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Stomach Cancer
· Stomach Cancer Introduction
· Risk Factors
· Stomach Cancer Symptoms
· Diagnosis
· Stomach Cancer Treatment
· Prognosis
· Prevention
· For More Information
· Web Links
· Multimedia
· Synonyms and Keywords
· References
· Authors and Editors
· Related stomach cancer articles:
Stomach cancer - on WebMD
Stomach Cancer Introduction
The stomach is a muscular bag with a capacity of about 1
liter or quart. It lies along the digestive tract between
the esophagus and the small intestine. The stomach serves
as a reservoir for food eaten during meals and begins the
process of digestion. Its inner walls are composed of glands
that secrete acid and digestive enzymes.
The most common form of cancer that affects the stomach
is adenocarcinoma, which arises in the glands of the innermost
layer of the stomach. This tumor tends to spread through
the wall of the stomach and from there into the adjoining
organs (pancreas and spleen) and lymph nodes. It can spread
through the bloodstream and lymph system to distant organs
(metastasize).
· The incidence and death rates for stomach cancer
have decreased markedly during the past 60 years. In 1930,
stomach cancer was the leading cause of cancer-related deaths
among American men. Since then, the death rate in men from
stomach cancer in the United States has dropped from 28
to 5 per 100,000 people.
· In 1996, about 22,800 new cases
of stomach cancer were diagnosed in the United States, and
14,000 Americans died of the disease. This form of cancer
is 1.5-2.5 times more common in African American, Hispanic,
and Native American people than in whites.
Risk Factors
· Stomach cancer remains the second most frequent
cause of cancer-related death worldwide, with particularly
high frequencies in Japan, China, Korea, parts of Eastern
Europe, and Latin America. Established risk factors for
stomach cancer include the following:
o Low socioeconomic status
o Male sex
o Advanced age
o A prior diagnosis of pernicious anemia
(a chronic progressive disease caused by the failure of
the body to absorb vitamin B-12)
o A diet deficient in fresh fruits and
vegetables and rich in salted or smoked fish or meats and
poorly preserved foods
· Treating benign stomach or duodenal
ulcer disease by removing part of your stomach is associated
with an increased risk of cancer developing in the remaining
stomach, especially at least 15 years after the surgery.
· Recent studies have demonstrated
a higher frequency of stomach cancer in people chronically
infected with Helicobacter pylori, a common cause of chronic
gastritis and peptic ulcer disease.
· A family history of stomach cancer
is a further risk factor in the disease.
· People with blood type A also
have an increased risk.
Stomach Cancer Symptoms
· Early symptoms of stomach cancer tend to be vague
and nonspecific. Seek medical attention if you have any
of the following symptoms:
o Mild upper abdominal discomfort associated with nausea
and loss of appetite
o Difficulty swallowing because of a tumor
involving the upper part of your stomach, near the esophagus
o Feeling of fullness after taking only
a small amount of food
· The following symptoms
may indicate advanced disease:
o Fatigue
o Weight loss
o Iron deficiency anemia
o Overt blood loss - Vomiting blood or
a material that looks like coffee grounds or passing black
stools
o Severe nausea and vomiting - A late
symptom caused by blockage of the stomach drainage by the
enlarging cancer
Diagnosis
Two procedures are used in the diagnosis of stomach cancer.
· Gastrointestinal (GI) endoscopy is superior because
it allows a direct view of the area of concern. The doctor
can also take a sample of tissue (biopsy) to confirm the
diagnosis.
· Barium studies are also effective
in detecting stomach cancers, although they may be less
effective in detecting small tumors.
o Suspicious areas seen on barium study always require further
endoscopic checking.
o Barium studies may have a major role
in screening because they cause less discomfort compared
with gastroscopy.
· Once doctors establish the diagnosis,
further tests are performed, including the following:
o A CT scan of the abdomen
o Chest x-ray film
o Nuclear bone scans: These may be helpful
in ruling out advanced disease that has spread outside your
stomach walls.
Stomach Cancer Treatment
The treatment of stomach cancer depends on the results of
tests and your overall health.
· People with advanced heart and lung disease may
not tolerate aggressive therapy.
· In many cases, the stomach cancer may have advanced
too far for any available treatment to work.
· You will require surgery to be
cured. Your stomach is removed entirely, and your esophagus
is attached to your small intestine.
· Surgery may relieve symptoms
of obstruction. The upper end of your stomach is connected
to your small bowel, bypassing the area of obstruction.
· Companion treatment with either
chemotherapy or radiation may improve your survival following
surgery.
· After your stomach has been removed,
your doctor will monitor your disease with repeat CT scans
of your abdomen and gastrointestinal endoscopy to make sure
the cancer does not return.
Prognosis
If you have advanced stomach cancer, your chance for recovery
is poor. Whether the cancer has spread into your abdominal
cavity is the crucial factor in predicting your outcome.
· The average survival time is usually less than
1 year, regardless of where the primary tumor was located.
None of the available treatments seem to improve the survival
time.
· Factors that point to poor recovery include the
following:
o Presence of cancer in your lymph nodes
o Involvement of distant organs
o Tumors involving the upper one third of your stomach
· Few people with these problems live 5 years.
· If your cancer is found at an early stage of development,
your chance of long-term survival approaches 70%.
Prevention
· The number of stomach cancers has decreased because
of the following:
o Improved socioeconomic standards
o Widespread use of refrigeration for food preservation
o Adoption of diets rich in fruits and vegetables
· In areas where frequency of stomach cancer remains
high, such as Japan, screening programs that include upper
GI barium studies and, more recently, gastrointestinal endoscopy
have improved survival rates.
· Doctors are finding more cases at an early stage
of development.
· Eliminating Helicobacter pylori infection in people
with peptic ulcer disease also may decrease rates of stomach
cancer.
· It has been suggested that people who had portions
of their stomachs removed 20 years ago or longer should
receive yearly endoscopies. This is because of the increased
risk of stomach cancer following such surgery.
· Evidence does not support mass screening of populations
with lower rates of stomach cancer.
References
1. Fuchs CS, Mayer RJ. Gastric carcinoma. N Engl J Med.
Jul 6 1995;333(1):32-41. [Medline].
2. Greene FL. Management of gastric remnant carcinoma based
on the results of a 15-year endoscopic screening program.
Ann Surg. Jun 1996;223(6):701-6; discussion 706-8. [Medline].
3. Hensrud DD, Heimburger DC. Diet, nutrients, and gastrointestinal
cancer. Gastroenterol Clin North Am. Jun 1998;27(2):325-46.
[Medline].
4. Stein HJ, Sendler A, Fink U, Siewert JR. Multidisciplinary
approach to esophageal and gastric cancer. Surg Clin North
Am. Apr 2000;80(2):659-82; discussions 683-6. [Medline].
5. Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the
stomach. A patient care study by the American College of
Surgeons. Ann Surg. Nov 1993;218(5):583-92. [Medline].
Authors and Editors
Author: Robert J Fingerote, MD, MSc, BSc, Consulting Staff,
Department of Medicine, Division of Gastroenterology, Queensway-Carleton
Hospital of Ottawa, Canada.
Editors: Scott
H Plantz, MD, FAAEM, Research Director, Assistant Professor,
Department of Emergency Medicine, Mount Sinai School of
Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy
Editor, eMedicine; Jerry Balentine, DO, Professor of Emergency
Medicine, New York College of Osteopathic Medicine; Medical
Director, Saint Barnabas Hospital.
http://www.emedicinehealth.com/
stomach_cancer/article_em.htm
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