Patients & Visitors

Upper GI Surgery

Stomach Cancer

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Overview Causes Symptoms Diagnosis & Assessment Treatment Options Prognosis Related Links & Information

Overview of Stomach Cancer

Stomach cancer is sometimes called gastric cancer. In the United Kingdom it is more common in men than in women and tends to occur mainly in older people. Most cases are in people over the age of 50.

Stomach cancer begins when the cells that form the lining of the stomach become abnormal and start to grow in an uncontrolled way. As these cancer cells multiply they form a tumour.

If the tumour continues to grow, it can invade deeper into the wall of the stomach. Eventually, it may pass through the wall of the stomach and grow into nearby organs such as the pancreas, liver or spleen. The tumour may also spread more widely throughout the stomach wall or into the oesophagus.

Cancer cells can also break away from the stomach and spread into lymph channels or into the blood stream. When this happens then cancer can spread to nearby lymph nodes or can spread to other parts of the body (such as the lungs, liver or bones).

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Causes of stomach cancer

The exact reason why cells within the stomach lining become cancerous is not fully understood. In many cases there is no apparent reason why someone has developed a stomach cancer. However, there are certain risk factors which do increase the chance of developing it. These include:

  • Ageing
    It is more common in older people
  • Smoking
    Stomach cancer is much more common in people who smoke
  • Diet
    In some countries of the world (such as Japan) where people eat a lot of salt, pickled and smoked foods, there is a higher rate of stomach cancer. Eating a lot of fruit and green vegetables is known to reduce the risk of stomach cancer
  • Helicobacter Pylori
    This is a very common, long term stomach infection in the United Kingdom, and the vast majority of people with this infection do not develop stomach cancer. However, it does very slightly increase the risk of causing stomach cancer

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Symptoms of stomach cancer

When a stomach cancer first grows it is small and usually causes no symptoms. Once the cancer becomes larger then it can produce symptoms which might include:

  • Pain or discomfort in the upper abdomen
    Especially after eating
  • Indigestion
    The vast majority of people who do have indigestion have problems with increased acidity in the stomach and not stomach cancer
  • Feeling sick or off food
    Many patients develop a sense of fullness after eating
  • Vomiting blood
  • Passage of blood into the gut
    The stomach cancer can cause small amounts of bleeding. This blood passes through the gut and eventually into the motions. A lot of bleeding from the stomach can turn the motions very black.

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Diagnosis & Assessment of Stomach Cancer

Initial assessment

If your doctor has concerns that you may have stomach cancer then he or she will usually examine you to look for any signs of a lump in the abdomen or for signs of anaemia.

Often physical examination is normal, especially if the cancer is at an early stage. Therefore, initial assessment usually involves a gastroscopy (endoscopy).

The gastroscope is a thin, flexible telescope which is passed through the mouth into the oesophagus and stomach. It contains fibreoptic channels down which light can be shone to visualize the lining of the stomach.

Biopsy to confirm diagnosis

A biopsy is a small sample of tissue taken through the gastroscope. The sample is examined under the microscope to look for any abnormal cells to help determine whether there is any evidence of cancer.

Assessing the extent and spread of cancer (staging)

If cancer of the stomach has been diagnosed then further tests may be needed to assess in more detail the size of the cancer and to determine whether the cancer may have spread to any other parts of the body. The extent to which the cancer has spread is described as “the stage” of the cancer. Tests used to determine the stage of the cancer are described as "staging investigations".

These assessments are intended to find out:

  • How much the cancer in the stomach has grown and whether it has grown partially or fully through the wall of the stomach
  • Whether the cancer has spread to local lymph nodes around the stomach
  • Whether the cancer has spread to other areas of the body (such as the lungs, liver, bones or distant lymph nodes)

A number of different investigations may be used to fully stage the stomach cancer and these might include:

CT scan (computerized tomography)

CT scan used x-ray beams and a computer to take cross sectional images of the chest and abdomen. This type of examination is useful in looking for evidence that cancer may have spread from the stomach to other parts of the body.

Endoscopic ultrasound (EUS)

Endoscopic ultrasound combines endoscopy and ultrasound to provide detailed information about the thickness of the cancer.

In many cases this is not needed when assessing stomach cancer. However, if the cancer affects the top part of the stomach where it joins to the oesophagus – then EUS can be used to assess whether there is any involvement of the oesophagus. This is important in planning further treatment.

Staging laparoscopy

This investigation involves passing a camera into the abdominal cavity under general anaesthetic. This allows direct visualization of the outer surface of the stomach and lining of the abdominal cavity. It is used to assess whether there has been any spread of cancer beyond the stomach into the abdominal cavity.

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Treatment Options

Treatment options may include surgery, chemotherapy and sometimes radiotherapy.

The treatment recommended in each case depends on both the stage of the cancer and your general health.

Some of the treatments are potentially quite difficult to tolerate and for patients with poor health, may not be safe.

These options are discussed in great detail with a specialist who will have discussed your case with other specialist colleagues through our Multi-Disciplinary Team. They will be able to discuss with you the pros and cons of each treatment, the likely success rate, possible side effects and other details about possible treatments.

Where possible, the aim of treatment will be to try and cure the cancer. In cases where the cancer is treated at an early stage, then this is possible.

However, in some cases, curative treatment is not realistic. This may be because the cancer has spread too far to be cured by any treatment or it may be that someone’s general health is so poor that any attempt at curative treatment would not be possible. In such circumstances, treatment would be aimed at limiting the growth or spread of the cancer and trying to keep patients free of symptoms for as long as possible.

Surgery

Where stomach cancer has been detected at an early stage and remains confined to the stomach, then it may be possible to operate and remove the stomach and contained cancer.

Such surgery may involve removing part or all of the stomach. These operations are major procedures and do carry some risk. The issues relating to surgery will be discussed in great detail with your specialist.

To improve the safety and success of such surgery, our cancer network has made arrangements for all operations to be carried out in a single centre at the University Hospitals Bristol NHS Foundation Trust (formerly know as the BRI). Although this does involve travelling, it does mean that if you need to undergo surgery then you will be cared for by a specialist team who have developed significant expertise in performing this operation on a very regular basis.

Chemotherapy

Chemotherapy uses anti-cancer drugs to kill cancer cells or stop them from growing.

Chemotherapy may be used in addition to other treatments such as surgery. For example, in many cases where surgery has been considered to treat stomach cancer, chemotherapy may be given before the operation.

The aim of this treatment is to kill any cancer cells that may have spread away from the site of the stomach cancer and to shrink the cancer and improve the success rates for operation.

For patients seen in Bath, we are usually able to provide all their chemotherapy treatment at the RUH.

Radiotherapy

Radiotherapy uses high energy x-ray beams focussed on to the cancer.

In cancer of the stomach, this treatment is not used very often. The main reason for this is because radiotherapy does not penetrate well into the tissues of the upper abdomen – where there are many other structures surrounding the stomach.

However, in a small number of cases, chronic bleeding from the stomach cancer can be problematic. In such cases, radiotherapy can be used to reduce bleeding.

Other treatments

Other operations or procedures can be used to improve symptoms rather than try and cure stomach cancer.

If the cancer is causing a blockage of the stomach and it is not possible to perform a curative operation, then smaller procedures can be used to either bypass the stomach (using an operation), or to endoscopically place a stent through the cancer to allow the stomach to empty.

These treatments will not cure the underlying stomach cancer but can delay or reduce symptoms.

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Prognosis

Without any treatment, stomach cancer will eventually get larger, spread to other parts of the body and would be potentially fatal.

If it is diagnosed and treated at an early stage (before the cancer has spread away from the stomach into the lymph glands or other parts of the body), then there is a good chance of curing the cancer with treatment.

In some cases, the cancer is not diagnosed at such an early stage, in which case treatment would be used to try and minimize symptoms and try and slow the growth of the cancer for as long as possible.

Each patient is assessed individually and your specialist will be able to give you a much more accurate assessment of your particular outlook.

All treatments for cancer are constantly under review and any new developments or trials are rapidly taken up by our specialists.

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Related Links and Information

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