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Back to Oncology Diseases
Stomach cancer
Stomach cancer (also called gastric cancer) can
develop in any part of the stomach and may spread throughout the
stomach and to other organs. The cancer may grow along the stomach
wall into the esophagus or small intestine.
It also may extend through the stomach wall and spread to nearby lymph
nodes and to organs such as the liver, pancreas, and colon. Stomach
cancer also may spread to distant organs, such as the lungs, the lymph
nodes above the collar bone, and the ovaries.
When cancer spreads to another part of the body, the new tumor has the
same kind of abnormal cells and the same name as the primary tumor.
For example, if stomach cancer spreads to the liver, the cancer cells
in the liver are stomach cancer cells and the disease is metastatic
stomach cancer, not liver cancer.
A well known complication of stomach cancer is when it spreads to an
ovary; the tumor in the ovary is called a Krukenberg tumor. This
tumor, named for the doctor who first described it, is not a different
disease; it is metastatic stomach cancer - the cancer cells in a
Krukenberg tumor are stomach cancer cells, the same as the cancer
cells in the primary tumor.
Epidemiology
Stomach cancer is more prevalent in China, Japan, Korea, and other
countries in Asia and South America, than in the United States.
Symptoms
Stomach cancer can be hard to find early. Often there are no symptoms
in the early stages and, in many cases, the cancer has spread before
it is found. When symptoms do occur, they are often so vague that the
person ignores them. Stomach cancer can cause the following:
- Indigestion or a burning sensation (heartburn);
- Discomfort or pain in the abdomen;
- Nausea and vomiting;
- Diarrhea or constipation;
- Bloating of the stomach after meals;
- Loss of appetite;
- Weakness and fatigue; and
- Bleeding (vomiting blood or having blood in the stool).
Any of these symptoms may be caused by cancer or by other, less
serious health problems, such as a stomach virus or an ulcer. Only a
doctor can tell the cause. People who have any of these symptoms
should see their doctor. They may be referred to a gastroenterologist,
a doctor who specializes in diagnosing and treating digestive
problems. These doctors are sometimes called gastrointestinal (or GI)
specialists.
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Diagnosis
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:
- Fecal occult blood test
- Upper GI series
- Gastroscopic exam
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.
Staging
If the pathologist finds cancer cells in the tissue sample, the
patient's doctor needs to know the stage, or extent, of the disease.
Staging exams and tests help the doctor find out whether the 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
(or CAT) scan, an ultrasound exam, or other tests to check these
areas.
Staging may not be complete until after surgery. The surgeon removes
nearby lymph nodes and may take samples of tissue from other areas in
the abdomen. All of these samples are examined by a pathologist to
check for cancer cells. Decisions about treatment after surgery depend
on these findings.
Treatment
The doctor develops a treatment plan to fit each patient's needs.
Treatment for stomach cancer depends on the size, location, and extent
of the tumor; the stage of the disease; the patient's general health;
and other factors.
Many people who have cancer want to learn all they can about the
disease and their treatment choices so they can take an active part in
decisions about their medical care. The doctor is the best person to
answer questions about their diagnosis and treatment plan.
When a person is diagnosed with cancer, shock and stress are natural
reactions. These feelings may make it difficult for people to think of
everything they want to ask the doctor. Often, it helps to make a list
of questions. Also, to help remember what the doctor says, patients
may take notes or ask whether they may use a tape recorder. Some
people also want to have a family member or friend with them when they
talk to the doctor -- to take part in the discussion, to take notes,
or just to listen. Patients should not feel the need to ask all their
questions or remember all the answers at one time. They will have
other chances to ask the doctor to explain things and to get more
information.
When talking about treatment choices, the patient may want to ask
about taking part in a research study. Such studies, called clinical
trials, are designed to improve cancer treatment.
Patients and their loved ones are naturally concerned about the
effectiveness of the treatment. Sometimes they use statistics to try
to figure out whether the patient will be cured, or how long he or she
will live. It is important to remember, however, that statistics are
averages based on large numbers of patients. They cannot be used to
predict what will happen to a particular person because no two cancer
patients are alike; treatments and responses vary greatly. Patients
may want to talk with the doctor about the chance of recovery
(prognosis). When doctors talk about surviving cancer, they may use
the term remission rather than cure. Even though many patients recover
completely, doctors use this term because the disease can return (the
return of cancer is called a recurrence).
Getting a Second Opinion
Treatment decisions are complex. Sometimes it is helpful for patients
to have a second opinion about the diagnosis and the treatment plan.
(Some insurance companies require a second opinion; others may pay for
a second opinion if the patient requests it.) There are several ways
to find another doctor to consult:
The patient's doctor may be able to suggest a specialist. Specialists
who treat this disease include gastroenterologists, surgeons, medical
oncologists and radiation oncologists.
The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about treatment facilities, including cancer centers and other
programs supported by the National Cancer Institute.
Patients can get the names of doctors from their local medical
society, a nearby hospital, or a medical school.
Methods of Treatment
Cancer of the stomach is difficult to cure unless it is found in 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. However, advanced stomach cancer
can be treated and the symptoms can be relieved. 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. A
patient may have one form of treatment or a combination of treatments.
Surgery is the most common treatment for stomach cancer. The operation
is called gastrectomy. The surgeon removes part (subtotal or partial
gastrectomy) or all (total gastrectomy) of the stomach, as well as
some of the tissue around the stomach. After a subtotal gastrectomy,
the doctor connects the remaining part of the stomach to the esophagus
or the small intestine. After a total gastrectomy, the doctor connects
the esophagus directly to the small intestine. Because cancer can
spread through the lymphatic system, lymph nodes near the tumor are
often removed during surgery so that the pathologist can check them
for cancer cells. If cancer cells are in the lymph nodes, the disease
may have spread to other parts of the body.
Chemotherapy is the use of drugs to kill cancer cells. This type of
treatment is called systemic therapy because the drugs enter the
bloodstream and travel through the body.
Clinical trials are in progress to find the best ways to use
chemotherapy to treat stomach cancer. Scientists are exploring the
benefits of giving chemotherapy before surgery to shrink the tumor, or
as adjuvant therapy after surgery to destroy remaining cancer cells.
Combination treatment with chemotherapy and radiation therapy is also
under study. Doctors are testing a treatment in which anticancer drugs
are put directly into the abdomen (intraperitoneal chemotherapy).
Chemotherapy also is being studied as a treatment for cancer that has
spread, and as a way to relieve symptoms of the disease.
Most anticancer drugs are given by injection; some are taken by mouth.
The doctor may use one drug or a combination of drugs. Chemotherapy is
given in cycles: a treatment period followed by a recovery period,
then another treatment, and so on. Usually a person receives
chemotherapy as an outpatient (at the hospital, at the doctor's
office, or at home). However, depending on which drugs are given and
the patient's general health, a short hospital stay may be needed.
Radiation therapy (also called radiotherapy) is the use of high-energy
rays to damage cancer cells and stop them from growing. Like surgery,
it is local therapy; the radiation can affect cancer cells only in the
treated area. Radiation therapy is sometimes given after surgery to
destroy cancer cells that may remain in the area. Researchers are
conducting clinical trials to find out whether it is helpful to give
radiation therapy during surgery (intraoperative radiation therapy).
Radiation therapy may also be used to relieve pain or blockage.
The patient goes to the hospital or clinic each day for radiation
therapy. Usually treatments are given 5 days a week for 5 to 6 weeks.
Biological therapy (also called immunotherapy) is a form of treatment
that helps the body's immune system attack and destroy cancer cells;
it may also help the body recover from some of the side effects of
treatment. In clinical trials, doctors are studying biological therapy
in combination with other treatments to try to prevent a recurrence of
stomach cancer. In another use of biological therapy, patients who
have low blood cell counts during or after chemotherapy may receive
colony-stimulating factors to help restore the blood cell levels.
Patients may need to stay in the hospital while receiving some types
of biological therapy.
Clinical trials
Many patients with stomach cancer are treated in clinical trials.
Doctors conduct clinical trials to find out whether a new approach is
both safe and effective and to answer scientific questions. Patients
who take part in these studies are often the first to receive
treatments that have shown promise in laboratory research. In clinical
trials, some patients may receive the new treatment while others
receive the standard approach. In this way, doctors can compare
different therapies. Patients who take part in a trial make an
important contribution to medical science and may have the first
chance to benefit from improved treatment methods. Researchers also
use clinical trials to look for ways to reduce the side effects of
treatment and to improve the quality of patients' lives.
Many clinical trials for people with stomach cancer are under way.
Patients who are interested in taking part in a trial should talk with
their doctor. The booklet Taking Part in Clinical Trials: What Cancer
Patients Need To Know explains the possible benefits and risks of
treatment studies.
One way to learn about clinical trials is through PDQ®, a computer
database developed by the National Cancer Institute. PDQ contains
information about cancer treatment and about clinical trials. The
Cancer Information Service can provide PDQ information to doctors,
patients, and the public.
Side effects of treatment
It is hard to limit the effects of therapy so that only cancer cells
are removed or destroyed. Because healthy cells and tissues also may
be damaged, treatment can cause unpleasant side effects.
The side effects of cancer treatment are different for each person,
and they may even be different from one treatment to the next. Doctors
try to plan treatment in ways that keep side effects to a minimum;
they can help with any problems that occur. For this reason, it is
very important to let the doctor know about any problems during or
after treatment.
The National Cancer Institute booklets Radiation Therapy and You and
Chemotherapy and You have helpful information about cancer treatment
and coping with side effects.
Surgery
Gastrectomy is major surgery. For a period of time after the surgery,
the person's activities are limited to allow healing to take place.
For the first few days after surgery, the patient is fed intravenously
(through a vein). Within several days, most patients are ready for
liquids, followed by soft, then solid, foods. Those who have had their
entire stomach removed cannot absorb vitamin B12, which is necessary
for healthy blood and nerves, so they need regular injections of this
vitamin. Patients may have temporary or permanent difficulty digesting
certain foods, and they may need to change their diet. Some
gastrectomy patients will need to follow a special diet for a few
weeks or months, while others will need to do so permanently. The
doctor or a dietitian (a nutrition specialist) will explain any
necessary dietary changes.
Some gastrectomy patients have cramps, nausea, diarrhea, and dizziness
shortly after eating because food and liquid enter the small intestine
too quickly. This group of symptoms is called the dumping syndrome.
Foods containing high amounts of sugar often make the symptoms worse.
The dumping syndrome can be treated by changing the patient's diet.
Doctors often advise patients to eat several small meals throughout
the day, to avoid foods that contain sugar, and to eat foods high in
protein. To reduce the amount of fluid that enters the small
intestine, patients are usually encouraged not to drink at mealtimes.
Medicine also can help control the dumping syndrome. The symptoms
usually disappear in 3 to 12 months, but they may be permanent.
Following gastrectomy, bile in the small intestine may back up into
the remaining part of the stomach or into the esophagus, causing the
symptoms of an upset stomach. The patient's doctor may prescribe
medicine or suggest over-the-counter products to control such
symptoms.
Chemotherapy
The side effects of chemotherapy depend mainly on the drugs the
patient receives. As with any other type of treatment, side effects
also vary from person to person. In general, anticancer drugs affect
cells that divide rapidly. These include blood cells, which fight
infection, help the blood to clot, or carry oxygen to all parts of the
body. When blood cells are affected by anticancer drugs, patients are
more likely to get infections, may bruise or bleed easily, and may
have less energy. Cells in hair roots and cells that line the
digestive tract also divide rapidly. As a result of chemotherapy,
patients may have side effects such as loss of appetite, nausea,
vomiting, hair loss, or mouth sores. For some patients, the doctor may
prescribe medicine to help with side effects, especially with nausea
and vomiting. These effects usually go away gradually during the
recovery period between treatments or after the treatments stop.
Radiation therapy
Patients who receive radiation to the abdomen may have nausea,
vomiting, and diarrhea. The doctor can prescribe medicine or suggest
dietary changes to relieve these problems. The skin in the treated
area may become red, dry, tender, and itchy. Patients should avoid
wearing clothes that rub; loose-fitting cotton clothes are usually
best. It is important for patients to take good care of their skin
during treatment, but they should not use lotions or creams without
the doctor's advice.
Patients are likely to become very tired during radiation therapy,
especially in the later weeks of treatment. Resting is important, but
doctors usually advise patients to try to stay as active as they can.
Biological therapy
The side effects of biological therapy vary with the type of
treatment. Some cause flu-like symptoms, such as chills, fever,
weakness, nausea, vomiting, and diarrhea. Patients sometimes get a
rash, and they may bruise or bleed easily. These problems may be
severe, and patients may need to stay in the hospital during
treatment.
Nutrition for cancer patients
It is sometimes difficult for patients who have been treated for
stomach cancer to eat well. Cancer often causes loss of appetite, and
people may not feel like eating when they are uncomfortable or tired.
It is hard for patients to eat when they have nausea, vomiting, mouth
sores, or the dumping syndrome. Patients who have had stomach surgery
are likely to feel full after eating only a small amount of food. For
some patients, the taste of food changes. Still, good nutrition is
important. Eating well means getting enough calories and protein to
help prevent weight loss, regain strength, and rebuild normal tissues.
Doctors, nurses, and dietitians can offer advice for healthy eating
during and after cancer treatment. Patients and their families also
may want to read the National Cancer Institute booklet Eating Hints
for Cancer Patients, which contains many useful suggestions.
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