Stomach (Gastric) Cancer

General Information

About

Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach. Stomach cancer can be serious and is a common cause of death worldwide. Fortunately, rates of stomach cancer in the United States are falling.

Risk Factors

A risk factor increases your chances of developing a disease. The risk factors for stomach cancer include:

  • Presence of H. Pylori: These stomach-dwelling bacteria can be with antibiotics. While not everyone who develops stomach cancer has H. Pylori bacteria, those who do may be at increased risk.
  • Gender: Men are more likely than women to develop stomach cancer.
  • Pernicious anemia: A severe lack of red blood cells can lead to stomach cancer.
  • Absence of acid production: Lack of sufficient acid in the stomach can contribute to the development of stomach cancer.
  • Gastric polyps: Certain types of gastric polyps are more likely to develop into cancer.
  • Certain inherited diseases: Diseases such as hereditary non-polyposis colon cancer (HPNCC) may be associated with stomach cancer.
  • Smoking
  • Alcohol consumption

 

Signs & Symptoms

These symptoms are similar to those of acid reflux. If you experience any of these, consult with your primary care doctor.

  • Abdominal pain
  • Heartburn
  • Nausea
  • Vomiting
  • Weight loss
  • Feeling full after small meals

Detection 

To determine if you are suffering from a GIST tumor, as well as whether it is surgically removable, your surgical oncologist will perform a number of diagnostic tests, including:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Endoscopic ultrasound (EUS): Sound waves create images of body tissues where high-energy sound waves are bounced off internal tissues and organs; the echoes are then changed into pictures called sonograms. EUS can also guide the removal of tissue for biopsies.
  • Laparoscopy: A laparoscope (a thin, lighted tube) is inserted through an incision in the abdominal wall to determine if the cancer is within the stomach only or has spread to nearby tissues and if it can be removed by surgery later.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.
  • Upper endoscopy: A procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus.
  • Barium Swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
  • CEA (carcinoembryonic antigen) assay: Tests that measure the level of CEA in the blood. This substance is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gastric cancer or other conditions.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.

 

Stages

Doctors use a staging system to describe the extent of spread of most types of cancer, including gastrointestinal stromal tumors (GISTs). The most common system used is the TNM system of the American Joint Committee on Cancer (AJCC). This system is based on 4 key pieces of information:

  • T describes the size of the primary tumor, measured in centimeters (cm).
  • N describes whether the cancer has spread to nearby (regional) lymph nodes (this is very rare for GISTs).
  • M indicates whether the cancer has metastasized (spread) to other organs of the body. If a GIST does spread, most often it is within the abdomen, such as to the liver. Less often, it may spread to the lungs and bones.
  • The mitotic rate is a measure of how fast the cancer cells are growing and dividing. It is described as either low or high. A low mitotic rate predicts a better outcome.

Numbers or letters appear after T, N, and M to provide more details about each of these factors:

  • The numbers 0 through 4 indicate increasing severity.
  • The letter X means “cannot be assessed” because the information is not available.

Stage 0 (Carcinoma in Situ)

  • In stage 0, abnormal cells are found in the inside lining of the mucosa (innermost layer) of the stomachwall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the inside lining of the mucosa (innermost layer) of the stomach wall. Stage I is divided into stage IA and stage IB, depending on where the cancer has spread.

  • Stage IA: Cancer may have spread into the submucosa (layer of tissue next to the mucosa) of the stomach wall.
  • Stage IB: Cancer: may have spread into the submucosa (layer of tissue next to the mucosa) of the stomachwall and is found in 1 or 2 lymph nodes near the tumor; or has spread to the muscle layer of the stomach wall.

Stage II

Stage II gastric cancer is divided into stage IIA and stage IIB, depending on where the cancer has spread.

  • Stage IIA: Cancer:
    • has spread to the subserosa (layer of tissue next to the serosa) of the stomach wall; or
    • has spread to the muscle layer of the stomach wall and is found in 1 or 2 lymph nodesnear the tumor; or
    • may have spread to the submucosa (layer of tissue next to the mucosa) of the stomach wall and is found in 3 to 6 lymph nodes near the tumor.
  • Stage IIB: Cancer:
    • has spread to the serosa (outermost layer) of the stomach wall; or
    • has spread to the subserosa (layer of tissue next to the serosa) of the stomach wall and is found in 1 or 2 lymph nodes near the tumor; or
    • has spread to the muscle layer of the stomach wall and is found in 3 to 6 lymph nodes near the tumor; or
    • may have spread to the submucosa (layer of tissue next to the mucosa) of the stomach wall and is found in 7 or more lymph nodes near the tumor.

Stage III

Stage III gastric cancer is divided into stage IIIA, stage IIIB, and stage IIIC, depending on where thecancer has spread.

  • Stage IIIA Cancer:
    • has spread to the serosa (outermost) layer of the stomach wall and is found in 1 or 2 lymph nodes near the tumor; or
    • has spread to the subserosa (layer of tissue next to the serosa) of the stomach wall and is found in 3 to 6 lymph nodes near the tumor; or
    • has spread to the muscle layer of the stomach wall and is found in 7 or more lymph nodes near the tumor.
  • Stage IIIB Cancer:
    • has spread to nearby organs such as the spleen, transverse colon, liver, diaphragm, pancreas, kidney,adrenal gland, or small intestine, and may be found in 1 or 2 lymph nodes near the tumor; or
    • has spread to the serosa (outermost layer) of the stomach wall and is found in 3 to 6 lymph nodes near the tumor; or
    • has spread to the subserosa (layer of tissue next to the serosa) of the stomach wall and is found in 7 or more lymph nodes near the tumor.
  • Stage IIIC Cancer:
    • has spread to nearby organs such as the spleen, transverse colon, liver, diaphragm, pancreas, kidney,adrenal gland, or small intestine, and may be found in 3 or more lymph nodes near thetumor; or
    • has spread to the serosa (outermost layer) of the stomach wall and is found in 7 or more lymph nodes near the tumor.

Stage IV: 

Stage IV cancer has spread to distant parts of the body.

 

Treatments

Your MedStar Health team, which includes a medical oncologist, radiation therapist, and surgical oncologist, will carefully evaluate your condition and determine the most effective form of treatment for you.

  • Surgery: After diagnosing your stomach cancer, and determining that it has not spread to other organs, your surgical oncologist will likely recommend that you have surgery. The extent of the surgery will depend on where your tumor is located and whether it has spread to the surrounding lymph nodes. Surgery generally involves removing part or all of the stomach as well as affected lymph nodes.
  • Chemotherapy: Major studies suggest that chemotherapy either with or without radiation may add to the benefits of surgery. Chemotherapy, which is cancer medication that you receive through your veins, can attack tumor cells in the body that surgery and imaging cannot detect.
  • Post-surgical Care: Your team will monitor your progress every three months for the first two years following stomach cancer surgery. We will repeat your endoscopy and CT scan to make sure the cancer is not coming back. We also encourage patients to meet with our:
    • Nutritionist, who will help you understand any necessary changes in your diet following your treatment.
    • Social worker, who will help you manage any other needs and concerns before, during, and after your treatment.

 

Services at Lombardi

Cancer information from the NCI PDQ service