Stomach Cancer

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Introduction

Stomach cancer, also called as gastric cancer, is a cancer which starts in the stomach. To understand stomach cancer, it helps to know about the normal structure and function of the stomach.

The Stomach

The stomach is part of the digestive system. It is a hollow organ in the upper abdomen, under the ribs. Food moves from the mouth through the esophagus to reach the stomach. The food becomes liquid in the stomach which then moves into the small intestine, where it is digested even more.

The wall of the stomach has five layers:

  • Inner layer or lining (mucosa): Juices made by glands in the inner layer help to digest food. Most stomach cancers begin in this layer.
  • Submucosa: It is the support tissue for the inner layer.
  • Muscle layer: Muscles in this layer create a rippling motion which mixes and mashes the food.
  • Subserosa: It is the support tissue for the outer layer.
  • Outer layer (serosa): The outer layer covers the stomach. It holds the stomach in place.

The layers are significant to determine the stage (extent) of the cancer and help to determine a person’s prognosis (outlook). As a cancer grows from the mucosa into the deep layers, the stage becomes more advances and the prognosis is not as good.

Development of Stomach Cancer

Stomach cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach. These early changes rarely cause any symptoms and hence often go undetected.

Cancers starting at different sections of the stomach cause different symptoms and tend to have different outcomes. Also the location of cancer can also affect the treatment options. Stomach cancer can spread or metastasize in different ways. They can grow through the wall of the stomach and invade the nearby organs. They can also spread to the lymph vessels and the nearby lymph nodes that are bean-sized structures which help to fight infections. The stomach has quite a rich network of lymph vessels and nodes. As the stomach cancer becomes more advanced, it can travel through the bloodstream and spread to organs such as lungs, liver and bones. If cancer has spread to the lymph nodes or other organs, the patient’s outlook is not as good. Contact us to know the stomach cancer treatment in India cost by filling our free consultation form.

Types of Stomach Cancer

Different types of stomach cancer include the following:

  • Adenocarcinoma Around 90 to 95 percent of cancers of the stomach are adenocarcinomas. These cancers develop from the cells that form the innermost lining of the stomach known as mucosa. When the term stomach cancer or gastric cancer is used, it almost refers to an adenocarcinoma.
  • Lymphoma These are cancers of the immune system tissue which are sometimes found in the wall of the stomach. Around 4% of the stomach cancers are lymphomas. The treatment and outlook depend on the type of lymphoma.
  • Carcinoid Tumor These tumors start in hormone-making cells of the stomach. About 3% of the stomach cancers are carcinoid tumors. Most of these tumors do not spread to other organs.
  • Gastrointestinal Stromal Tumor (GIST) These are rare tumors which begin in very early forms of the cells in the wall of the stomach called as interstitial cells of Cajal. Some of these tumors are non-cancerous (benign) while others are cancerous. Though GIST’s can be found anywhere in the digestive tract, most are found in the stomach.

Other Cancers

Other types of cancers such as small cell carcinoma, squamous cell carcinoma and leiomyosarcoma can also begin in the stomach but these cancers are very rare.

Risk Factors for Stomach Cancer

A risk factor is anything affecting your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors such as smoking, can be changed. Others, like a person’s age or family history cannot be changed.

But risk factors do not tell us everything. Having a risk factor or even several risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.

Some of the risk factors that make a person more likely to get stomach cancer can be controlled while others cannot be controlled. The following are risk factors for stomach cancer:

  • Gender: Men are more likely to develop stomach cancer than women
  • Age: Often people diagnosed with stomach cancer are aged in between 60’s and 80’s.
  • Ethnicity: Stomach cancer is more common in African Americans, Hispanic Americans and Asian/ Pacific Islanders than the non-hispanic whites.
  • Geography: It is more common in Japan, Southern and Eastern Europe, China and South and Central America. This disease is very less common in South Central Asia, North America and Northern and Western Africa.
  • Stomach Lymphoma: People with certain type of lymphoma of the stomach known as mucosa-associated lymphoid tissue (MALT) lymphoma are at increased risk to get stomach cancer.
  • Helicobacter pylori infection: Infection with helicobacter pylori or H pylori bacteria seems a major cause for stomach cancer in the lower part of the stomach. Long-term infection of stomach with H pylori may lead to inflammation and stomach ulcers. People with stomach cancer have higher rate of H pylori infection but only a small number of people develop stomach cancer.
  • Diet: People with diets of large amounts of salted fish, smoked foods, pickled vegetables and meet are at higher risk of stomach cancer. Eating lots of fresh fruits and vegetables appear to lower the risk of stomach cancer.
  • Tobacco use: Smoking increases the risk for stomach cancers especially for the cancer of the upper portion of the stomach near the esophagus.


Other risk factors are:

  • Previous stomach surgery
  • Being overweight or obese
  • Mentrier disease or hypertrophic gastropathy
  • Pernicious anemia
  • A family history of stomach cancer
  • Type A blood
  • Epstein-Barr virus (EBV) infection
  • Some types of stomach polyps
  • Common variable immune deficiency (CVID)
  • Certain occupations such as workers in the coal, rubber and metal industries
  • Inherited cancer syndromes
    • Hereditary diffuse gastric cancer
    • Hereditary non-polyposis colorectal cancer (HNPCC)
    • Familial adenomatous polyposis (FAP)
    • BRCA1 and BRCA2
    • Li-Fraumeni syndrome
    • Peutz-Jeghers syndrome (PJS)

If you think you may be at risk, then talk with your doctor who will suggest ways to reduce your risk and can plan a schedule for checkups.

Symptoms

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

  • Feeling full or bloated after a small meal
  • Weight loss without trying
  • Discomfort in the stomach area
  • Nausea and vomiting
  • Poor appetite
  • Abdominal pain
  • Heartburn or indigestion
  • Low red blood cell count or anemia
  • Swelling or fluid build-up in the abdomen


Often these symptoms are not due to cancer instead it can be due to ulcer or infection. Anyone with these symptoms should tell their doctor so that problems can be found treated as soon as possible. Get in touch with us to find out the cost of stomach cancer Surgery in India.

Diagnosis

Usually stomach cancers are found when a person goes to the doctor due to the signs and symptoms they have. The doctor will take a history and examine the patient. If stomach cancer is suspected then tests will be needed to confirm the diagnosis.

  • Medical history and physical exam: While taking your medical history, the doctor will ask you questions about your symptoms and the possible risk factors to see if they might suggest stomach cancer or any another cause.

    The physical exam gives your doctor information about your general health, the possible signs of stomach cancer, and other health problems. The doctor will feel your abdomen for any abnormal changes. If your doctor thinks you might have stomach cancer or another type of stomach problem, then he/she will refer you to a gastroenterologist, a doctor who specializes in diseases of the digestive tract for further examination and testing.

  • Upper endoscopy: The doctor passes an endoscope, a thin, flexible, light tube with a small video camera on the end, down your throat, to see the lining of your esophagus, stomach and first part of the small intestine. You are given medication to make you sleepy sedation before this test. It can also be used as a part of special imaging test known as endoscopic ultrasound (EUS) which can be done to see how far a cancer may have spread into the wall of the stomach to the nearby tissues and lymph nodes.
  • Biopsy: The doctor uses an endoscope to remove the tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. This is the only sure way to know if cancer cells are present.
  • Imaging Tests: They use x-rays, sound waves, magnetic fields, or radioactive substances to create pictures of the inside of your body. Imaging tests are done for a number of reasons such as:
    • To find out whether a suspicious area might be cancerous
    • To learn how far the cancer may have spread
    • To determine if treatment has been effective
    The imaging tests are:
    • Upper gastrointestinal (GI) series
    • Computed Tomography (CT or CAT) Scan
    • CT-guided needle biopsy
    • Magnetic Imaging Resonance (MRI) Scan
    • Positron Emission Tomography (PET) Scan
    • Chest X-ray
  • Other Tests
    • Laparoscopy
    • Lab Tests

Staging

The stage of stomach cancer is one of the most significant factors to evaluate the treatment options.

TNM System for Stomach Cancer

This staging system evaluates the extent and spread of stomach cancer. The staging process is basis to select the treatment options and helps the doctors to communicate the potential outcomes (prognosis). TNM system considers the following three key factors:

T- describes the size and growth of the primary stomach tumor
N- provides information about stomach cancer found in regional lymph nodes
M- indicates whether the cancer has metastasized, or spread to other areas

Each of these categories are rated on a numbered scale, the higher the number it indicates of increased severity. And they are grouped into stomach cancer stages from 0-IV.

  • Stage 0: It is carcinoma in situ that is, the cancer is found only in the inner layer of the stomach.
  • Stage I: is one of the following:
    • The tumor has invaded only the submucosa. The cancer cells may be found up to 6 lymph nodes.
    • The tumor has invaded the muscle layer or subserosa. The cancer cells have not spread to lymph nodes or other organs.
  • Stage II: is one of the following:
    • The tumor has invaded only the submucosa. The cancer cells have spread to 7 to 15 lymph nodes.
    • The tumor has invaded the muscle layer or subserosa. The cancer cells have spread to 1 to 6 lymph nodes.
    • The tumor has penetrated the outer layer of the stomach. The cancer cells have not spread to lymph nodes or other organs.
  • Stage III: is one of the following:
    • The tumor has invaded the muscle layer or subserosa. The cancer cells have spread to 7 to 15 lymph nodes.
    • The tumor has penetrated the outer layer. The cancer cells have spread to 1 to 15 lymph nodes.
    • The tumor has invaded nearby organs such as liver or spleen. The cancer cells have not spread to lymph nodes or to distant organs.
  • Stage IV: is one of the following:
    • Cancer cells have spread to over 15 lymph nodes
    • The tumor has invaded nearby organs and at least one lymph node.
    • Or the cancer cells have spread to distant organs

Recurrent Cancer: When the cancer has recurred after a period of time when it could not be detected. It may recur in the stomach or in another part of the body.

Treatment

The multidisciplinary team at the stomach gastric cancer treatment hospital in India includes different types of doctor’s who work together to create a patient’s overall treatment plan which combines different types of treatments. The team includes:

  • Gastroenterologist, a doctor who specializes in the gastrointestinal tract including the stomach and intestines
  • Medical oncologist, a doctor who specializes in treating cancer with medication
  • Surgeon or surgical oncologist, a doctor who specializes in treating cancer using surgery
  • Radiation oncologist, a doctor who specializes in giving radiation therapy to treat cancer


As you sope with stomach cancer and seek treatment, you should talk openly with your doctor, nurse and cancer care team and ask the following questions:

  • Where is the cancer in my stomach?
  • What kind of stomach cancer do I have?
  • What is the stage of my cancer and what does it mean?
  • Are there other tests which should be done before deciding on the treatment?
  • Do I need to see other doctors?
  • What treatment choices do I have?
  • What do you recommend and why?
  • How much experience you have treating this type of cancer?
  • What is the goal of treatment?
  • How quickly do we need to decide on treatment?
  • What should I do to be prepared for treatment?
  • How long will the treatment last? What will it involve and where will it be done?
  • Are there any risks or side effects for the treatments you suggest? How long will they last?
  • Will the treatment affect my daily life and the way I eat?
  • What is my prognosis?
  • What type of follow-up will I need post treatment?
  • What are my options if treatment doesn’t work or the cancer recurs?

Also ensure to ask more information about recovery time or in case you want to get a second opinion. Send us your query to know more about the stomach cancer top hospital in Mumbai India. Book your Low Cost Stomach Cancer Treatment in India on our website.

Getting a Second Opinion

Before starting treatment, you may want to get a second opinion about your diagnosis and treatment plan. Most insurance companies cover a second opinion if you or your doctor requests it. This may take some time and effort as you need to gather medical records and arrange to see another doctor. Although it is not a problem to take several weeks to get a second opinion since in most cases, the delay in starting treatment will not make the treatment less effective. However, ensure to discuss this delay with your doctor as in some cases people with stomach cancer need treatment right away.

Surgery

It is the most common treatment for stomach cancer and the type of surgery depends on the extent of the cancer. There are two main types of stomach cancer surgery.

  • Partial (subtotal) gastrectomy: The surgeon removes part of the stomach with cancer and may also remove part of the esophagus or part of the small intestine. The nearby lymph nodes and other tissues may also be removed.
  • Total gastrectomy: The surgeon removes the entire stomach, nearby lymph nodes and other tissues near the tumor, parts of the esophagus and small intestine. The spleen may also be removed. The surgeon will then connect the esophagus directly to the small intestine. The surgeon will make a new stomach out of tissues from the intestine.

During the surgery, the surgeon will place a feeding tube into your small intestine which helps you to get enough nutrition while you heal. The time taken to heal post surgery varies for each person. You may be uncomfortable for the first few days and medicines will help to control your pain. Discuss the plan for pain relief with your doctor before surgery. Find out the Total Budget of Stomach Gastric Cancer Surgery in India by contacting us.

Most people feel tired or weak for a while post surgery and some of them can also have constipation or diarrhea. Usually, these symptoms can be controlled with diet changes and medicines. Your healthcare team will watch for signs of infection, bleeding, or other problems that need treatment. Get in touch with us to know the Stomach Cancer Surgery Delhi India Cost at the best stomach cancer hospital in Delhi.

Chemotherapy

It uses the anticancer drugs which enter the bloodstream to kill cancer cells. Most people will receive chemotherapy post surgery. Radiation therapy may be given along with chemotherapy. The anticancer drugs for stomach cancer are injected into a blood vessel but some drugs are given by mouth. Your treatment will be done at a clinic at the hospital, doctor’s office or at home and some of you may need to stay in the hospital during treatment.

The side effects of chemotherapy depend on the specific drugs and its doses. They affect the cancer cells and other cells which divide the blood cells, cells in the hair roots, cells that line the digestive tract rapidly. It may also cause skin rash or itching. Your healthcare team will suggest ways to control the side effects.

Radiation Therapy

It uses the high-energy rays to kill the cancer cells in the treated area only. Most people go to a hospital or clinic for treatment which takes usually five days a week for several weeks.

Side effects depend on the dose of radiation and the part of your body being treated. It may cause pain in the stomach or intestine. You may have diarrhea or nausea. Also, your skin may become dry, red and tender. You will feel very tired especially later weeks post treatment. Though resting is important, doctors advise patients to try to stay as active as possible. The side effects usually go away after the treatment ends.

Follow-Up Care

If you have completed with the treatment, your doctors will still watch you closely. It is vital to go to all your follow-up appointments. During these visits, your doctor will ask question about any problems you have and may do exams, lab or imaging tests to look for signs of cancer or treatment side effects. Most doctors will recommend careful follow-up with a physical exam and review of symptoms every three to six months for the first few years and then at least an annual visit.

If you have had surgery, your healthcare team will suggest you to meet a nutritionist to adjust changes in your eating habits. If you had surgery and the upper part of their stomach is removed then you will need to have your vitamin blood levels tested regularly and may need to get vitamin supplements including B12 injections.

Weight loss after stomach cancer surgery is common. A registered dietician will suggest ways to deal with problems with eating. You’ll receive nutrition by a feeding tube or by injection into a blood vessel while some are helped by nutritional beverage products.

Another common problem post stomach surgery is dumping syndrome that occurs when food or liquid enters the small intestine too fast. It could cause nausea, cramps, diarrhea, dizziness and bloating. Eating smaller meals can help prevent it and also cut down on very sweet foods and drink.



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