The stomach cancer is a disease caused by uncontrolled growth of cells of the stomach. The most common malignant tumor of the stomach is adenocarcinoma, accounting for more than 90%, followed by non-Hodgkin’s lymphomas and leiomyosarcoma.
Benign tumors such as adenomas or leiomyomas are rare, but they can be important as precursors of more advanced lesions or causing gastrointestinal bleeding.
Gastric adenocarcinoma has been the leading cause of cancer death in Western countries until about 30 years ago. In recent years its incidence has decreased. In Spain, in 1980, gastric cancer was still the second malignant tumor that caused death, surpassed globally only by lung cancer and, in women, by breast cancer.
The incidence of stomach cancer is highly variable depending on the geographical area considered. There are countries like Japan, Chile, Colombia, etc. with high incidence. The incidence is low in the USA, Senegal, New Zealand, Uganda, etc.
In Spain the incidence is medium, with very low rates in the Mediterranean area and very high in areas of the Castilian plateau. It affects more men than women. Regarding the age of onset, the maximum incidence is between 60 and 80 years. Around 10%, in patients under 50 years of age.
It has an unfavorable prognosis, with a mean overall survival of about 11 months.
Causes of stomach cancer
There are several factors that increase the incidence of gastric adenocarcinoma:
Genetic : some familial aggregation and a higher incidence in blood group A have been shown.
Environmental : there is an association between diet and the appearance of gastric adeno. Thus, the incidence increases: salt, smoked foods, the high proportion of grasses and tubers, some canned foods, salted foods and the nitrate content of drinking water; decrease the incidence: proteins, fat of animal origin, fresh fruit, vegetables, citrus fruits, vitamins C, A and E and selenium, and refrigerated foods.
Pre-cancerous disorders such as :
- Pernicious anemia and gastritis of the fundus.
- Previous gastric surgery.
- Common variable immunodeficiency (adult hypoganmaglobulinemia).
- Antisecretory drugs used in the treatment of peptic ulcer.
Precancerous lesions such as :
- Chronic atrophic gastritis.
- H. pylori.
- Intestinal metaplasia.
- Hypertrophic gastropathy.
- Gastric ulcer.
- Gastric polyps.
The gastric adeno would be the result of a complex process of many years of evolution, in which the interaction of several environmental factors, among which the most important would be an infection by H. Pylori and the consumption of a specific diet, on a predisposed terrain (perhaps genetically conditioned), would successively lead to mucosal inflammation, atrophy, intestinal metaplasia, dysplasia and finally adenocarcinoma.
The carcinogenesis process would be slow, especially in its early stages. As cancer develops, its evolution would be faster, estimating that the doubling time of the tumor mass is 30 times faster in the final stages than in the initial stages.
Symptoms of stomach cancer
Often there is pain or discomfort in the epigastrium, any persistent epigastric symptoms, however bland it may seem, should motivate a further investigation.
Less commonly, patients present with dysphagia, especially in subcardial tumors, or a pyloric stenosis syndrome when the tumor prevents gastric emptying.
Sometimes the first clinical manifestation is an upper gastrointestinal bleeding (UHD), and in others, a chronic anemic syndrome.
Very often, unspecific general manifestations predominate in the clinical picture, such as weight loss, asthenia, anorexia, sometimes selective to meat, or progressive deterioration of the general state.
Physical examination in early cancer is negative in most cases.
In advanced cancer, there is often: nutritional deficit, paleness and palpation of an epigastric mass.
How is it diagnosed?
Various diagnostic techniques are used:
Laboratory data : there may be anemia, usually microcytic, and other nonspecific data.
Tumor markers : CEA, Ca 19-9 and Ca 72-4 are especially elevated.
Gastric acid secretion study : invasive examination that lacks sufficient discriminatory value.
Radiology : it is an effective procedure. Gastric cancer can present three basic radiological patterns:
- Add-on image in ulcerated cancers.
- Defect of repletion in vegetants.
- Zones of wall stiffness in infiltrating forms.
Fibrogastroscopy : allows the taking of histological and cytological samples. Endoscopic signs that suggest malignancy are:
- Irregular morphology of the ulceration.
- Settlement on a vegetative mass or on an infiltrated area.
- Poorly delimited and nodular contours.
- Necrotic and irregular background.
- Folds that do not reach the edge of the lesion with a hard and friable consistency.
- Stiffness and loss of compliance of the neighboring mucosa.
Endoscopic ultrasound : a development technique that in the future will make it possible to assess the extent of the tumor through the wall.
CT : allows to assess the extent of the tumor lesion.
Stomach Cancer Treatments
Surgery is the treatment of choice for stomach cancer.
Prior to the intervention, a complete diagnostic process must be carried out to better understand the extent of the tumor and the surgical risk of the patient.
If your general condition does not prevent it, it is advisable to always try the surgical approach, since, although in less than half of the cases the entire tumor can be resected, in others it is possible to carry out palliative techniques that improve the quality of life.
In essence there are three basic surgical techniques:
- Distal subtotal gastrectomy. Approximately 80% of the distal stomach, the gastrohepatic omentum, and a portion of the greater omentum are resected. It is completed with reconstruction of the intestinal transit. It is used for tumors of the gastric antrum without evidence of spread or invasion of the perisplenic nodes.
- Total gastrectomy. The entire stomach, greater and lesser omentum, and spleen are resected, along with careful lymphatic dissection. It is completed with reconstruction of the intestinal transit. It is used for more widespread gastric body and antrum tumors.
- Extended total gastrectomy. In addition, variable portions of the infiltrated neighboring organs, such as the transverse colon, the tail, and the body of the pancreas, or the left lobe of the liver, are resected.
The radiotherapy is beneficial action in solving problems or palliation of algic.
The role of chemotherapy is disputed.
How to avoid it?
The intake of a diet rich in fruits, vegetables and proteins and poor in salted, smoked and especially in salt should be recommended to the population.
International recommendations for the nitrate content of drinking waters should be followed.
Control environmental exposure to asbestos, chromium, and vinyl chloride.
It is not known whether eradication of H. Pylori in young ages will lead to a decrease in this tumor.
It is debated whether previously gastrectomized patients with pernicious anemia or atrophic gastritis should undergo periodic check-ups, with endoscopy and biopsy, although it seems reasonable to assume that mortality from gastric cancer would be reduced.
A correct initial diagnosis of malignant gastric ulcers would determine a lower mortality from gastric cancer, therefore, fibrogastroscopy with biopsy taking is recommended in all gastric ulcers.
The appearance of persistent epigastric pain, however bland it may seem, will require a doctor’s visit to initiate a complete study.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.