Gastric cancer: What is the Diagnosis Process and Treatment?

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Gastric cancer is also known as stomach cancer and is characterized by the growth of cancerous cells in the stomach’s inner lining. Different types of gastric cancer can occur in the stomach. Gastric adenocarcinoma (90%) is the most common type. It is usually seen in men over age 40.

Following are the stages of gastric cancer –

  • Stage I tumors are confined to the stomach lining. 1
  • Stages II–III tumors have extended deeper into the layers of the stomach and to nearby lymph nodes.
  • Stage IV tumors have spread beyond the abdomen to nearby lymph nodes or parts of the body or distant lymph nodes and parts of the body.

What Causes Gastric cancer?

 Though the cause of gastric cancer is unknown, it was found linked to DNA mutations. One or more of the following reasons can cause gastric cancer –

  •  Precancerous conditions – Atrophic gastritis, intestinal metaplasia, dysplasia
  • DNA mutations – H. pylori bacteria may convert food substances into chemicals that cause DNA mutations.

 What are the Risk Factors?

  • GERD (Gastroesophageal reflux disease)
  • A highly salty diet or smoked foods
  • A diet low in fruits and vegetables
  • Excessive weight (Obesity)
  • Family history of stomach cancer
  • Personal history of stomach surgery
  • Infection with Helicobacter pylori
  • Long-term stomach inflammation (gastritis)
  • Smoking, alcohol
  • Stomach polyps
  • Pernicious anemia
  • Lynch syndrome
  • Familial adenomatous polyposis (FAP)
  • Epstein-Barr virus (EBV) infection

Types of Cancers

 Signs and symptoms

  •  Poor appetite
  • Weight loss
  • Abdominal pain
  • Indigestion and stomach discomfort
  • Heartburn or indigestion
  • Nausea, Vomiting
  • Swelling or fluid build-up in the abdomen
  • Blood in the stool
  • Fatigue
  • Yellowing of the skin and eyes

 What are the Complications?

 Complications of gastric cancer can be gastric outlet obstruction, iron-deficiency anemia, malnutrition, ascites, weight loss, etc.

 Diagnosis: How to diagnose Gastric cancer?

  •  The medical history helps to check for symptoms and other risk factors.
  • Physical examination – Appearance of the patient, palpation
  • Diagnostic tests – The tests performed are:
    • Upper endoscopy – endoscope used to see the inner lining of the esophagus and stomach.
    • Endoscopic ultrasound is a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a sonogram (picture of body tissues).
    • A biopsy is a procedure that removes a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells ( needle biopsy, endoscopic biopsy, laparoscopic biopsy).
    • Upper gastrointestinal (GI) series (barium swallow) – Special x-ray test that uses barium to coat the stomach’s inner lining.
    • CT scan is a procedure that makes a series of detailed pictures of areas inside the body
    • MRI: A technique that uses a magnet, radio waves, and a computer to create a series of clear images of areas inside the body.
    • PET scan: A procedure that uses radioactive glucose to find malignant tumor cells in the body.

 Treatment: How is Gastric cancer treated?

  • Surgery is the only treatment that can cure stomach cancer. The types of surgeries are: 
    • Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection(ESD) – Remove early-stage cancer
    • Partial gastrectomy – some part of the stomach is removed
    • Total gastrectomy – entire stomach is removed
    • lymph node dissection – Surgery to remove lymph nodes
    • Palliative surgery – surgery to relieve signs and symptoms.
  • Radiotherapy
    • An oncosurgeon recommend radiotherapy to reduce the risk of cancer recurrence after surgery.
    • In certain situations, a physician may also recommend radiation therapy before surgery to shrink a tumor and make it easier to remove.
  •  Chemotherapy
    • Chemotherapy uses anti-cancer drugs to stop the growth of cancer cells.
  • Medications – 
    • Platinum compound: Cisplatin, carboplatin, Topoisomerase -1 inhibitors: Irinotecan, Antimetabolites: 5-FU (fluorouracil), taxanes (docetaxel, paclitaxel). 
    • Epirubicin
    • Trifluridine and tipiracil (Lonsurf)
  • Targeted therapy –
    • Trastuzumab (Herceptin, others) and Fam-trastuzumab deruxtecan – targets HER2 (growth-promoting protein)
    • Ramucirumab – Angiogenesis inhibitor – binds to vascular endothelial growth factor (VEGF)
    • Larotrectinib and entrectinib – target the TRK proteins.
  •  Immunotherapy
    • Immune checkpoint inhibitor– The immunotherapy drugs pembrolizumab (Keytruda) and nivolumab are approved to treat tumors with either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor’s location in the body.

Cancer Specialists

 Prevention: Can we prevent it?

 Prevention of Gastric cancer –

  •  Healthy weight
  • Avoid alcohol
  • Diet with low consumption of red meat, high in fruits and vegetables.
  • Vaccination and prevention of H. Pylori infection.

 Living with Gastric cancer–

  •  Follow-up care ( doctor visits and tests)
  • Limit consumption of alcohol
  • Staying at a healthy weight
  • Regular physical activities
  • Diet rich in fruits and vegetables

 When to see a doctor? :

 It is wise to consult with a gastroenterologist immediately if observed any symptoms. The typical consultation fee for a gastroenterologist ranges from Rs. 1000 to Rs. 2000 in India.

Consult Oncosurgeons

 References:

  1. Know the Cancer | Stomach Cancer Treatment | Esophageal.
  2. Liver (Hepatocellular) Cancer Screening (PDQ®)–Patient
  3. How does Ulcerative Colitis affect our life and health

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