Stomach/Gastric Cancer Surgeon
Stomach / Gastric Cancer
Gastric cancer/ stomach cancer 4th most common cancer in India and 3rd most common cancer in men is the fifth most common cancer in India. It has very high propensity for spread to draining lymph nodes and peritoenum.
Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. Stomach cancer, also called gastric cancer, starts in the stomach.
In India, it is the fifth most common cancer amongst men and sixth most common in women. It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44.
To understand stomach cancer, it helps to know about the normal structure and function of the stomach.
Parts of the stomach?
The stomach has 5 parts:
Cardia: The first part is closest to the esophagus
Fundus: The upper part of the stomach next to the cardia
Body (corpus): The main part of the stomach, between the upper and lower parts
Antrum: The lower portion (near the intestine), where the food mixes with gastric juice
Pylorus: The last part of the stomach, which acts as a valve to control emptying of the stomachcontents into the small intestine
The first 3 parts of the stomach (cardia, fundus, and body) are sometimes called the proximal stomach. The lower 2 parts (antrum and pylorus) are called the distal stomach. Antrum/distal gastric cancer are the commonest in Indian population.
Risk factors that you can modify
Risk factors include less consumption of fruits and vegetables, consumption of salty, smoked and poorly preserved foods, cigarette smoking, tobacco chewing, and radiation exposure.
Fruit and vegetables
Less consumption of fruits and vegetables may increase the risk of getting stomach cancer.
Eating foods that are high in salt can increase the risk of stomach cancer.
Risk of stomach cancer also increases if you eat lots of pickled vegetables which usually have high salt content.
Red and processed meat
A diet high in processed meat such as ham, bacon, salami and sausages has been linked to risk of stomach cancer.
Smoking of food may lead to the release of cancer causing chemicals. Frequent intake of smoked foods has been associated with increased risk of cancers in the gastro-intestinal tract.
Smokers have about 1.5-2.5 times increased risk of stomach cancer than non-smokers. Tobacco chewing has also been linked to an increased risk of stomach cancer
Heavy drinking increases the risk of stomach cancer.
It is a bacteria commonly found inside the lining of the stomach and the duodenum. It has been established as the root cause of most of the stomach ulcers and gastritis. H. pylori infection can be treated with antibiotics. If neglected, these peptic ulcers and gastritis can lead to stomach cancer and MALT (mucosa-associated lymphoid tissue) lymphoma of the stomach.
Certain Medical Conditions
Long-term inflammation of the stomach, anemia due to vitamin B12 deficiency, stomach polyps, obesity etc may increase the risk of stomach cancer.
Eating foods like groundnuts contaminated with a fungus called aflatoxin may increase the risk of stomach cancer.
Risk factors that are not modifiable
Stomach cancer is more common in older people, especially those above 75 years.
Gender: Men are nearly twice as likely to get the disease compared to women.
Certain Genetic Conditions
• Family history of stomach cancer. Risk increases if you had/have a mother, father, sister, or brother who has had stomach cancer.
• Blood group A:Individuals with blood group A have increased risk for stomach cancer [ 31 ]
• Certain inherited syndromes such as Li – Fraumeni syndrome and Familial adenomatous polyposis (FAP) are associated with familial stoamch cancers.
Progression 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 symptoms and therefore often go undetected.
Cancers starting in different sections of the stomach may cause different symptoms and tend to have different outcomes. The cancer’s location can also affect the treatment options. For example, cancers that start at the gastroesophageal junction are staged and treated the same as cancers of the esophagus. A cancer that starts in the cardia of the stomach but then grows into the gastroesophageal junction is also staged and treated like a cancer of the esophagus.
When should you consult a doctor?
If you have one or more of the following symptoms, it is advisable to consult your doctor:
- Difficulty in swallowing (dysphagia)
- Feeling bloated or full after eating small amounts of food
- Unexplained discomfort in the abdomen, usually above navel
- Severe, persistent heartburn or indigestion
- Unexplained, persistent nausea
- Stomach ache
- Persistent vomiting with or without blood
- Unintentional weight loss
- Dark stools due to presence of altered blood
- Swelling in the abdomen
Upper GI endoscopy (Esophagogastroduodenoscopy or EGD).
A thin, flexible lighted tube containing a micro camera at the end is passed down through the mouth into your stomach to look for signs of cancer. If any suspicious area is found, a small piece of tissue is taken from that site (biopsy) for laboratory examination.
Endoscopic ultrasound (EUS):This allows the doctor to look at the layers of the stomach wall. If cancer is there, the doctor can check the nearby lymph nodes and other structures just outside the stomach to determine the extent of cancer spread. EUS can also be used to help in guiding a needle into a suspicious area to get a tissue sample (EUS-guided needle biopsy).
Imaging tests: Contrast enhanced Computerized tomograpgy (CT) of the chest, abdomen and pelvis or PETCECT. Imaging is primarily used for staging in stomach cancer and also for post-treatment response assessment.
BiopsyA small tissue piece is taken from a suspicious-looking area found during endoscopy. Biopsy may also be taken from nearby lymph nodes or suspicious-appearing areas in other parts of the body to confirm spread of the stomach cancer.
Staging laparoscopy – In non- metastatic, locally advanced disease, staging laparoscopy is usually advocated to look for peritoneal metastases before neo-adjuvant chemotherapy.
Who treats stomach cancer?
It is important to have a team of doctors with different specialties involved in your care before plans for treating your stomach cancer are made. Most likely, your team will include:
A gastroenterologist: a doctor who specializes in treatment of diseases of the digestive system.
A surgical oncologist: a doctor who treats cancer with surgery.
A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.
A radiation oncologist: a doctor who treats cancer with radiation therapy.
Dr Krunal is known as the best gi onco surgeon & surgical gastroenterologist in mumbai
The main treatments for stomach cancer are:.
Surgery for Stomach Cancer
Surgery may be done to remove the cancer and part or all of the stomach and some nearby lymph nodes, depending on the type and stage of stomach cancer. The surgeon will try to leave behind as much normal stomach as possible. Sometimes other organs will need to be removed as well.
A. Endoscopic resection
B. Subtotal (partial) gastrectomy
C. Total gastrectomy
D. Lymph node removal – D2 lymphadenectomy
E. Placement of feeding tube
F. Palliative procedure – gastrojejunostomy, placement of feeding tube
Chemotherapy for Stomach Cancer
Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond where it started.
Chemo can be used in different ways to help treat stomach cancer:
Chemo can be given before surgery for stomach cancer. This, known as neoadjuvant treatment.
Chemo may be given after surgery to remove the cancer which is called adjuvant treatment.
Targeted Therapies for Stomach Cancer
Targeted drugs may work in some cases when standard chemo drugs don’t. They also tend to have different side effects from standard chemo drugs
Immunotherapy for Stomach Cancer
Radiation Therapy for Stomach Cancer Radiation therapy uses high-energy rays or particles to killcancer cells in a specific body area. Radiation can be used in different ways to help treat stomachcancer.
Tips to avoid gastric/stomach cancer and precautions to be taken
There is no sure way to prevent stomach cancer, but there are things you can do that could lower your risk.
Diet, nutrition, body weight, and physical activity
Being overweight or obese increases the risk of some types of stomach cancer. Getting regular physical activity might also help lower your risk of stomach cancer.
A diet high in fresh fruits and vegetables probably also lowers stomach cancer risk. Citrus fruits (such as oranges, lemons, and grapefruit) may be especially helpful.
Alcohol use probably increases the risk of stomach cancer, so avoiding or limiting alcohol might lower your risk.
Avoiding tobacco use
Tobacco use can increase the risk of cancers of the proximal stomach (the portion of the stomach closest to the esophagus).
Treating H pylori infection - Some early studies have suggested that giving antibiotics to people with H pylori infection might lower the number of pre-cancerous lesions in the stomach and reduce the risk of developing stomach cancer.
For people at greatly increased risk
Only a small percentage of stomach cancers are known to be caused by hereditary diffuse gastric cancer syndrome. But it's very important to recognize it, because most people who inherit this condition eventually get stomach cancer. A personal history of invasive lobular breast cancer before age 50 as well as having close family members who have had stomach cancer suggests that they might be at risk for having this syndrome. These people can talk to a genetics professional about getting genetic testing. If the testing shows the person has a mutation (abnormal change) in the CDH1 gene, many doctors will recommend they have their stomach removed before the cancer develops. Another hereditary cancer syndrome with an increased risk for stomach cancer is Lynch syndrome.