Brief overview
- Symptoms: Initially, bloating, loss of appetite, aversion to certain foods, later bloody, gushing vomiting, blood in stool, pain in upper abdomen, heartburn, difficulty swallowing, unwanted weight loss, night sweats and fever
- Course: Progressively spreads from its site of origin to adjacent tissues and metastasizes to other organs as the disease progresses
- Causes: Stomach cancer is caused by changes in the genetic material of stomach cells. It is not known exactly why these occur.
- Risk factors: Important risk factors include a diet high in salt and low in fiber. Alcohol, nicotine and certain toxins produced by smoking, grilling and curing food also increase the risk of disease.
- Therapy: If possible, the tumor is removed surgically. Chemotherapy and radiotherapy are used before surgery to reduce the size of the tumor. After surgery, they are used to prevent recurrence.
- Prevention: To prevent gastric cancer, it is helpful to avoid the risk factors. In particular, consistent treatment of Helicobacter pylori infections and a healthy diet seem to reduce the risk of disease.
What is stomach cancer?
Most often, glandular cells of the gastric mucosa that produce gastric juice degenerate. Doctors then speak of an adenocarcinoma. In rare cases, the tumor originates from lymphatic cells (MALT lymphoma) or from muscle and connective tissue cells (sarcoma).
Stomach cancer: frequency
Stomach cancer is a disease of older age. The average age of onset is 72 for men and 76 for women. Only about ten percent of all those affected develop the disease at the age of 30 to 40.
Stomach cancer stages
Depending on its malignancy and the spread of cancer cells in the stomach itself, as well as in the lymph nodes or other parts of the body, doctors divide gastric cancer into different stages.
Classification according to malignancy
In the G4 stage, on the other hand, the differences are very great, and the degenerated gastric cells have already lost many of their typical properties and capabilities. In this context, physicians also speak of undifferentiated cells. The more advanced the stage, the more aggressive the tumor usually grows.
Classification according to degree of spread
Tumor size (T):
- T1: early tumor limited to the innermost mucosal layer
- T2: tumor additionally affects the smooth muscle layer of the stomach
- T3: tumor additionally affects the outer connective tissue layer (serosa) of the stomach
- T4: Tumor additionally affects surrounding organs
Lymph nodes (N):
- N1: One to two surrounding (regional) lymph nodes are affected by cancer cells.
- N2: Three to six regional lymph nodes are affected by cancer cells.
Metastases (M):
- M0: There are no distant metastases in other organs.
- M1: There are distant metastases in other organs.
Example: a T2N2M0 tumor is a gastric cancer that has already invaded the muscle layer of the stomach (T2), affected three to six surrounding lymph nodes (N2), but has not yet caused gastric cancer metastases (M0).
What are the symptoms of stomach cancer?
As the disease progresses, those affected often complain of a persistent feeling of fullness in the upper abdomen or a sudden loss of appetite. If these very unspecific symptoms do not disappear on their own after eight weeks at the latest, they may be symptoms of stomach cancer. It is then important for those affected to see a doctor immediately.
Vomiting blood and tarry stools
The change in color and consistency is due to the reaction of the blood with gastric acid. In addition, the bright red blood coagulates on its way through the intestine, which also brings about a change in color. On the other hand, the lighter and fresher blood is in the stool, the further down in the digestive tract is usually the source of bleeding.
Anemia
Stomach cancer symptoms in the advanced stage
In the advanced tumor stage, further symptoms of stomach cancer become apparent: those affected often notice an unwanted weight loss caused by the tumor. If the stomach carcinoma is located at the stomach outlet, the passage of food into the intestine may be impeded. This causes a feeling of fullness, often accompanied by nausea and vomiting. The vomiting often occurs in gushes.
In advanced cancer, the tumor can sometimes be felt in the upper abdomen. As a further sign of stomach cancer, swallowing difficulties and a general feeling of weakness sometimes occur during the course of the disease.
Symptoms of metastatic stomach cancer
In advanced stages, stomach cancer often forms daughter tumors in other organs. Depending on which organ is involved, further symptoms appear:
In women, gastric carcinoma sometimes spreads to the ovaries. The tumor cells “drip” down from the stomach into the abdominal cavity and usually affect both ovaries. Physicians call the resulting tumor a “Krukenberg tumor.” The symptoms here are also relatively non-specific. For example, vaginal bleeding, pain during sexual intercourse and B symptoms occur.
Possible stomach cancer signs? Absolutely take seriously!
However, those affected often do not take possible stomach cancer symptoms seriously. Seniors in particular often attribute their complaints to old age or mistakenly find another explanation for the suspicious signs. Stomach cancer is a serious disease that is more difficult to treat the later it is detected. If the doctor diagnoses the disease early, on the other hand, there is a good chance of cure.
Is stomach cancer curable?
But even if the disease is already far advanced and there is no longer any hope of a cure, medicine offers comprehensive options for making the remaining time of life as painless and pleasant as possible for those affected. In Germany, there are specialists in palliative medicine specifically for this purpose, who specialize, among other things, in providing optimal care for people with stomach cancer and their relatives.
Causes and risk factors
Why the genetic changes that lead to stomach cancer occur is still not known exactly. However, there are numerous risk factors that promote gastric cancer.
Dietary habits
Toxins from certain types of mold, the aflatoxins, are equally carcinogenic. For this reason, it is not advisable to still consume moldy foods.
Smoking and alcohol
Nicotine and alcohol are also carcinogenic substances that increase the risk of stomach cancer and other cancers.
Other diseases
Certain diseases are also linked to the development of stomach cancer:
- Gastric ulcer (a wound of the gastric mucosa caused by too much gastric acid)
- Ménétrier’s disease (“giant fold gastritis” with proliferating gastric mucosa)
- Infection with the “stomach germ” Helicobacter pylori (this bacterial infection also leads to gastritis)
- Chronic atrophic gastritis (chronic gastric mucosal inflammation with associated tissue atrophy)
Genetic factors
The risk is particularly high if a certain genetic change occurs in the family: in the case of hereditary diffuse gastric carcinoma (HDCG), a mutation in the so-called CDH1 gene causes gastric cancer to occur more frequently already in young adulthood. About one to three percent of all people affected with gastric cancer belong to this group.
Similarly, a hereditary tumor syndrome of the intestine, hereditary colorectal carcinoma without polyposis (HNPCC, Lynch syndrome), increases the risk of stomach cancer.
If stomach cancer is suspected (for example, due to vomiting or black tarry stools), the doctor will first perform a gastroscopy. During this examination, the doctor examines the stomach from the inside and, if necessary, takes a tissue sample (biopsy). This sample is then examined in the laboratory for the presence of stomach cancer cells. The gastroscopy also provides information about the spread of an existing tumor.
An X-ray of the lungs and a computer tomography (CT) scan are also used in the search for metastases. A laparoscopy is a surgical procedure in which the doctor inserts an endoscope equipped with a camera and a light source into the abdomen through a small incision in the skin to examine it more closely. Laparoscopy is used primarily for advanced stomach cancer.
Treatment
Surgical measures for stomach cancer
In the case of more advanced stomach cancer, partial to complete removal of the stomach (gastric resection) is necessary. To ensure that food passage is still possible, the surgeon connects the remaining part of the stomach or the esophagus (in the case of complete stomach removal) directly to the small intestine. If the stomach cancer has already affected the spleen or pancreas, the doctor usually removes these as well.
Those affected often need additional minerals and vitamins, for example vitamin B12: In order to absorb this from food, the body needs a certain sugar-protein compound that is normally produced in the stomach lining (the so-called “intrinsic factor”). This is why vitamin B12 deficiency is more common after gastric resection.
Chemotherapy and radiotherapy for stomach cancer
Even if it is no longer possible to remove the tumor completely by surgery, the physician may advise chemotherapy, combined radiochemotherapy or other drug-based tumor therapy if the patient is in sufficiently good general condition. The goal is to improve survival and maintain quality of life.
Therapy for advanced gastric cancer
Antibody therapy is available as a newer treatment approach in certain cases: In about 20 percent of all gastric carcinomas, there is an increased number of so-called HER2 receptors – docking sites for growth factors that are important for tumor growth – on the surface of the cancer cells. HER2 antibodies occupy these HER2 receptors and thus help to slow tumor growth. In addition, patients receive chemotherapy.
Nutritional tube & pain medication
Many people suffer from severe pain in the advanced stages of stomach cancer. Pain-relieving medications then help to significantly improve the quality of life.
Prevention
There is also evidence that a Mediterranean diet with plenty of fruit and vegetables and high vitamin C content is protective. The fact that diet influences the risk of stomach cancer is also shown by the fact that the disease occurs relatively frequently in Japan, for example. Japanese who have emigrated to the USA, on the other hand, do not have an increased risk of stomach cancer in the next generation.
