Cancer Treatment & Information

What are the symptoms of Stomach Cancer?

Early symptoms of stomach cancer tend to be vague and nonspecific. Seek medical attention if you have any of the following symptoms:

• Mild upper abdominal discomfort associated with nausea and loss of appetite
• Difficulty swallowing because of a tumor involving the upper part of your stomach, near the esophagus
• Feeling of fullness after taking only a small amount of food

The following symptoms may indicate advanced disease:

• Fatigue
• Weight loss
• Iron deficiency anemia
• Overt blood loss - Vomiting blood or a material that looks like coffee grounds or passing black stools
• Severe nausea and vomiting - A late symptom caused by blockage of the stomach drainage by the enlarging cancer

How is Stomach Cancer diagnosed?

If you have a symptom that suggests stomach cancer, your doctor must find out whether it is really due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems. The doctor asks about your personal and family health history. You may have blood or other lab tests. You also may have:

• Physical exam: The doctor checks your abdomen for fluid, swelling, or other changes. The doctor also feels for swollen lymph nodes. Your skin and eyes are checked to see if they seem yellow.
• Upper GI series: The doctor orders x-rays of your esophagus and stomach. The x-rays are taken after you drink a barium solution. The solution makes your stomach show up more clearly on the x-rays.
• Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into your stomach. The doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.
• Biopsy: The doctor uses an endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

You may want to ask your doctor these questions about having a biopsy:

• How will the biopsy be done?
• Will I have to go to the hospital?
• Will I have to do anything to prepare for it?
• How long will it take? Will I be awake? Will it hurt?
• Are there any risks? What are the chances of infection or bleeding after the procedure?
• How long will it take me to recover? When can I resume my normal diet?
• How soon will I know the results? Who will explain them to me?
• If I do have cancer, who will talk to me about next steps? When?

What Is Stomach Cancer?

Stomach cancer, also called gastric cancer, is a cancer that starts in the stomach. After food is chewed and swallowed, it enters the esophagus, a tube that carries food through the neck and chest to the stomach. The esophagus joins the stomach just beneath the diaphragm (the breathing muscle under the lungs). The stomach is a sac-like organ that holds food and starts to digest it by secreting gastric juice. The food and gastric juice are mixed and then emptied into the first part of the small intestine called the duodenum.Some people use the word stomach to refer to the area of the body between the chest and the pelvic area. The medical term for this area is the abdomen. For instance, some people with pain in this area would say they have a “stomach ache,” when in fact the pain could be coming from the appendix, small intestine, colon (large intestine), or other organs in the area. Doctors would refer to this symptom as abdominal pain.

This is important because the stomach is only one of many organs in the abdomen in which cancers may start. Stomach cancer should not be confused with cancers of the colon (large intestine), liver, pancreas, or small intestine because these cancers may have different symptoms, a different outlook, and different treatments.

The stomach has 5 sections. The upper portion (closest to the esophagus) is called the cardia. Next to this is the fundus. Some cells in these areas of the stomach make acid and pepsin (a digestive enzyme), the parts of the gastric juice that help digest food. The lower portion (closest to the intestine) includes the antrum, where the food is mixed with gastric juice, and the pylorus, which acts as a valve to control emptying of the stomach contents into the small intestine. The area between the proximal and distal stomach is the body (corpus) of the stomach. The upper parts of the stomach (cardia, fundus, and body) are sometimes called the proximal stomach, and the lower two (antrum and pyloris) are called distal stomach.

Cancers starting in different sections of the stomach may cause different symptoms and tend to have different outcomes. The location can also affect treatment options. The stomach has 2 curves, which form its upper and lower borders. They are called the lesser curve and greater curve, respectively. Other organs next to the stomach include the colon, liver, spleen, small intestine, and pancreas.

The stomach has 5 layers. It is important to know about these layers because as a cancer grows deeper into them, the prognosis (outlook for survival) is not as good. The innermost layer is the mucosa. This is where stomach acid and digestive enzymes are made, and where most stomach cancers start. Under this is a supporting layer called the submucosa. This is surrounded by the muscularis, a layer of muscle that moves and mixes the stomach contents. The next 2 layers, the subserosa and the outermost serosa, act as wrapping layers for the stomach. Stomach cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the lining of the stomach. These early changes rarely cause symptoms and therefore often go undetected.Stomach cancers can spread, or metastasize, in different ways. They can grow through the wall of the stomach and invade nearby organs. They can also spread to the lymph vessels and lymph nodes. Lymph nodes are bean-sized structures near many body structures that help fight infections. The stomach has a very rich network of lymph vessels and nodes. If cancer spreads to the lymph nodes, the outlook for survival is not as good. When the stomach cancer becomes more advanced, it can travel through the bloodstream and spread to organs such as the liver, lungs, and bones.

What causes Stomach Cancer?

While there are many known risk factors for stomach cancer, it is not known exactly how these factors cause cells of the stomach lining to become cancerous. This is the subject of ongoing research. Several changes that are thought to be pre-cancerous can occur in the stomach lining. One of these conditions is atrophic gastritis. This is a condition where the normal glands of the stomach are either decreased or absent. There is some degree of inflammation (the stomach cells are damaged by cells of the immune system), which is often due to H. pylori infection. It is not known exactly why this condition progresses to cancer.

Another change that may also be pre-cancerous is intestinal metaplasia. This is a condition where the normal lining of the stomach is replaced with cells that closely resemble the cells that usually line the intestine. People with this condition usually have chronic atrophic gastritis as well. How and why this change occurs and progresses to stomach cancer is not well understood. This might also be related to H. pylori infection.

Recent research has provided clues to how some stomach cancers form. For instance, H. pylori bacteria, particularly certain subtypes, can convert some of the chemicals in high-risk foods into cancer-causing chemicals that cause mutations (changes) in the DNA of the cells in the stomach lining. This may also explain why certain foods such as preserved meats increase a person’s risk for stomach cancer. On the other hand, some of the foods that lower stomach cancer risk contain antioxidants, which can block substances that damage a cell’s DNA.

During the past few years, scientists have made great progress in understanding how certain changes in DNA can cause normal stomach cells to grow abnormally and form cancers. DNA is the chemical in each cell that carries our genes - the instructions for how our cells function. We resemble our parents because they are the source of our DNA.

But DNA affects more than our outward appearance. Some genes contain instructions for controlling when cells grow and divide. Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. There are also genes that make enzymes to repair the DNA when it develops abnormal changes. Loss of or damage to these genes can also lead to some cancers.