Stomach cancer or gastric cancer is cancer that develops from the lining of the stomach.

Early symptoms may include heartburn, upper abdominal pain, nausea, and loss of appetite.

Later symptoms may include weight loss, yellow skin, vomiting, difficulty swallowing, and blood in the stool among others.

The cancer may spread from the stomach to other parts of the body, particularly the liver, lungs, bones, lining of the abdomen and lymph nodes.

The most common cause is infection by the bacteria Helicobacter pylori which accounts for more than 60% of cases. Certain type of H. pylori have greater risks than others.

Most cases of stomach cancers are gastric carcinomas. This type can be divided into a number of subtypes. Lymphomas and mesenchymal tumors may also develop within the stomach.

Most of the time, stomach cancer develops through a number of stages over a number of years. Diagnosis is usually by biopsy done during endoscopy. This is then followed by medical imaging to determine if the disease has spread to other parts of the body.

If cancer is treated early many cases can be cured. Treatments may include some combination of surgery, chemotherapy, radiation therapy and targeted therapy. If treated late, palliative care may be advised.

Stomach cancer is often either asymptomatic (producing no noticeable symptoms) or it may cause only nonspecific symptoms (symptoms which are specific not only to stomach cancer but also to other related or unrelated disorders) in its early stages. By the time symptoms occur, the cancer has often reached an advanced stage.

Stomach cancer can cause the following signs and symptoms:

Gastric cancers that have enlarged and invaded normal tissue can cause weakness, fatigue, bloating of the stomach after meals, abdominal pain in the upper abdomen, nausea and occasional vomiting, diarrhea or constipation.

Further enlargement may cause weight loss, or bleeding with vomiting blood or having blood in the stool, the latter appears as black discoloration (melena) and sometimes leading to anemia.

Smoking increases the risk of developing gastric cancer significantly. Gastric cancers due to smoking mostly occur in the upper part of the stomach near the esophagus.

There is a correlation between iodine deficiency and gastric cancer.

Gastric cancer shows a male predominance in its incidence as up to three males are affected by every female. Estrogen may protect women against the development of this cancer form.

To find the cause of symptoms, the doctor asks about the patient’s medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:

The gastroscopic exam is the diagnostic method of choice. This involves the insertion of a fiber optic camera into the stomach to visualize it.

Upper GI series (maybe called barium roentgenogram).

Computed tomography or CT scanning of the abdomen may reveal gastric cancer but is more useful to determine invasion into adjacent tissues, or the presence of spread to local lymph nodes.

Abnormal tissue seen in a gastroscope examination will be biopsied by the surgeon or gastroenterologist. This tissue is then sent to a pathologist for histological examination under a microscope to check for the presence of cancerous cells.

A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells.

Various gastroscopic modalities have been developed to increase the yield of detected mucosa with a dye that accentuates the cell structure and can identify areas of dysplasia.

Endocytoscopy involves ultra-high magnification to visualize cellular structure to better determine areas of dysplasia. Other gastroscopic modalities such as optical coherence tomography are also being tested investigationally for similar applications.

A number of cutaneous conditions are associated with gastric cancer. A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as acanthosis nigricans, is associated with intra-abdominal cancers such as gastric cancer.

Various blood tests may be done including a complete blood count (CBC) to check for anemia, and a fecal occult blood test to check for blood in the stool.

If cancer cells are found in the tissue sample, the next step is to stage or find out the extent of the disease. Various tests determine whether cancer has spread and, if so, what parts of the body are affected.

Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a CT scan, a PET scan, an endoscopic ultrasound exam, or other tests to check these areas.

Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for examination by a pathologist.

The clinical stages of stomach cancer are:

Stage 0. Limited to the inner lining of the stomach. Treatable by endoscopic mucosal resection when found very early (in routine screenings); otherwise by gastrectomy and lymphadenectomy without need for chemotherapy or radiation.

Stage I. Penetration to the second or third layers of the stomach (Stage 1A) or to the second layer and nearby lymph nodes (Stage 1B).

Stage 1A is treated by surgery, including removal of the omentum.

Stage 1B may be treated with chemotherapy (5-fluorouracil) and radiation therapy.

Stage II. Penetration to the second layer and more distant lymph nodes, or the third layer and only nearby lymph nodes, or all four layers but not the lymph nodes. Treated as for Stage I, sometimes with additional neoadjuvant chemotherapy.

Stage III. Penetration to the third layer and more distant lymph nodes, or penetration to the fourth layer and either nearby tissues or nearby or more distant lymph nodes. Treated as for Stage II; a cure is still possible in some cases.

Stage IV. Cancer has spread to nearby tissues and more distant lymph nodes or has metastasized to other organs. A cure is very rarely possible at this stage.

Cancer of the stomach is difficult to cure unless it is found at an early stage (before it has begun to spread).

Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made.

Treatment for stomach cancer may include surgery, chemotherapy, and/or radiation therapy. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials.

The prognosis of stomach cancer is generally poor, due to the fact the tumor has often metastasized by the time of discovery and the fact that most people with the condition are elderly (median age is between 70 and 75 years) at presentation.

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