Stomach cancer is a malignant disease of the stomach. The medical term is “stomach carcinoma”. In about 95 percent of cases, gastric cancer originates in the glandular cells of the stomach lining. They produce the gastric juice and the layer of mucus that lines the stomach. In the case of cancer, the gland cells change, they degenerate and multiply unchecked.
If many small tumor foci spread across the stomach wall, experts speak of “diffuse gastric cancer”. If the tumor is located at the transition from the esophagus to the stomach, doctors count it as esophageal cancer. This type of carcinoma is favored by a long-standing reflux disease and by being overweight.
In the early stages, stomach cancer often causes no or only mild symptoms. These signs can also appear in the context of other, less dangerous diseases. Therefore, most people with gastric cancer do not immediately associate their symptoms with cancer, but rather think of a sensitive stomach or assume that they have not tolerated a food. This is one of the reasons why doctors only find gastric cancer at an advanced stage in around two-thirds of patients.
To be on the safe side, always consult your doctor if you have such possible symptoms of stomach cancer. This is especially true if the symptoms do not subside within about two weeks. Behind the signs can be harmless diseases in the digestive tract, but also stomach cancer. The earlier doctors detect the malignant tumor in the stomach, the better it can be treated and the better the chances of recovery.
In contrast to other types of cancer such as breast or colon cancer, there are no suitable measures for the early detection of stomach cancer. Doctors do not recommend screening for gastric cancer in healthy people. Even if gastric cancer runs in the family, a general gastroscopy for early detection is (currently) not recommended. Because it has not been proven that such precautionary measures actually benefit the close relatives of patients with stomach cancer.
Even if there is no program for the early detection of stomach cancer – you can start with the prevention yourself. Incidentally, the term “precaution” includes all measures that can be used to prevent diseases. And with gastric cancer, some risk factors are known that are based on lifestyle.
Stomach cancer originates in the glands of the stomach lining in up to 95 percent of cases. Doctors therefore classify gastric cancer as an adenocarcinoma, in which the tumors form from glandular tissue.
The cause of gastric cancer is partly unknown. However, doctors are aware of several factors that increase the risk of this type of cancer. As with many other types of cancer, several factors probably come together to cause gastric cancer to develop. Age is an important risk factor for many types of cancer. The risk of cancer generally increases with age.
Infection with the gastric bacterium Helicobacter pylori is considered the most important risk factor for gastric cancer. The infection probably happens from person to person, usually in childhood. For example, parents can transmit the germs to their offspring if they lick the pacifier and then put it in their offspring’s mouth. So far there is no protection against infection.
The bacterium nests in the gastric mucosa and triggers chronic inflammation there. Anyone who has contracted the germ has a roughly two to three times higher risk of developing stomach cancer. Some experts assume an even higher risk.
However, not everyone who has been infected with Helicobacter gets stomach cancer. Otherwise the gastric cancer numbers would have to be significantly higher because the infection is widespread. In Germany alone, around 25 percent of adults are carriers of Helicobacter pylori without noticing the secret roommate.
There is some evidence that reflux disease (persistent heartburn), chronic inflammation of the lining of the stomach (gastritis) and a stomach ulcer increase the risk of stomach cancer. Most patients with such gastric diseases harbor a dangerous guest: the gastric bacterium Helicobacter pylori. However, reflux disease is only associated with tumors at the junction between the stomach and esophagus, but not in other regions of the stomach.
Stomach surgery could also promote gastric cancer. For example, patients who have undergone gastric ulcer surgery with partial removal of the stomach have a slightly increased risk of developing stomach cancer many years later.
There are also some stomach diseases that are not caused by Helicobacter. These are also linked to gastric cancer. One example is the rare autoimmune disease type A gastritis, in which the body’s own immune system attacks the cells in the stomach lining and triggers inflammation. This ultimately results in a lack of vitamin B12 and, as a result, anemia. Pernicious anemia is the technical term for it. The rare Ménétrier syndrome also increases the risk of stomach cancer. In these patients, the gastric mucosa proliferates, forms large folds and is chronically inflamed.
Dietary habits affect the risk of gastric cancer. People who eat a lot of animal-based foods are probably more susceptible to this form of cancer. You should therefore consume the following foods sparingly:
Conversely, a diet high in plant-based foods (fruit, vegetables) and dietary fiber (indigestible plant fibers) reduces the risk of stomach cancer. A diet high in antioxidants that scavenge free radicals reduces the risk. Experts call free radicals aggressive oxygen molecules that are produced in various metabolic processes. Good radical scavengers are vitamin C, vitamin E or beta-carotene. So if you eat a lot of fruit and vegetables, you are doing your body and your stomach good.
Stomach cancer runs more frequently in some families – so gastric cancer seems to be hereditary, at least to a certain extent. First-degree relatives (parents, siblings, children) of patients with gastric cancer are more than twice as likely to develop this type of cancer. If two or more first-degree relatives are ill, your own cancer risk increases tenfold. However, the prerequisite is that, in addition to the hereditary factors, there are also other unfavorable conditions, such as unhealthy lifestyle, an infection with Helicobacter pylori or a combination of both.
Rarely is a congenital gene defect behind gastric cancer. An example is familial or hereditary diffuse gastric cancer (HDGC). The so-called CDH-1 gene is changed (mutated). Children inherit this mutation from one parent. Typical are:
Those affected should take advantage of the offer of genetic counseling. Men with this mutation have an approximately 40 to 70 percent risk of developing hereditary gastric cancer in their lifetime. In women, the risk is even higher, at 60 to 80 percent. Women also have a 40 to 50 percent chance of developing breast cancer that starts in the glandular lobes (lobular breast cancer). Anyone who is a carrier of this mutation in the CDH1 gene should therefore think about a preventive complete removal of the stomach. However, it is important to have good information and advice beforehand.
Patients with an inherited form of colorectal cancer – hereditary colorectal cancer without polyposis (HNPCC, Lynch syndrome) – also have an increased risk of developing stomach cancer at some point in their lives. Experts put the probability at 2 to 30 percent.
In people with HNPCC, certain genes are altered at birth that can repair errors in the genome. Children inherit this mutation from one parent. For patients with HNPCC, there are precise early detection and prevention plans that begin at an early age. Information is available on the website of the joint project “Familial Colon Cancer” (www.hnpcc.de).
If you have symptoms such as pain in the upper abdomen, nausea, vomiting or loss of appetite, please consult your family doctor first. If necessary, he will refer you to a gastrointestinal specialist, a specialist in gastroenterology.
At the beginning there is always a discussion with the doctor about your medical history. For example, the following questions are important for the diagnosis of gastric cancer:
These questions give your doctor a first indication of the possible cause. Then follows a physical examination, during which the doctor scans the abdominal organs from the outside for changes.
If the suspicion of stomach cancer is confirmed, a gastroscopy follows. The doctor pushes a thin, flexible instrument through the esophagus into the stomach, which is equipped with a light source and a camera. This gives him a good view of the inside of the organ. In addition, gastroscopy allows tissue to be removed from suspicious areas of the stomach (biopsy). A pathologist then examines the cells in the laboratory under a microscope. Malignant cells are easy to identify and the doctor can diagnose stomach cancer with a high degree of certainty.
If stomach cancer is suspected, doctors usually do a blood test. In fact, certain tumor markers in the blood can be elevated in the case of gastric cancer. These values are called CEA, CA-19-9 and CA 72-4. However, they can also increase with benign diseases in the abdomen. Therefore, their informative value is rather low. Researchers are looking for new tumor markers that provide reliable indications of gastric cancer.
The treatment of gastric cancer belongs in the hands of doctors who have a lot of experience with this clinical picture. Recently there are (still few) certified gastric cancer centers in which doctors from a wide variety of disciplines work hand in hand: surgeons, pathologists, oncologists, radiologists or anesthesiologists. Your treating gastroenterologist often knows a good clinic, because you are certainly not his first patient with stomach cancer.
Gastric cancer treatment always depends on the stage of the cancer and how aggressive it is. Experience has shown that the tumor in the stomach is already more advanced in the majority of patients when doctors discover it. About 35 out of 100 patients with gastric cancer already have distant metastases in other organs, often in the liver, when they are first diagnosed. It is then no longer possible to cure stomach cancer.
In general, the earlier doctors discover stomach cancer, the better it can be treated and the higher the chances of recovery. Age, physical condition and personal wishes also play a role in therapy. In any case, doctors must plan the treatment of gastric cancer carefully.
Surgery is a key treatment for gastric cancer. About six out of ten patients with gastric cancer are operated on in Germany. As a rule, the procedure increases the chances of recovery if doctors are able to completely cut out the cancer. Without surgery, on the other hand, life expectancy decreases because the tumor cells can continue to spread. If the cancer has already formed metastases, an operation does not always make sense. Removal of the stomach would not lead to healing, but it does limit the quality of life. Therefore, drugs are more likely to be used in this case.
Very small tumors that are limited to the lining of the stomach, doctors can sometimes remove them with a small endoscopic procedure. This operation works in a similar way to a gastroscopy. Unfortunately, minimally invasive treatment is rarely an option because gastric cancer is often already at an advanced stage when it is first diagnosed.
Larger tumors that have grown into the stomach wall usually require open stomach cancer surgery via an abdominal incision. Doctors remove part of the stomach and connect the remainder to the esophagus (gastric resection or partial gastric resection). Sometimes they also have to remove the entire stomach (gastrectomy). Then they connect the esophagus directly to the intestine. There are various surgical techniques for such interventions.
Depending on the extent of the tumor, the surgeon often removes surrounding tissue, lymph nodes, the peritoneum, parts of the pancreas or esophagus during cancer surgery. Overall, the operation for stomach cancer is a major and stressful procedure. The operation also involves some risks, such as infections or bleeding. However, it also offers the chance to cure stomach cancer, as long as there are no dormant metastases in the body.
Targeted drugs (“targeted therapy”) are suitable for patients with advanced gastric cancer. The drugs are directed against certain characteristics of a tumor. The prerequisite is that cancer cells actually have these characteristics. Other drugs target processes that the tumor needs to grow. Two antibodies are approved for gastric cancer:
There are also some therapies that doctors use to help counteract the side effects of cancer treatments or cancer-related symptoms. These “supportive therapies” primarily help against pain, nerve damage, anemia, tiredness or exhaustion. Psycho-oncology supports patients with various treatment options to cope with the illness mentally. Specialists are also available for nutritional advice.
The chances of recovery from gastric cancer depend crucially on the stage, aggressiveness and type of tumour. Life expectancy is higher the earlier doctors discover the tumor. In addition, the treatment is usually gentler at an early stage.
One problem, however, is that stomach cancer causes hardly any symptoms at the beginning – so doctors usually only discover the cancer at an advanced stage. Then he has often spread. If metastases are found, this worsens the prognosis for patients with gastric cancer. The following figures show this:
Stomach cancer patients are less likely to survive their tumor than people with other types of cancer. Nevertheless, doctors can still support those affected even if their cancer has metastasized and there is no longer any prospect of a cure. Palliative care relieves symptoms and often maintains a good quality of life.
As with all types of cancer, follow-up care for stomach cancer is extremely important. Regular monitoring of the state of health reveals how the disease and the condition are developing. The following points are of particular importance:
There are no well-defined time intervals for follow-up appointments. First they are shorter, then they gradually lengthen. It is best to discuss with your doctor at what intervals follow-up checks are advisable for you. They also depend on the type of treatment you have undergone or are currently receiving. And if you have any symptoms, you should always see your doctor right away.
Gastric cancer usually occurs in older people. On average, people develop it when they are about 72 years old. Females are slightly older than males at diagnosis: 73.3 years versus 70.5 years. Stomach cancer at 30 is extremely rare, but possible. Then a family predisposition and the genes usually play a role. Men develop malignant tumors more often than women. The reasons could include lifestyle (nutrition, smoking, alcohol). However, the number of cases of gastric cancer has been declining worldwide for several years.
While a healthy lifestyle does not offer 100% protection against stomach cancer, it can reduce the risk.
Some studies have found a protective effect of acetylsalicylic acid (ASA) and other painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) for gastric cancer. However, this only applied if people took the funds long-term. Nevertheless, the results of the investigations are inconsistent; The drugs also have some side effects. Doctors therefore advise against taking these drugs to reduce the risk of stomach cancer.
This article was written by Ingrid Müller, biologist
The original of this post “Doctors often recognize stomach cancer late: Take these symptoms seriously” comes from FOCUS doctor search.