscopy – EGD)

A flexible tube with a camera is inserted through the mouth to visualize the stomach lining. Suspicious areas are biopsied for microscopic examination.

3. Biopsy and Histopathology

Tissue samples from endoscopy are examined to confirm cancer type, grade, and stage.

4. Imaging Studies

• CT scan: Helps determine tumor size and spread to lymph nodes or organs.
• Endoscopic ultrasound (EUS): Assesses depth of tumor invasion and nearby lymph nodes.
• PET scan: Detects metastasis (cancer spread).
• Barium swallow X-ray: Occasionally used to detect blockages or tumors.

5. Laboratory Tests

• Blood tests for anemia, liver function, and tumor markers (e.g., CEA, CA 19-9).
• Testing for H. pylori infection.

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Staging of Gastric Cancer

Staging describes the extent of cancer spread and guides treatment. The TNM system is commonly used:

• T (Tumor): Depth of tumor invasion in the stomach wall.
• N (Nodes): Involvement of regional lymph nodes.
• M (Metastasis): Presence or absence of distant metastasis.

Stages range from 0 (early cancer) to IV (advanced cancer with metastasis).

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Treatment Options for Gastric Cancer

Treatment depends on the cancer’s stage, location, patient’s health, and preferences. A multidisciplinary approach is often required.

1. Surgery

Surgery is the primary treatment for localized gastric cancer.

• Endoscopic resection: For very early-stage tumors confined to the mucosa.
• Subtotal (partial) gastrectomy: Removal of part of the stomach.
• Total gastrectomy: Complete removal of the stomach, with reconstruction.
• Lymph node dissection: To remove nearby lymph nodes potentially affected.

2. Chemotherapy

Chemotherapy uses drugs to kill cancer cells and is used in:

• Neoadjuvant setting (before surgery) to shrink tumors.
• Adjuvant setting (after surgery) to kill residual cancer cells.
• Advanced/metastatic disease to control symptoms and prolong survival.

Common chemotherapy agents include fluorouracil, cisplatin, and oxaliplatin.

3. Radiation Therapy

Radiation uses high-energy rays to destroy cancer cells. It is often combined with chemotherapy (chemoradiation) for better effectiveness, particularly in locally advanced cancer.

4. Targeted Therapy

Newer drugs target specific molecules involved in cancer growth.

• HER2 inhibitors: For HER2-positive gastric cancers (e.g., trastuzumab).
• VEGF inhibitors: To block blood vessel formation (angiogenesis).
• Immune checkpoint inhibitors: Emerging treatments that boost the immune system.

5. Palliative Care

For advanced cases where cure is not possible, palliative treatments focus on symptom relief and improving quality of life, such as pain management and nutritional support.

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Lifestyle and Supportive Care During Treatment

• Nutritional support: Eating small, frequent meals and nutritional supplements may be necessary.
• Psychological support: Counseling or support groups help cope with emotional stress.
• Physical activity: Maintaining some activity improves strength and mood.

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Prevention of Gastric Cancer

While not all cases are preventable, certain measures can reduce risk:

• Eradication of H. pylori infection with antibiotics.
• Reducing salt intake and avoiding smoked, pickled foods.
• Eating a diet rich in fruits and vegetables.
• Avoiding tobacco and limiting alcohol consumption.
• Regular medical check-ups, especially for those with risk factors.

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Prognosis and Survival Rates

The prognosis of gastric cancer depends on the stage at diagnosis:

• Early-stage detection has a 5-year survival rate of up to 70%.
• Advanced-stage diagnosis has significantly lower survival, often less than 20%.

Regular follow-up after treatment is essential to detect recurrence early.

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Conclusion

Gastric cancer remains a challenging disease due to its subtle early symptoms and aggressive nature. Understanding the symptoms, causes, types, and treatment options can empower patients and caregivers to seek timely medical attention and make informed decisions. Advances in diagnostic techniques and targeted therapies offer hope for improved outcomes, but prevention through lifestyle modification and H. pylori eradication remains vital.

If you or someone you know experiences persistent stomach-related symptoms, do not delay consulting a healthcare professional. Early diagnosis and multidisciplinary care are the keys to combating gastric cancer effectively.

Frequenlty Asked Questions (FAQs) About Gastric Cancer

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