Conditions:

Gastric Cancer

Despite medical advances, gastric (stomach) cancer is the second most common cancer causing death in the world overall. It is found most commonly in Japan, affecting approximately 100 in every 100 000 people. In Western countries, it affects approximately 35 per 100 000 people.

Gastric cancer can occur anywhere in the stomach and is usually adenocarcinoma in type.

What causes gastric cancer?

As in many diseases, the exact cause is not exactly understood, but certain risks factors are known, namely

1. Sex - twice as common in men compared to women.
2. Age - most common in the sixth and seventh decade.
3. Smoking
4. Diet - foods high in salts, nitrates and nitrites.
5. Chronic Gastritis - as well as Helicobacter pylori infection.
6. Previous radiation exposure
7. Family history of gastric cancer.

What symptoms does gastric cancer cause?

Gastric cancer can be sometimes difficult to diagnoses and cause few symptoms for a long time. The most common symptoms are

1. Weight loss
2. Abdominal pain, often mimicking the pain of indigestion.
3. Nausea
4. Decreased appetite
5. Bleeding, usually seen as "jet black" stools (malaena)
6. Vomiting blood

How is gastric cancer diagnosed?

The best test to diagnose gastric cancer is gastroscopy. Gastroscopy is a day procedure that involves the passage of a flexible tube down the oesophagus and into the stomach which allows the surgeon to visualise the cancer and also take biopsies to confirm the diagnosis. The procedure is done with sedation and takes approximately ten minutes.

How is gastric cancer treated?

As with most cancers, the single most important question that must be answered prior to developing a treatment plan is whether the cancer is curable. Gastric cancer is potentially curable if it has not spread elsewhere in the body.

This process of determining if the cancer has spread is known as staging. All of Dr Fenton-Lee's patients undergo the following minimum staging procedures once the diagnosis of gastric cancer has been confirmed with gastroscopy.

1. Blood tests - these can give clues to cancer spread to the liver.
2. Chest x-ray - looking for obvious spread to the lung.
3. CT san of the abdomen and chest - this is performed to ascertain spread to the lungs and liver.
4. Endoscopic Ultrasound - This procedure is similar to a gastroscope and is the best test to determine the depth and local invasion of the tumour. It also allows biopsies to be taken of surrounding lymph nodes to determine if they are involved which may alter the treatment plan.
5. Staging laparoscopy - This is the best test to look for small cancer nodules and lymph node involvement within the abdominal cavity that CT scan can miss. Laparoscopy is a minor procedure that is done when all other staging procedures are clear. It is done to prevent major surgery being performed in patients whose cancer is not curable.

Other tests that are sometimes used to look for cancer spread are PET scans and MRI scans.

Once all these staging procedures are performed and cleared, surgery can be considered. Surgery is the only treatment available to cure gastric cancer. Click here to learn more about surgery for gastric cancer.

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What are the chances of cure?

The success of curing gastric cancer is dependant on early diagnosis. The prognosis is calculated by staging that takes three factors into consideration. These factors are

1. Degree of tumour invasion (T staging)
2. Lymph node involvement (N staging)
3. Presence of distant metastases (M staging)

These factors are subcategorised into groups as follows

T staging
T1 - cancer within inner lining of stomach only
T2 - tumour involving muscle of stomach only
T3 - tumour past stomach wall, but not surrounding structures
T4 - tumour invading surrounding structures.

N staging
N0 - No regional lymph node involvement
N1 - 1-6 regional lymph node involvement
N2 - 7-15 regional lymph nodes involved
N3 - >15 regional lymph nodes involved

M staging
M0 - No distant metastases
M1 - Distant metastases

The stage grouping and the 5 year survival for these groupings are as follows

What other treatment options are available?

Although surgery provides the only chance of cure, other treatments are available as adjuvant or palliative treatment. Palliation is treatment that involves prolonging the length of disease free time, as well as improving the quality of life for patients whose cancers cannot be cured.

Other forms of treatment available include

1. Chemotherapy - used both in improving cure rates in potentially curable cancers and also in slowing growth time in incurable cancers
2. Radiotherapy - can often work very well in slowing down the tumour growth.
3. Surgery - this can often also be performed to improve quality of life in select cases. This is usually done if the tumour is bleeding excessively or is blocking the passage of food through the stomach.

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