Gastric cancer is a disease in which malignat (cancer) cells form in the lining of the stomach.
The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system,
which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods. Food
moves from the throat to the stomach through a hollow, muscular tube called the esophagus..
Risk of developing gastric cancer.
Helicobacter pylori (H. pylori) infection of the stomach.
Chronic gastritis (inflammation of the stomach).
Pernicious anemia.
Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
Familial adenomatous polyposis (FAP) or gastric polyps.
Eating a diet high in salted, smoked foods and low in fruits and vegetables.
Eating foods that have not been prepared or stored properly.
Being older or male.
Smoking cigarettes.
Having a mother, father, sister, or brother who has had stomach cancer.
This factors do not ensures the cancer but just increases the risk)
Symptoms of gastric cancer
In the early stages of gastric cancer, the following symptoms may occur:
Indigestion and stomach discomfort.
A bloated feeling after eating.
Heartburn.
Mild nausea, Loss of appetite.
In more advanced stages of gastric cancer, the following signs and symptoms may occur: Blood in the stool, Vomiting.
Weight loss for no known reason, Stomach pain.
Jaundice (yellowing of eyes and skin).
Ascites (build-up of fluid in the abdomen).
Trouble swallowing.
Tests that examine the stomach and esophagus are used to detect and diagnose gastric cancer.
Physical exam and history : An examination of the body to check general signs of health,
including checking for signs of disease, such as lumps or anything else that seems unusual.
A history of the patient's health habits and past illnesses and treatments will also be taken.
Upper endoscopy : A procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine)
to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat
into the esophagus and stomach and directly visualize cancer along with biopsy.
CT scan : The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly .
Certain factors affect prognosis (chance of recovery) and treatment options.
• The stage of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body).
• The patient's general health.
When gastric cancer is found very early, there is a better chance of recovery.
There are different types of treatment for patients with gastric cancer.
Surgery
• Surgery is a common treatment of all stages of gastric cancer. The following types of surgery Removal of the part of the stomach or stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor.
• Inoperable cases may require bypass surgery in form of gastrojejunostomy where stomach anstomosed with small intestine.
• If the tumor is blocking the stomach but the cancer cannot be completely removed by standard surgery, Endoluminal stent placement can be done.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
What is the esophagus ?
The esophagus muscular tube travels down through the chest, between the lungs. It then passes through a hole in the diaphragm to connect with the stomach.
Risk for esophageal cancer
Risk factors for this type of cancer include smoking and alcohol use. Other potential carcinogens include nitrosamines, asbestos fibers, and petroleum products.
Lower esophageal cancer in most cases arise in the setting of Barrett's esophagus (chronic irritation due to stomach acid called as Gastro esophageal reflux disease), which is a condition in which the normal lining of the esophagus is replaced by lining normally found in the stomach. Barrett's esophagus is diagnosed by endoscopy. Other pre-existing esophageal conditions may also increase the risk like achalasia, which is a condition where there is ineffective peristalsis (movement) in the esophagus, as well as caustic esophageal injury, from acid ingestion, can increase the risk of esophageal cancer
How to revent eso ha eal cancer ?
Smoking cessation and decreasing alcohol intake are by far the best methods of decreasing the risk of developing squamous cell carcinoma of the esophagus. The best prevention of adenocarcinoma would be decreasing the risk of chronic GERD, the cause of Barrett's esophagus.
What screening tests are available ?
The "gold standard" for diagnosis is endoscopy and biopsy.
The primary goal of endoscopy is to detect dysplasia early perticularly in Barrett's esophagus.
What are signs of esophageal cancer ?
Over 90% of people with esophageal cancer present with problems swallowing, often leading
to a significant amount of weight loss prior to the actual diagnosis. Patients also report
a sensation that food "gets stuck" somewhere in the chest, where the growing of the cancer precludes the passage of food.
Problems usually start with food, though eventually even liquids could "get stuck" if the cancer progresses and continues
to grow into the hollow tube that the esophagus is. A larger tumor can erode the wall to the point where it causes bleeding.
This can cause patients to cough up blood, or vomit blood. Additionally, if the blood is swallowed, one may notice blood
in the stool or black tarry stools also known as melena. The trachea (windpipe) is located directly in front of the esophagus,
and it is possible for an esophageal cancer to erode the entire way through the esophageal wall and into the trachea, creating
what is called a tracheoesophageal (respiratory) fistula. This causes cough, an irritating sensation with breathing (especially with deep breaths), and hoarseness.
How is esophageal cancer diagnosed ?
An endoscopy is commonly done when people first present with symptoms. Using endoscopy,
the area of concern in the esophagus can be viewed directly with the fiber-optic camera,
and the location of the abnormality, the presence or absence of bleeding, and the amount of
obstruction can all be seen. Endoscopy also allows a biopsy to be performed. The standard of
care today would also include performing an ultrasound during the endoscopy, called an endoscopic ultrasound examination (EUS).
This allows for the prediction of how much of the esophageal wall is involved by tumor.
The CT scan should include imaging of chest and upper abdomen to assess the stage.
What are the treatments for esophageal cancer?
Certain very early tumors, limited to the submucosa (the superficial layer of the esophagus),
may be treated with endoscopic resection. More commonly, people present with advanced stage disease
because symptoms often develop only after the tumor has grown to a large size or has spread.
There are a number of different modalities that can be used to treat esophageal cancer including surgery, radiation,
and chemotherapy. However, in people who can tolerate it, combined modality is preferred.
When the esophagus is removed, the stomach is pulled up into the chest to keep the passageway for food intact.
Not only is there a risk of infection and bleeding from the surgery itself, but the recovery period after
surgery can be difficult. Additionally, there is the risk of a leak forming at the new connection
that is formed between the stomach and the remaining portion of the esophagus (known as an anastamosis),
which can then require further surgery and potentially lead to very serious complications.
Though the results of these studies are somewhat mixed, it is thought that both radiation
and chemotherapy add a benefit. Therefore, radiation therapy (for local tumor control) and chemotherapy
(for distant control as well as to improve the effectiveness of radiation therapy) is almost always recommended either before or after the surgery.