Stomach cancer

Reviewed by Alastair J Munro, professor of radiation oncology

What is stomach cancer?

Stomach cancer is the result of cell changes in the lining of the stomach. In Western Europe, stomach cancer is only about one third as common as it was 50 years ago.

The location of the tumours within the stomach has also changed. It used to be that most of the tumours were located near where the stomach joins the small bowel, now the commonest site is close to the junction with the oesophagus (gullet).

Stomach cancer is very common in Japan and the Japanese have developed an intensive and effective approach to screening for stomach cancer.

What causes stomach cancer?

The causes of stomach cancer continue to be debated. A combination of heredity (the genes inherited from your parents) and environment (diet, smoking, etc) are all thought to play a part.

Milk, fresh vegetables, vitamin C and frozen food all appear to reduce the risk of stomach cancer. Any kind of food that has been smoked, pickled or salted appears to increase the risk.

Other risk factors that have been suggested include being blood group A, and having the bacteria Helicobacter pylori in the stomach.

Stomach cancer is more common in men than women, and has its peak age range between 40 and 60 years old.

What are the symptoms of stomach cancer?

Stomach cancer can grow slowly and imperceptibly. Sometimes symptoms will only develop once the disease has spread beyond the stomach, for example to involve the liver. In this case, the symptoms would be those of cancer involving the liver.

There may be internal bleeding appearing as blood in the vomit, or black, tar-like, faeces, or the bleeding may be so slight as to pass undetected, and the patient goes to the doctor with iron-deficiency anaemia. Or there may be vomiting due to the obstruction of the food passage by the tumour, which is the first sign that something is wrong.

Excessive belching can be an early, and embarrassing, symptom. This can progress to a sensation of vague discomfort followed by pain if the tumour grows through the stomach wall.

As with cancer of the oesophagus, it may take a long time, often many months, from the time that symptoms first appear to the patient seeking medical advice. This delay may allow time for the tumour to spread and to progress from being potentially curable to being inoperable.

Good advice

If you have the slightest suspicion of any of the symptoms mentioned, you should contact your doctor at once for an assessment.

How is stomach cancer diagnosed?

Investigations for cancer of the stomach include:

X-ray examination, in this case a barium meal. This involves swallowing a white, chalky liquid and having a series of X-ray pictures taken of the stomach area.

the most important test is a gastroscopy. During a gastroscopy, the doctor examines the inside of the stomach using a camera attached to a flexible tube and is able to take a sample from the tumour for biopsy and microscopy.

How is stomach cancer treated?

The most effective treatment is surgery and the sooner the disease is discovered, the better the chances of a complete recovery. The cure rate after surgery is about 30 per cent.

In Japan, where stomach cancers are detected much earlier in the course of the disease, survival rates are higher. This shows the importance of early diagnosis.

Unfortunately, in the UK, many patients do not realise the significance of their symptoms until the later stages of the disease and this significantly reduces the chances of cure.

Chemotherapy has recently been shown to be highly effective against some forms of stomach cancer and may help convert an inoperable tumour into an operable one. The regime used is toxic and complicated and, unfortunately, only a minority of patients are fit enough to be treated in this way.

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