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Stomach (Gastric) Cancer

Gastric cancer, or stomach cancer, originates in the stomach. Although its occurrence has declined significantly over the past two decades, gastric cancer is still among the most prevalent cancers worldwide. The most common type is adenocarcinoma, one that starts from the inner lining. There are other types that start from middle or outer parts of the stomach, but they are relatively rare.

What can cause gastric cancer?

Some factors are known to be related to gastric cancer. Various dietary patterns, such as consuming high amounts of smoked or salted foods and processed meat; consuming low amounts of vegetables; drinking alcohol and smoking are among the factors that increase the risk. Helicobacter pylori, a microorganism that infects the inner lining of stomach, also contributes to cancer development.

Additionally, some non-cancerous conditions in the stomach, such as sores or limited proliferation of the inner lining may precede gastric cancer. Finally, some hereditary conditions predispose people to gastric cancer.

However, gastric cancer can still occur in the absence of any of these factors or conditions.

A: Early gastric cancer; B: Endoscopic view.
A: Early gastric cancer; B: Endoscopic view. (Click to enlarge.)

What are symptoms of gastric cancer?

Many patients receive a diagnosis of gastric cancer at a later stage, since the cancer may not cause any symptoms in its earlier stages. Some symptoms of gastric cancer, such as early satiety (fullness), mild belly pain and fatigue are the same as or similar to the manifestations of other less serious and common conditions.

However, some symptoms are more suggestive of gastric cancer. If you experience any of the following symptoms for more than two weeks, it is advised that you see a gastroenterologist:

  • Unexplained weight loss
  • Severe abdominal pain
  • Nausea and vomiting
  • Loss of appetite
  • Vomiting blood
  • Tarry stool
  • Difficulty or painful swallowing

Gastric Cancer Diagnosis at Johns Hopkins

During your appointment, your doctor will ask about your health-related information and perform a thorough physical examination. These will provide your doctor with many important details and guide the clinical decision. You may have additional blood and stool tests as well.

Other diagnostic procedures include:

  • Endoscopy with biopsy
  • TNM staging of gastric cancer, showing depth of invasion.
    TNM staging of gastric cancer, showing depth of invasion. (Click to enlarge.)
  • Endoscopic ultrasound

Endoscopy with Biopsy

An endoscope is a thin, lighted tube with a tiny camera at its tip that is passed through your mouth. Your doctor can see your pharynx, esophagus, stomach and initial parts of the small intestine from a screen that displays the footage on the camera. Endoscopy provides the most reliable and accurate means of detecting gastrointestinal conditions, especially the ones from the inner lining, including gastric cancers.

During an endoscopy:

  • You lie on your left side.
  • You receive anesthesia so you will be half-asleep or asleep throughout the procedure.
  • Your doctor uses an endoscope to see the inner lining of your stomach, as well as your mouth, pharynx and esophagus.
  • Your doctor performs a biopsy, which is removing a small part of the abnormal tissue and sending it to the lab for analysis. Biopsy provides a definitive diagnosis.

You may also undergo an additional endoscopy after your diagnosis, in order to establish the extent of the cancer to establish treatments and follow-ups.

Endoscopic Ultrasound

Double-snare technique for endoscopic mucosal resection of early gastric cancer.
Double-snare technique for endoscopic mucosal resection of early gastric cancer. (Click to enlarge.)

An endoscopic ultrasound combines the endoscope with a sound-wave generating imaging probe to provide detailed images and information about your digestive tract. It is especially useful in seeing the middle and outer layers beyond the inner lining. The depth of the tumor and whether it has spread (metastasized) can be established by the endoscopic ultrasound.

Gastric Cancer Treatment at Johns Hopkins

Advanced endoscopic techniques lead to earlier detection of gastric cancer, which means the cancer is easier to treat. The most effective treatment method for patients with early gastric cancer is resection, which is endoscopy or surgery to remove the cancer. The exact type of procedure you have will depend on the cancer’s stage and where it is located. Your doctor may remove only the cancerous section or your entire stomach. Learn more about treatment for gastric cancer at Johns Hopkins.

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