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Stomach Cancer (Gastric Cancer)

  • What is stomach cancer?

    Stomach cancer

    The stomach is the organ located between the oesophagus and small intestine. It receives food from the oesophagus for digestion, and then passes it to the small intestine.

    Stomach cancer (also called gastric cancer) is an abnormal growth of tissue in the stomach. This abnormal growth of cells may form a tumour or ulcer (painful sore) within the stomach or spread through the wall of the stomach.

    There are different types of stomach cancer, and tumours can develop in different parts of the stomach, but the most common type is adenocarcinoma, which forms in the cells of the stomach lining.

    In Singapore, stomach or gastric cancer is the 7th most common cancer in men and the 9th most common cancer in women. On average, it is responsible for 300 deaths every year. In many cases, stomach cancer is asymptomatic in its early stages, causing many patients to present at a late or advanced stage.

  • Stomach cancer forms when cells grow abnormally but it is unclear what causes it.

    Risk factors for stomach cancer

    • Age

      Stomach cancer is more common after the age of 50.
    • Chronic gastritis

      Long-term gastritis or inflammation of the stomach may affect the stomach lining, where stomach cancer usually forms.
    • Diet

      A diet high in salted, pickled, and smoked foods is linked to increased risk for stomach cancer.
    • Ethnicity

      People of Asian descent appear to have higher risk for stomach cancer.
    • Exposure to certain chemicals or substances

      Substances such as asbestos are known carcinogens and the working environment in coal, metal, timber and rubber industries may also increase your risk.
    • Family history

      Those who have a close family member with stomach cancer or inherited genetic conditions such as Lynch syndrome face a higher risk as well. People with Type A blood are also at higher risk.
    • Gender

      Men are more likely to get stomach cancer compared to women.
    • Infection with helicobacter pylori (H. pylori) bacterium or Epstein-Barr virus

      People with stomach cancer often have an infection with helicobacter pylori (a bacterium) but not everyone who has this infection will develop stomach cancer.
    • Prior surgical procedures

      Past surgery affecting the stomach, such as surgery for stomach ulcers, may increase the risk for stomach cancer.
    • Smoking

      Smoking increases your risk for many types of cancer, including stomach cancer.
    • Stomach polyps and ulcers

      Polyps are abnormal growths that form on the stomach lining.

    Reducing the risk of stomach cancer

    • Eat less salted, pickled and smoked foods

      Over time, these foods can damage the stomach lining hence limiting your intake of these foods may help to reduce your risk.
    • Eat more fruits, vegetables and whole grains

      A healthy and balanced diet can help reduce your risk for many types of cancer, including stomach cancer.
    • Get more exercise

      Being active and fit benefits your overall health and lowers your risk for many diseases.
    • Maintain a healthy body weight

      If you are overweight or obese, losing weight can help reduce your risk.
    • Stop smoking

      In relation to stomach cancer, smoking increases the risk of cancer developing in the part of the stomach near the oesophagus. Smoking also increases your risk for many other types of cancer.
    • Seek treatment for infections and ulcers

      Infection with the bacterium H. pylori can be treated with antibiotics.
  • In its early stages, stomach cancer is often asymptomatic. However, as it develops, symptoms may include:

    • Chronic pain in the stomach or abdomen
    • Discomfort similar to indigestion
    • Feeling bloated after eating
    • Heartburn or acid reflux
    • Loss of appetite
    • Unexplained weight loss

    As the cancer progresses, more serious symptoms may include:

    • Anaemia (lack of red blood cells in blood)
    • Blood in the stools, which makes the stools appear black
    • Build-up of fluid in the abdomen
    • Difficulty swallowing
    • Jaundice
    • Vomiting
  • Stomach cancer is diagnosed using several tests and procedures, following an examination of your health, lifestyle and family history.

    These may include one or more of the following:

    • Biopsy

      A biopsy is a procedure to collect tissue or cell samples, which are then analysed for the presence of cancer cells.
    • Blood tests

      Analysis of your blood may reveal the presence of certain substances or markers that point towards cancer. A complete blood count is also helpful to measure if red and white blood cells, platelets and haemoglobin levels are within the normal range.
    • Computed tomography (CT) scan

      A CT scan provides detailed images of internal organs and tissues to check if and how far the cancer has spread. It may be performed with a dye for greater clarity.
    • Endoscopic ultrasound

      Ultrasound uses soundwaves to create an image of the tumour, to see how far it has spread. It may also be used to check the lymph nodes around the tumour.
    • Upper endoscopy

      An endoscope is a small device with a camera. It is inserted via the mouth to view the inside of the oesophagus, stomach and duodenum (the first section of the small intestine).
    • X-ray with barium

      A chemical, barium, is consumed to line the oesophagus and stomach, allowing anomalies to show up more clearly on X-ray.

    These tests will help your doctor to determine the stage or extent of the stomach cancer, which are:

    • Stage 0

      In Stage 0, abnormal cells are detected in the innermost layer of the stomach wall. It is also called carcinoma in situ.
    • Stage I

      Stage I is divided into Stage IA and Stage IB, indicating the presence of cancer cells in the innermost layer of the stomach wall and may have spread to the next layer or the nearby lymph nodes or the muscle layer.
    • Stage II

      Stage II is divided into Stage IIA and IIB, indicating the cancer has spread to more lymph nodes, past the muscle layer, the next layer of connective tissue, or it has spread to the outermost layer of the stomach wall.
    • Stage III

      Stage III is further divided into Stage IIIA, Stage IIIB and Stage IIIC. These indicate the cancer has spread to even more lymph nodes, past the muscle layer, the next layer of connective tissue and the outermost layer of the stomach wall. At this stage, it may also have spread to nearby organs such as the spleen, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, small intestine or the back of the abdomen.
    • Stage IV

      In Stage IV, the cancer has spread to more distant parts of the body such as the lungs, distant lymph nodes and the tissue that lines the abdomen wall.
  • Treatment for stomach cancer depends on how far it has spread. It includes:

    • Endoscopic submucosal dissection

      This procedure uses an endoscope to remove cancer in its early stages.
    • Surgery

      Surgery to remove the stomach is called a gastrectomy. It is performed to remove part or all of the stomach, which may also include removal of nearby lymph nodes, the spleen, and parts of the oesophagus or small intestine. Surgery can nowadays be done using minimal access techniques such as laparoscopic surgery and robotic surgery.
    • Chemotherapy

      Chemotherapy may be recommended to kill cancer cells or stop the cancer cells from spreading, on its own or in conjunction with radiotherapy. It may also help to reduce the symptoms of stomach cancer if surgery is not possible.
    • Radiotherapy

      Radiotherapy uses high-energy x-rays to destroy remaining cancer cells after surgery. It may be recommended in conjunction with chemotherapy.

    • Targeted therapy

      Targeted therapy is aimed at specific cancer cells to stop the growth and spread of a tumour. It is associated with milder side effects when compared to chemotherapy or radiotherapy.

    • Immunotherapy

      Immunotherapy uses medications to enhance your body’s immune system to fight cancer.

    Early diagnosis of stomach cancer is important for effective treatment. If you are at risk for stomach cancer, speak to your doctor about the necessary screening or diagnostic checks.

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  • Complications of stomach cancer, if left untreated, include the more severe symptoms such as jaundice and build-up of fluid in the abdomen. It can lead to life-threatening bleeding, perforation, and spread to other organs like the liver, lung and bones.

    Possible complications post-surgery, especially if part or all of the stomach has been removed, may include:

    • Changes in bowel habits

      Surgery to remove the stomach affects how your body processes food.
    • Inability to eat regular meals

      You may find that you feel very full even after small meals. To ensure you consume enough nutrients, you may need to eat smaller meals more frequently throughout the day.
    • Vitamin deficiency

      Your ability to absorb nutrients will be affected, which may lead to conditions like anaemia or brittle bones (osteoporosis). Speak to your doctor about nutritional supplements.
    • Dumping syndrome

      Your reduced capacity for digesting sugar and starch may lead to a sudden drop in blood pressure, as your small intestine will draw water from the rest of the body, including your blood. You can ease the symptoms by eating slowly, avoiding sugary foods and liquid foods, and resting for at least 20 minutes after eating.
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