Stomach Cancer

What is stomach cancer?
Cancer of the stomach mostly originates from the inner lining (mucosa) of the stomach, when the cells divide and reproduce at an uncontrollable rate and form growths which have the potential of spreading to other parts of the body.
What are the causes of stomach cancer?

The exact causes are unknown, but there are certain risk factors which are associated with the disease, increasing the chances of getting stomach cancer:

  • Helicobacter pylori infection – a bacteria which commonly infects the mucosa of the stomach, causing inflammation and ulcers.
  • Long-term inflammation of the stomach – with the blood disease pernicious anaemia, and those who have had part of their stomach removed
  • Smoking – smokers are more likely than nonsmokers to develop stomach cancer
  • Family history – close relatives having the disease increase the risk of one getting afflicted, especially when many relatives were affected
  • Poor diet, lack of physical activity, or obesity – studies have showed that a diet rich in preserved (smoked, pickled, salted) is associated with stomach cancer, as is a lack of physical activity and obesity
What are the symptoms of stomach cancer?

Early stomach cancer often does not cause symptoms. As the cancer grows, the most common symptoms are:

  • Discomfort or pain in the stomach area
  • Difficulty swallowing
  • Nausea and vomiting
  • Weight loss
  • Feeling full or bloated after a small meal
  • Vomiting blood or having blood in the stool
How is stomach cancer diagnosed?
If you have symptoms that suggest stomach cancer, you will need to undergo a thorough consultation and investigation. This starts off with a comprehensive personal and family health history and physical examination. Subsequently, a gastroscopy (also known as OGD or oesophagogastroduodenoscopy) may be required, to perform a biopsy. A biopsy is the removal of tissue from the stomach, for a pathologist (a doctor specialised in looking at tissue under the microscope) to analyse. The biopsy is the only sure way to know if cancer cells are present.
Should I be screened for stomach cancer?

The incidence of stomach cancer in South East Asia is not as high as in Japan or Korea, where screening is recommended for those above 40 years. Nevertheless, there are certain population groups which see an incidence which can possibly warrant a useful screening with gastroscopy.

In addition, while inherited genetically-linked stomach cancer is uncommon, certain disease patterns in families will warrant an individual for screening:

  • Chinese males aged 50–70
  • At least 2 cases of stomach cancer in the family, with at least one diagnosed before 50
  • Family history of gastric cancer before age 45
  • Family history of diffuse gastric cancer
How is stomach cancer treated?
The choice of treatment depends mainly on the size and location of the tumour, stage of disease and your general health. While the earliest stages of stomach cancer can be treated through gastroscopy guided procedures, the mainstay of treatment still involve surgery, chemotherapy or radiation therapy. Most patients receive more than one type of treatment, and have a team of specialists planning the treatment.
What kind of surgery is needed for stomach cancer?

The type of surgery depends on mainly on where the cancer is located – either the whole stomach or the part bearing the cancer is removed.

  • Subtotal gastrectomy for tumours at the lower part of the stomach: the lower part of the stomach is removed, and the remaining part attached to the intestine
  • Total gastrectomy for tumours at the upper part of the stomach: the entire stomach is removed, and the oesophagus is connected directly to the small intestine

The systematic removal of surrounding lymph nodes is also routinely performed, for the most comprehensive clearance of disease. The surgery is always performed under general anaesthesia (GA), through a cut in the abdomen. In selected cases, it can also be accomplished via laparoscopy (key-hole) surgery.

While the time to discharge from hospital after surgery is normally within a week, recovery and time to healing differs between individuals. Post-surgery pain is normally tolerable, and controlled with medicine. Mobility is normally achievable on the day after surgery, while the health care team watches for signs of bleeding, infection or other problems.

Is chemotherapy and radiotherapy needed for stomach cancer?
Most people with stomach cancer get chemotherapy, which can be given before or after surgery. After surgery, radiation therapy may be given alongside chemotherapy. Chemotherapy can be given either through a vein (intravenous), orally or in combination.
What nutritional precautions should I have after stomach surgery?
Nutrition is an important part of your treatment for stomach cancer. You need the right amount of calories, protein, vitamins and minerals to maintain your strength and to heal. While the capacity of the stomach is greatly reduced or even nullified from removal after surgery, digestion of food remains normal. However, you may need to take daily supplements of vitamins and minerals, such as vitamin D, calcium and iron. You may also need vitamin B12 shots.

Some people have problems eating and drinking after stomach surgery. Liquids may pass into the small intestine too fast, which causes dumping syndrome. The symptoms are cramps, nausea, bloating, diarrhea and dizziness. To prevent these symptoms, it may help to make the following changes:

  • Plan to have smaller, more frequent meals
  • Drink liquids before or after meals
  • Cut down on very sweet foods and drinks (such as cookies, candy, soda and juices)
What follow-up care should I expect after stomach cancer surgery?

You will require regular checkups after treatment for stomach cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact the Clinic. Checkups may include a physical exam, blood tests, x-rays, CT scans, endoscopy or other tests.