Stomach cancer, sometimes known as gastric cancer, is an abnormal growth of cells that begins in the stomach. Although it can affect any part of the stomach, most stomach cancers form in the main part of the stomach.
This cancer is relatively common in Malaysia, as it was ranked twelfth for new cancer cases in 2020 and attributed to 3 cases in every 100 new cancer cases. Stomach cancer usually affects the older adults, as 6 in 10 newly diagnosed cases each year are age 65 or older.
There are four types of stomach cancer:
- Adenocarcinoma makes up of 90-95% of stomach cancers, which begins in the cells of the stomach lining. The intestinal type has a better prognosis or outcome; the diffuse type spreads faster and is more challenging to treat.
- Lymphoma describes tumour that begins in lymphocytes (immune system cells). It usually starts in other parts of the body, but some can start in the wall of the stomach.
- Gastrointestinal stromal tumour (GIST) is uncommon and mostly begins in the stomach. However, it can develop in any part of the digestive system.
- Neuroendocrine tumour arises from the cells of the neuroendocrine system. Most of these tumours grow slowly and are confined to the stomach, but some may grow and spread quickly.
The following risk factors put one at a higher risk of developing stomach cancer:
- Male gender
- Age 65 and above
- Smoking or vaping
- Drinking too much alcohol
- A diet rich in fatty, pickled, smoked, or salted food
- A diet low in fruits and vegetables
- Helicobacter pylori (H. pylori) infection
- Epstein-Barr virus infection
- Stomach polyps
- Long-term severe gastritis
- Gastroesophageal reflux disease (GERD)
- Family history of stomach cancer
- Certain genetic mutations
Early detection of stomach cancer may be tricky because it rarely shows symptoms. These symptoms may be observed in patients with advanced stomach cancer:
- Loss of appetite
- Unexplained weight loss
- Nausea and vomiting
- Blood in the stool or vomiting blood
- Pain or difficulty swallowing
- Heartburn and indigestion
- Pain in the upper part of the abdomen
- Lump at the upper part of the abdomen
- Feeling full after consuming a small amount of food
- Feeling bloated or gassy after eating
Stomach cancer diagnosis is made based on various investigations. Your doctor would first inquire about your general health and symptoms. Other investigations include:
- Blood tests find anaemia due to bleeding from stomach cancer. It can also show organ function, as poor organ function may mean that cancer has spread to that organ.
- Upper endoscopy is the most commonly done procedure to examine the oesophagus, stomach, and duodenum (first part of the intestine) for abnormal areas.
- Biopsy may be done during upper endoscopy whereby a small sample of tissue may be removed and sent to the laboratory to be examined if abnormal areas are seen.
- Computed tomography (CT) scan provides comprehensive, cross-sectional images of the body's soft tissues using x-rays to determine the location of cancer and the extent of cancer spread to other body parts.
- Endoscopic ultrasound is done to know the extent of cancer spread from stomach lining to stomach wall, or into nearby areas or nearby lymph nodes.
- Positron emission tomography (PET) scan aids in determining the extent of cancer spread to other parts of the body.
- Barium study examines the oesophagus and stomach. Drinking a barium liquid before the test is needed to make the stomach lining more visible on the x-ray.
- Laparoscopy is a minor surgery that might be done if stomach cancer has been found and has not spread to other body parts. This can confirm that the cancer is still limited to the stomach, suggesting that surgical removal of the tumour remains a viable option.
Learn more about the different types of screening and diagnostic procedures performed to diagnose stomach cancer.
The treatment of choice for stomach cancer depends on the type of cancer, the tumour's position and size, and the stage of cancer. The key treatment options used are surgery, chemotherapy, radiotherapy, and targeted therapy.
- Surgery is often part of the treatment for stomach cancer if the cancer remains localised. Surgery may be conducted to remove the cancer and part or all of the stomach, and the affected nearby structures. Meanwhile, palliative surgery is done to prevent bleeding from the tumour or avoid the stomach from obstruction due to the growing tumour – but it is not expected to cure the cancer.
- Chemotherapy employs potent cancer-killing medications and can be given before surgery to shrink the size of the tumour or after surgery to destroy the remaining cancer cells. It is used to reduce the rate of spread of cancer and can be done in a combination with radiotherapy or targeted drug therapy.
- Radiotherapy uses high-energy radiation to shrink tumours and destroy cancer cells. This treatment option is used to relieve symptoms associated with advanced cancer.
- Targeted therapy involves medications aimed at inhibiting the progression of advanced stomach cancer by zeroing in on the weaknesses in cancer cells to kill them. It is often used with chemotherapy in relapse or advanced cases.
- Immunotherapy boosts the immune system to identify and destroy cancer cells that may be difficult to detect, usually for recurring or advanced cancer.
- Palliative care maximises the quality of life by minimising signs and symptoms of cancer, as well as provides additional support that complements the care received from regular providers.
Learn more about the different types of treatment technologies to treat stomach cancer.
While stomach cancer is not always preventable, there are steps you can take to help lower your risk of developing this condition, such as:
- Treat H. pylori infection if tested positive
- Treat ulcers, gastritis, and other stomach conditions promptly
- Quit smoking
- Reduce the intake of alcohol
- Maintain a healthy weight
- Exercising regularly and maintaining an active lifestyle
- Minimise the intake of fried, smoked, and salty food
- Consume more vegetables and fruits
No recommendation on routine screening for stomach cancer in people at average risk is available. However, mass screening with endoscopy has helped detect many stomach cancers at an early, possibly more curable stage.
Discuss with your doctor to understand if you would benefit from screening for stomach cancer.
Gleneagles Hospital works with oncologists to assist patients through cancer treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.