Overview
Gastric Cancer: Gastric cancer is a type of cancer that originates in the cells lining the stomach, an organ that aids in digestion and nutrient absorption. This cancer can grow and spread to other parts of the body, such as the liver, lungs, or lymph nodes.
Gastric cancer can be classified by the location, histology, or molecular features of the tumor. The location refers to the part of the stomach where the cancer begins, such as the cardia, fundus, body, antrum, or pylorus. Histology refers to the appearance and characteristics of the cancer cells under a microscope, such as adenocarcinoma, lymphoma, carcinoid, or sarcoma. Molecular features refer to the genetic or biomarker changes in the cancer cells, such as HER2, MSI, or PD-L1.
Type of cancer
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Types of Gastric Cancer: Gastric cancer refers to cancer that begins in the cells lining the stomach. The type of gastric cancer is determined by the kind of cells in which the cancer originated.
1. Adenocarcinoma: This is the most common type of gastric cancer, accounting for up to 95% of all cases. Adenocarcinoma starts in the glandular cells that line the inner surface of the stomach.
2. Lymphoma: This type of cancer originates in the lymphatic tissue, which is sometimes found in the wall of the stomach.
3. Carcinoid: This slow-growing type of cancer starts in the hormone-producing cells of the stomach.
4. Sarcoma: This rare type of gastric cancer begins in the connective tissue of the stomach wall.
5. Gastroesophageal Junction Cancer: This type of cancer occurs where the esophagus joins the stomach.
Stage
Stages of Gastric Cancer: The stage of gastric cancer is determined by how far the cancer has spread from its original location. The TNM system, which stands for Tumor, Node, and Metastasis, is used to stage gastric cancer.
1. Stage 0: Also known as carcinoma in situ or intramucosal carcinoma, the cancer is in its earliest stage and has not grown beyond the inner layer of the stomach wall (mucosa).
2. Stage I: The cancer has grown into the next layer of the stomach wall (submucosa) or the muscle layer (muscularis propria). It may or may not have spread to nearby lymph nodes, but it has not spread to distant organs.
3. Stage II: The cancer has grown deeper into the stomach wall, reaching the outer layer (serosa) or nearby structures. It may or may not have spread to nearby lymph nodes, but it has not spread to distant organs.
4. Stage III: The cancer has spread to nearby lymph nodes and/or nearby organs, such as the spleen, liver, or colon. It has not spread to distant organs.
5. Stage IV: The cancer has spread to distant organs, such as the lungs, bones, or brain. It may or may not have spread to nearby lymph nodes or nearby organs.
Remember, these classifications are general and the exact stage and type of cancer can vary from patient to patient. Always consult with a healthcare provider for accurate information.
Incidence Rates
Gastric Cancer Statistics: Gastric cancer is the fifth most common cancer worldwide, accounting for approximately 6% of all cancer cases and 8% of all cancer deaths. In 2020, it was estimated that over 1 million new cases of gastric cancer occurred worldwide, leading to more than 768,000 deaths.
The incidence rates of gastric cancer were highest in Eastern Asia and Central Asia, while the highest mortality rates were observed in Central Asia and Eastern Europe. By 2040, the burden of gastric cancer is projected to increase to 1.8 million new cases per year (a 63% increase) and 1.3 million deaths per year (a 66% increase).
In Asia, the incidence and mortality rates of gastric cancer vary by region and country. For both sexes, Mongolia has the world’s highest incidence rate (32.5 per 100,000) and mortality rate (24.6 per 100,000), followed by Japan, South Korea, Tajikistan, and China.
The incidence and mortality rates of gastric cancer are influenced by the location, histology, and molecular features of the tumor, as well as risk factors such as Helicobacter pylori infection, smoking, alcohol consumption, diet, and exposure to industrial chemicals.
Symptoms
Symptoms of Gastric Cancer: In the early stages, gastric cancer may not present any symptoms. However, as the disease progresses, the following symptoms may appear:
1. Difficulty swallowing.
2. Abdominal pain, bloating, or discomfort.
3. Loss of appetite or weight loss.
4. Nausea, vomiting, or bleeding.
5. Anemia, jaundice, or ascites.
Cause
Causes of Gastric Cancer: The exact cause of gastric cancer is unknown, but it is believed to result from changes in the DNA of the cells that line the inside of the stomach. These changes can cause the cells to grow and divide abnormally, forming tumors that can invade the stomach wall or spread to other parts of the body. Some of these changes are inherited, while others are acquired during a person's lifetime.
Several factors can contribute to these changes:
Helicobacter pylori infection: This bacterium can cause changes in the stomach that can lead to cancer.
Diet: A diet high in salty and smoked foods and low in fruits and vegetables can increase the risk of stomach cancer.
Smoking: Smoking can cause changes in the cells of the stomach that increase the risk of cancer.
Alcohol consumption: Heavy drinking can damage the cells of the stomach, leading to cancer.
Risk factors
Risk Factors for Gastric Cancer: Several factors can increase the risk of developing gastric cancer:
1. Age: The risk of gastric cancer increases with age, particularly after 55.
2. Gender: Men are at a higher risk of developing gastric cancer than women.
3. Bacteria: Infection with Helicobacter pylori bacteria can increase the risk of stomach cancer.
4. Family History/Genetics: Individuals with a family history of stomach cancer or certain inherited genetic conditions are at a higher risk.
5. Race/Ethnicity: Stomach cancer is more common in some parts of the world, such as Japan, Korea, and China.
6. Diet: A diet high in salty and smoked foods and low in fruits and vegetables can increase the risk of stomach cancer.
7. Previous Surgery or Health Conditions: People who have had stomach surgery or certain health conditions, such as pernicious anemia, may be at a higher risk.
8. Occupational Exposure: Exposure to certain chemicals, such as asbestos, can increase the risk of stomach cancer.
Remember, having one or more risk factors does not guarantee that you will develop gastric cancer, but it does increase the likelihood. Regular screenings and maintaining a healthy lifestyle can help reduce your risk.
Diagnosis and Test
Diagnosing Gastric Cancer: Doctors typically use a series of methods to diagnose gastric cancer:
1. Medical History and Physical Exam: Your doctor will inquire about your symptoms, risk factors, family history, and past health issues. They will conduct a physical examination of your body, focusing on your abdomen and stomach for signs of cancer or other issues.
2. Blood Test: Blood tests such as a complete blood count (CBC) to detect anemia, liver function tests to check for cancer spread, and tumor marker tests to measure specific proteins may be ordered.
3. Stool Test: You might need to provide a stool sample for testing. This can detect hidden blood or DNA changes that suggest cancer or polyps. Types of stool tests include fecal occult blood test (FOBT), fecal immunochemical test (FIT), or stool DNA test (FIT-DNA).
4. Upper Endoscopy with Biopsy: This involves using an endoscope to examine the esophagus, stomach, and duodenum and possibly removing polyps or abnormal tissue for analysis. A biopsy can confirm gastric cancer and reveal the cancer cells’ features.
5. Imaging Tests: These may be done to visualize the abdomen and check for cancer spread using x-rays, ultrasound, CT scan, MRI, or PET scan.
These are conventional diagnostic methods for gastric cancer; your doctor may suggest additional tests based on individual needs.
Treatment
Treatment Options for Gastric Cancer: The treatment and prognosis of gastric cancer depend on several factors, such as the type, stage, and location of the tumor, the patient’s age, general health, and personal preferences, and the potential benefits and side effects of each treatment option. Some common treatment options for gastric cancer are:
1. Surgery: This involves removing part or all of the stomach, along with some surrounding normal tissue and nearby lymph nodes.
2. Chemotherapy: This uses drugs to kill cancer cells or stop them from growing.
3. Radiation Therapy: This uses high-energy rays or particles to destroy cancer cells or slow their growth.
4. Targeted Therapy: This involves drugs that target specific features of cancer cells, such as proteins or genes, that help them grow and survive.
5. Immunotherapy: This includes drugs that help the body’s immune system recognize and attack cancer cells.
Prognosis
Prognosis for Gastric Cancer: The prognosis or outlook for gastric cancer patients is based on the type and stage of the cancer, the patient’s health, and their response to treatment. Prognosis can also be influenced by factors such as age, race, genetics, lifestyle, and quality of care. It can help patients and doctors make informed decisions about treatment and planning for the future.
One way to measure prognosis for gastric cancer patients is through survival rates, which reflect the percentage of people who survive a certain amount of time after diagnosis. Survival rates are based on outcomes of large groups of people with the same cancer type and stage but can’t predict individual outcomes. They are relative, comparing cancer patients’ survival with that of the general population.
According to research, survival rates for gastric cancer vary by stage, type, patient age, and race. Key facts and figures include:
· The five-year relative survival rate for all gastric cancer patients is 32.1%, irrespective of stage at diagnosis.
· The overall 5-year relative survival rate is 31%. With localized stage cancer, the rate is 69%. If cancer has spread to surrounding tissues, organs, or regional lymph nodes, the rate is 31%. For distant spread, the rate drops to 5%.
· Younger patients have higher survival rates; before age 50, the rate is 54%, compared to 26% for those diagnosed at age 65 or older.
· Survival rates are lower for black patients (25%) than for white patients (33%).
· Rates can also vary according to the cancer’s histology, grade, molecular features, and treatment response.
Supportive
Supportive Care for Gastric Cancer: Supportive care is an integral part of cancer care, helping individuals cope with the physical, emotional, social, and spiritual challenges of gastric cancer. There are numerous programs and services available to meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.
Key aspects of supportive care for gastric cancer include:
1. Pain Management: Gastric cancer and its treatment can cause pain, affecting daily activities and well-being. Pain management strategies can include medications, nerve blocks, complementary therapies, and other methods to alleviate pain and improve comfort.
2. Nutrition: Gastric cancer and its treatment can impact appetite, digestion, and nutrient absorption. Nutritional support can include dietary advice, supplements, tube feeding, or parenteral nutrition to help maintain weight and strength and prevent malnutrition.
3. Psychological Counseling: Gastric cancer and its treatment can cause stress, anxiety, depression, and other emotional issues. Psychological counseling can include individual, group, or family therapy, cognitive-behavioral therapy, relaxation techniques, and other methods to help cope and improve mood.
4. Social Work: Gastric cancer and its treatment can affect practical and financial matters, such as work, income, insurance, transportation, and housing. Social work can provide information, referral, advocacy, and assistance to help access resources and support services.
5. Spiritual Care: Gastric cancer and its treatment can affect beliefs, values, and the meaning of life. Spiritual care can include chaplaincy, pastoral counseling, prayer, meditation, and other methods to help find hope and peace.
6. Palliative Care: Gastric cancer and its treatment can cause symptoms and side effects, such as nausea, vomiting, fatigue, and shortness of breath. Palliative care can include medicines, procedures, and other methods to relieve symptoms and improve quality of life. Palliative care can be given at any stage of cancer, along with curative or life-prolonging treatments.
