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Stomach Cancer


Stomach Cancer overview and Definition

When cells multiplies out of control in the gastric region(stomach) it might leads to the Stomach cancer.


Epidemiology

It is more commom among men when compared to women.


Structure of Stomach Cancer

The stomach is an organ which aids in the digestive mechanism. It consists of fundus, body and pyloric region. Cardia is the first part and it is closest to the esophagus. Fundus is the uppermost part of the stomach. Body is the main part of the stomach. And the pyloric region is the last part od the stomach and it contains the valve which mediates the passage of food into the small intestine. Antrum is the lower portion of the stomach where the gastric fluids( acid) mixes with the food.


Pathophysiology

Types of Stomach Cancer:

Adenocarcinomas:

Adenocarcinomas develops from the gland cells in the innermost lining of the stomach.

There are two types of stomach adenocarcinomas:

Intestinal: These tends to have better prognosis.

Diffuse: This type tends to grow and spread more quickly. It is less common and it tends to be harder than to treat.

Gastrointestinal stromal tumours(GIST):

They are started in the wall of the stomach called interstitial cells of Cajal. They commonly occurs in the stomach.

Neuroendocrine Tumours (Including Carcinoids):

Neuroendocrine tumors (NETs) start in cells in the stomach (or other parts of the digestive tract) that act like nerve cells in some ways and like hormone-making (endocrine) cells in others. Most NETs tend to grow slowly and do not spread to other organs, but some can grow and spread quickly.

Lymphomas:

They gets started in the immune system called lymphocytes. Lymphocytes usually can start in other parts of the body but it can also start in the wall of the stomach.


Clinical signs & symptoms

  • Difficulty swallowing
  • Feeling bloated after eating
  • Feeling full after eating small amounts of food
  • Heartburn
  • Indigestion
  • Nausea
  • Stomach pain
  • Unintentional weight loss
  • Vomiting
  • Changes in the bowel habits.

 


Differential Diagnosis

Biopsy:

It is the removal of a small amount of tissue for examination under the microscope. A biopsy is the confirmatory test for stomach cancer.

Fine needle aspiration:

In this type of biopsy the physician moves the fine needle  through the abdomen and take the tissue needed for the diagnosis.

Endoscopic biopsy:

In this type of biopsy, the physician uses an endoscope an hollow tube . light emitting structure to down the stomach and tissues are obtained.

Molecular diagnosis of the tumour:

Specific genes, proteins and other unique genes can be identifies in this test.

PD-L1 and high microsatellite instability which is called as mismatch repair defect.

Human epidermal growth factor is secreated in larger amount in this disease. And these things should be  noted carefully.

Blood test:

Patient with the stomach cancer  tends to show low levels of platelets, white blood cells, red blood cells.  This results in the aneamia in patients. Complete blood count might reveal whether the bleeding is occurring or not.

Computed tomography:

A CT scan takes three dimensional pictures of the abnormal tissues from different angles.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Ultrasound:

A sound waves to create the picture of the internal organs to find out if the cancer is spread or not.

Abdominal ultrasound:  with the patient symptoms it can be used to view the pancreas. But it cannot reveal the spread of pancreas.

Endoscopic ultrasound: in this method the doctor uses an ultrasound probe, and with the guidance of endoscope it is passed in to the small intestine and then into the pancreas to view the structures.

Barium Swallow:

The patient is asked to swallow the liquid Barium. Barium gets deposited in the lining of the stomach ,

esophagus and small intestine.

If X rays are taken at this time it might show some blockages in the stomach and other areas clearly.

Positron emission tomography (PET) or PET-CT scan:

A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. With the help of the PET scan one can be able to find out the stage of cancer.

Liver function test:

              The bilirubin levels and the level of other digestive enzymes and liver enzymes such as Alanine transaminase, Aspartate transaminase and Alkaline phosphatase should be checked.

Liver function test is useful when Liver acts as a secondary site.

Tumour marker:

  • CA 19-9
  • Carcinoembryonic antigen (CEA)
  • Stage 0:
  • The cancer is not spread but has potential development of the cancer in the future which is termed as carcinoma insitu.
  • Stage 1:
  • The cancer cells are consider to the localized area. This is also called the early stage cancer
  • Stage 2 and Stage 3:
  • It indicates that the cancer cell has spread to the nearby lymphnodes or tissues.
  • Stage 4:
  • It indicates that the cancer has spread to distant organs.


Prognosis

The five year survival rate of the cancer which is diagnosed earlier and does not spread to the distant organ is 70%

The fiver year survival rate of the cancer with distant spread is 30%.

 


Prevention

Avoid alcohol consumption

Check the blood sugar regularly

Follow the healthy diet

Be physicaly active

Don’t neglect the initial symptoms and have the proper treatment.

Avoid spicy foods.


Reference

https://www.cancer.net/cancer-types/stomach-cancer/types-treatment

https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/syc-20352438

https://www.cancer.org/cancer/stomach-cancer/about/what-is-stomach-cancer.html

https://www.nhs.uk/conditions/stomach-cancer/

https://www.cancer.net/cancer-types/stomach-cancer/statistics#:~:text=If%20the%20cancer%20is%20diagnosed,year%20survival%20rate%20is%2032%25.