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Cancer, stomach

 

Cancer of the stomach, also known as gastric cancer, affects approximately 480 people in Ireland every year.

However, the number of new cases of stomach cancer are decreasing, and the condition is now only half as common as it was 30 years ago.

Stomach cancer tends to affect those over the age of 55, and it is almost twice as common among men than women.

The stomach

The stomach is an organ that links the oesophagus (gullet) and the duodenum (top of the small intestine). It is part of the digestive system, and its main function is to digest food so that the nutrients can be easily absorbed into the body. It does this by contracting the muscles in the stomach wall that help to break down solid food.

Types of stomach cancer

There are different types of stomach cancer. The most common is adenocarcinoma of the stomach, and this develops in the stomach lining.

A less common type of stomach cancer is lymphoma of the stomach, which develops in the lymphatic tissue (tissue that drains away fluid and helps fight infection).

Another less common type is sarcoma of the stomach, which develops in the muscle or connective tissue of the stomach wall (the most common of which is called a gastrointestinal stromal tumour, or GIST).

 

There are several symptoms of stomach cancer. However, as these are similar to those of many other, less serious conditions, stomach cancer can sometimes be difficult to recognise. For this reason, it can often be quite advanced by the time it is diagnosed.

It is important to get any possible symptoms of stomach cancer checked out as soon as possible. Although it does not necessarily mean that you have stomach cancer, you should see your GP if you experience any of the symptoms outlined below.

Early symptoms of stomach cancer may include:

  • persistent indigestion
  • trapped wind and frequent burping
  • heartburn
  • feeling full very quickly when eating
  • feeling bloated after eating
  • pain in your stomach or breastbone (sternum)
  • difficulty swallowing
  • nausea
  • vomiting (which may be streaked with blood)

The symptoms of more advanced stomach cancer may include:

  • blood in your stools, or black stools
  • loss of appetite
  • weight loss
  • tiredness
  • lumpiness in your stomach (caused by a build-up of fluid)
  • anaemia (lack of red blood cells caused by bleeding from the wall of your stomach)

 

Cancer is caused by the cells in a certain area of your body dividing and multiplying too rapidly. It is not fully understood why cancer of the stomach occurs, but research into the condition is continuing.

Although the cause of stomach cancer is not fully understood, there are several possible risk factors that may make developing the condition more likely. Some factors you cannot do anything about, but there are others that you can change.

Age

Your risk of getting stomach cancer increases with age. Most cases occur in people over the age of 55.

Gender

Men are twice as likely as women to develop stomach cancer.

Smoking

Smokers may be twice as likely to develop stomach cancer compared with non-smokers. This is because some tobacco smoke will always be swallowed when you inhale and end up in your stomach.

Diet

The risk of developing stomach cancer is believed to be linked to eating a large amount of salty foods, such as those that are pickled or smoked. Research has shown that in countries where these types of food are popular, such as in Japan, there are high rates of stomach cancer.

Helicobacter pylori infection

Infection with bacteria called Helicobacter pylori (H pylori) may be linked to stomach cancer in the lower part of your stomach. H pylori infections are very common, but only a small number of people who have H pylori infections develop stomach cancer as a result.

It is possible to be infected with H pylori without knowing it because it does not usually cause any symptoms. However, in some cases, an H pylori infection can cause conditions such as peptic ulcers, recurring bouts of indigestion (dyspepsia), or chronic inflammation of the stomach lining (atrophic gastritis).

Family history

You are more likely to develop stomach cancer if you have a close relative with the condition, such as one of your parents or your brother or sister. It is not fully understood why this is, but it is possible that it is due to family members having certain risk factors in common.

Research into stomach cancer has also shown that you may be more at risk of getting the condition if you have the blood type A. Your blood type is passed on from your parents, so this could be another way in which family history may increase your risk of developing stomach cancer.

There is also a condition that runs in families called familial adenomatous polyposis (FAP), which may make developing stomach cancer more likely. FAP causes small growths, called polyps, to form in your digestive system, and it is known to increase your risk of developing bowel cancer.

Having another type of cancer

If you have had another type of cancer, such as cancer of the oesophagus (gullet), or non-Hodgkin's lymphoma (cancer that develops in the white blood cells in your immune system), you have an increased risk of developing stomach cancer.

There are also other cancers that can make developing stomach cancer more likely, for both men and women. If you are a man, your risk of stomach cancer is increased if you have had cancer of the prostate, bladder, bowel or testicle. If you are a woman, your risk of developing stomach cancer increases if you have had cancer of the ovary, breast or cervix.

Certain medical conditions

Having certain medical conditions can also increase your risk of developing stomach cancer. These are outlined below.

  • Oesophagitis: inflammation of your gullet (oesophagus) caused by a reflux of stomach acid.
  • Gastroesophageal reflux disease (GORD): a severe form of oesophagitis.
  • Pernicious anaemia: a vitamin B12 deficiency, which occurs when you body cannot absorb it properly.
  • Peptic stomach ulcers : an ulcer in your stomach lining, often caused by H pylori infection.
  • Barrett's oesophagus: abnormal changes to the cells in the gullet. This condition also increases your risk of developing cancer of the oesophagus.

Surgery affecting the stomach

If you have had surgery to your stomach, or to a part of your body that affects your stomach, you may be more likely to develop stomach cancer. This can include surgery to remove part of your stomach (known as a partial gastrectomy), surgery to remove part of your vagus nerve (the nerve that carries information from your brain to organs such as your heart, lungs, and digestive system) or surgery to remove a peptic stomach ulcer.

 

Further tests

If you are diagnosed with stomach cancer, further tests may be needed to help to identify the stage and grade of your condition. Your oncologist (specialist in cancer) will discuss this with you.

The stage is used to describe the spread of the cancer at the time of diagnosis, and the grade indicates how aggressively it is spreading. However, it may not always be possible to identify the exact stage of your condition until your treatment starts and you have surgery.

Stages and grades help your doctors to decide on the best kind of treatment for your condition. However, it is important to remember that the stage and grade of your stomach cancer alone cannot predict how your condition will progress.

The additional tests that you may have to show the stage and grade of your condition are outlined below.

Laparoscopy

If your specialist needs to examine your stomach in more detail, in order to look for the signs of the spread of cancer, you may have a small operation called a laparoscopy. This procedure is carried out under a general anaesthetic, which means that you will be asleep.

Your specialist will insert a thin viewing tube with a camera on the end (a laparoscope) through a small cut (incision) in the lower part of your stomach in order to examine it. In some cases, your specialist may need to examine more than one area of your stomach, and may need to make more than one incision.

Computerised tomography (CT) or positron emission tomography (PET) scan

CT or PET scans take a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body.

These scans will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours anywhere else in the body. The scan helps your doctors to work out which type of treatment will be most effective and appropriate for you.

Liver ultrasound scan

If your specialist thinks that your stomach cancer may have spread to your liver, you may need to have a liver ultrasound. This type of scan uses high frequency sound waves to produce an image of your liver.

 

Surgery

If you are diagnosed with stomach cancer at an early stage, you may require surgery to try to remove the cancer.

However, if your cancer has spread beyond your stomach, it may not be possible to remove it completely through surgery. If this is the case, you may still have surgery to remove any cancer that is blocking your stomach, to ease your symptoms. This will depend on balancing the control of your symptoms and the risks and side effects of undertaking a major surgical procedure.

After surgery for stomach cancer

Any kind of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, you will usually have to stay in hospital for around two weeks. You will also need several weeks to recover at home.

Surgery to remove stomach cancer

If you have surgery to remove the cancer in your stomach, and depending on where in your stomach the cancer is, it is likely that you will need to have part or all of your stomach removed.

Surgery to remove part of your stomach is known as a partial gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may also remove part of your oesophagus (gullet), as well as the whole of your stomach, which is known as an oesophagogastrectomy.

During both of these operations, your surgeon will also remove the lymph nodes (tissues that remove bacteria from your body) nearest to the cancer in your stomach. It is possible that your stomach cancer may have spread to these lymph nodes, so removing them helps to prevent the cancer from recurring.

Partial gastrectomy

If your cancer is in the lower part of your stomach, you may have a partial gastrectomy, in which only part of your stomach is removed. This means that the lower part of your stomach will be removed and, afterwards, your stomach will be smaller than it was before surgery. However, the operation will not affect the top part of your stomach, where your oesophagus (gullet) feeds into it.

Total gastrectomy or oesophagogastrectomy

If your cancer is in the middle or at the top of your stomach, you may need to have a total gastrectomy, where the whole of your stomach is removed. If the cancer is close to the end of your oesophagus (gullet), where it meets your stomach, you may also need to have part of your gullet removed. This kind of surgery is known as an oesophagogastrectomy.

If you have a total gastrectomy, your stomach will be removed and the end of your gullet will be joined to the top of your duodenum (the top part of your small intestine). If you have an oesophagogastrectomy, your stomach and the end of your gullet will be removed, and the remaining part of your gullet will be joined to your duodenum.

Surgery to ease your symptoms

If your stomach cancer has spread beyond your stomach, it may not be possible to remove it through surgery.

However, if you have a large amount of cancer in your stomach, it can cause a blockage which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting, and feeling very full after eating.

If you have a blocked stomach, there are a few options which can be considered.

  • You may have a stent inserted where the blockage is. A stent is a plastic or wire mesh tube that is inserted during an endoscopy. After insertion, the stent will expand in place and open up the stomach. 
  • You may be able to have a partial or total gastrectomy to reduce the blockage and improve your symptoms.
  • You may have bypass surgery. In a bypass operation, the part of your stomach above the blockage is joined to your duodenum (the top part of your small intestine), leaving the blocked part of your stomach out of your digestive system. This allows food to move through the unblocked part of your stomach and into your intestines, without coming into contact with the blockage.

 

Chemotherapy

Chemotherapy is a specialist treatment for cancer that uses medicines that can stop the growth of cancer cells. These medicines are known as cytotoxic, which means they target rapidly growing cancer cells, stopping them from dividing and multiplying. As it circulates through your system, the medicine can target cancer cells in your stomach, as well as any that may have spread elsewhere in your body.

You may have chemotherapy for stomach cancer before surgery in order to reduce the amount of cancer that your operation has to remove. You may also have chemotherapy after surgery to destroy any remaining cancer cells, and prevent the cancer from recurring.

Chemotherapy can also be used to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery.

If you need to have chemotherapy, the medicine may be given as tablets or intravenously (by injection or a drip through a vein directly into your bloodstream) or a combination of both. Intravenous chemotherapy is usually given in hospital, while oral chemotherapy is taken at home. Chemotherapy is often given in cycles, each lasting about three weeks.

Alternatively, the medicine may be fed into your system through a small pump, which gives you a constant low dose of chemotherapy over a period of a few weeks or months. The pumps are portable and can be worn at home, which can mean fewer trips to hospital.

Side effects of chemotherapy

Chemotherapy works by preventing cells, such as those that are cancerous, from growing rapidly. However, there are other cells that occur naturally in your body that also divide and multiply rapidly, including hair follicles and red and white blood cells. Chemotherapy destroys these non-cancerous cells, which can cause different side effects including:

  • hair loss
  • nausea and vomiting
  • diarrhoea or constipation
  • rashes on the skin of your hands and feet
  • loss of appetite
  • sores around your mouth
  • anaemia (this may cause tiredness and breathlessness brought on by a lack of red blood cells)
  • leukopenia (this may increase the risk of infection brought on by a lack of white blood cells)

If you need to have chemotherapy, the side effects you experience will depend on the type of cytotoxic medicine that you take, the number of treatment sessions you need to have and your individual reaction to the treatment. You will be told who to contact if you are experiencing serious side effects from chemotherapy and it is very important that this contact information is recorded carefully.

If you experience nausea and vomiting as a result of chemotherapy, you may be able to take anti-sickness medication to counter it. This may be given intravenously (by injection directly into your bloodstream) at the same time as your chemotherapy.

The side effects of chemotherapy will only last for as long as your course of treatment lasts. Once your treatment is over, the rapidly growing cells that occur naturally in your body will repair themselves. This means that your hair will grow back, although it might look or feel different from how it did before your chemotherapy. For example, it may be a slightly different colour, or be softer or curlier than before.

 

Radiotherapy

Radiotherapy uses high energy X-rays and, like chemotherapy, works by targeting rapidly growing cancer cells. Radiotherapy is not often used to treat stomach cancer because there is a risk that other organs that are very close to your stomach might be damaged by the treatment.

However, you may need to have radiotherapy for stomach cancer if you have an advanced form of the condition that is causing bleeding or pain.

In some cases, following surgery, you may have chemotherapy and radiotherapy together, to help to prevent the stomach cancer from recurring. However, this type of treatment is still being researched and, if it is offered to you, it is likely to be as part of a clinical trial.

If you need to have radiotherapy, your treatment will begin several months after your surgery or chemotherapy to give your body a chance to recover. It is a painless procedure in which you lie under a radiotherapy machine while it directs radiation at your stomach. You will be positioned by your radiographer (a specialist in radiotherapy) so that the machine targets only the cancer cells and avoids as much of your healthy tissue as possible.

It is likely that you will have radiotherapy sessions five days a week, for about five weeks. Each session will only last a few minutes. The radiation does not stay in your system afterwards, and it is perfectly safe to be around others in between your treatments.

Side effects of radiotherapy

As radiotherapy works by targeting rapidly growing cancer cells, like chemotherapy, it can have several side effects. Other rapidly growing cells that occur naturally in your body are also damaged by radiotherapy, including the skin cells and the cells that line your digestive system. The side effects of radiotherapy may include:

  • nausea, with or without vomiting
  • diarrhoea
  • tiredness
  • stomach pain
  • irritation and darkening of your skin where the treatment takes place

However, as radiotherapy is usually only used to treat advanced stomach cancer, you may not experience side effects. The aim of the treatment is to relieve your symptoms and make you feel better, so any side effects should be kept under control. You may be given medicines for this, such as anti-sickness medication.

Clinical trials

A great deal of progress has been made in stomach cancer treatment and more people now live longer and have fewer side effects of treatment. These advances were discovered in clinical trials, where new treatments and treatment combinations are compared with standard ones.

All cancer trials in this country are carefully overseen to ensure the trial is worthwhile and safely conducted. In fact, participants in clinical trials can do better overall than in routine care.

If you are asked to take part in a trial, you will be given an information sheet and, if you want to take part, you will be asked to sign a consent form. You are always free to refuse or withdraw from a clinical trial without it affecting your care.

As the causes of stomach cancer are not fully understood, it is not known if there is anything that can prevent it altogether. However, a few factors have been identified that may make the chances of developing stomach cancer less likely.

Eating a healthy diet

The risk of developing stomach cancer is believed to be linked to the kinds of foods that you eat. The fall in the number of cases of stomach cancer over the last 30 years is thought to be due to improvements in diet.

It is possible that stomach cancer may be caused by eating a large amount of salty foods, such as those that are pickled or smoked. Research has shown that in countries where these types of food are popular, such as in Japan, there are high rates of stomach cancer. As people in Ireland do not tend to eat these kinds of foods as often, there tend to be far fewer cases of the condition. Technology such as refrigeration also means that we now eat more fresh food and less pickled or smoked food.

Eating a diet that is low in salt and processed foods and high in fruit and vegetables may help to reduce the risk of stomach cancer.

The FSAI recommends that adults should consume no more than 6g of salt a day, and that you should eat at least five portions of fruit and vegetables a day. As well as helping to prevent stomach cancer, following these recommendations will help to protect against other forms of cancer and heart disease, and will improve your overall health.

 

Quitting smoking

If you smoke, your risk of developing stomach cancer may be twice that of someone who is a non-smoker.

As well as stomach cancer, smoking causes many other forms of cancer and increases your risk of heart disease and stroke.

Research has shown that you are up to four times more likely to successfully give up smoking if you use NHS support together with stop-smoking medicines, such as patches or gum. Ask your doctor about this.

You can also call the National Smokers Quitline at 1850 201 203, or log on to www.quit.ie, or the HSE facebook page at www.facebook.com/hsequit.

 

Recovery and follow up

Recovery

Getting back to normal after surgery can take time. It is important to take things slowly and give yourself time to recover. During this time, avoid lifting things (such as children or heavy shopping bags) and heavy housework. You may also be advised not to drive.

Some other treatments, particularly radiotherapy and chemotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Do not be afraid to ask for practical help from family and friends.

Follow-up

After your treatment has finished, you will be invited for regular check-ups, usually every three months for the first year. During the check-up, your doctor will examine you and may do blood tests or X-rays to see how your cancer is responding to treatment.

Diet after surgery

If you have had a partial gastrectomy, you will only be able to eat small amounts of food for a while after your operation. This is because your stomach will not be able to hold as much food as it could before the surgery, and your body will need to adjust to its new stomach capacity. You should gradually be able to increase the amount that you eat as your stomach begins to expand.

If you have surgery to remove all of your stomach, it may be quite some time before you can eat normally again. As with a partial gastrectomy, you will only be able to eat small amounts of food until your body adjusts. You may have to eat little and often, and make changes to the types of food that you eat. Your cancer team will be able to advise you about what and when you should eat.

Having surgery to remove your stomach also means that you will need to have regular injections of vitamin B12. This is normally absorbed through your stomach from the food that you eat, and is needed to help prevent anaemia (fatigue and weakness caused by a lack of red blood cells) and nerve problems.

Relationships with others

It is not always easy to talk about cancer, either for you or your family and friends. You may sense that some people feel awkward around you or avoid you. Being open about how you feel and what your family and friends can do to help may put them at ease. But do not feel shy about telling them that you need some time to yourself, if that is what you need.

Talk to others

If you have questions, your GP or nurse may be able to reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information on these. Some people find it helpful to talk to other people who have stomach cancer, either at a local support group or in an internet chatroom.

Caring for someone with stomach cancer

Being a carer is not an easy role. When you are busy responding to the needs of others, it can deplete your reserves of emotional and physical energy and make it easy for you to forget your own health and mental wellbeing. Research on carers' health shows that high numbers of carers suffer health effects through caring. And if you are trying to combine caring with a paid job or looking after a family, this can cause even more stress.

But putting yourself last on the list does not work in the long-term. If you are caring for someone else, it is important to look after yourself and get as much help as possible. It is in your best interests and those of the person you are caring for.

Look after your health

Eat regularly and healthily. If you do not have time to sit down for every meal, try to make time to sit down for at least one of your day's meals. Instead of relying on fast food snacks, go for healthier options, such as fruit.

Look after your emotional health

It is understandable if there are times when you feel resentful and then guilty for feeling like this. Combine that with exhaustion, isolation and worries about the person you are caring for. But you are human and those feelings are natural.

Look for support

Friends and family may not always understand what you are going through and it can be helpful to talk to people in the same situation.

Dealing with dying

If you are told that there is nothing more that can be done to treat your stomach cancer, your GP will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.

 


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.