PhytoScience - Article

Stomach Cancer

 

Stomach cancer is cancer that occurs in the stomach; the muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach is responsible for receiving and holding the food you eat and then helping to break down and digest it.

Another term for stomach cancer is gastric cancer. These two terms most often refer to stomach cancer that begins in the mucus-producing cells on the inside lining of the stomach (adenocarcinoma). Adenocarcinoma is the most common type of stomach cancer.

Stomach cancer is uncommon in North America, and the number of people diagnosed with the disease each year is declining. Stomach cancer is much more common in other areas of the world, particularly Japan.

Signs and symptoms

Signs and symptoms of stomach cancer may include:

  • Fatigue
  • Feeling bloated after eating
  • Feeling full after eating little
  • Heartburn
  • Indigestion
  • Nausea
  • Stomach pain
  • Vomiting
  • Weight loss

When to see a doctor
If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more common causes of these signs and symptoms first.

Causes

Doctors aren't sure what causes stomach cancer. There is a strong correlation between a diet high in smoked, salted and pickled foods and stomach cancer. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined.

In general, cancer begins when an error (mutation) occurs in a cell's DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when normal cells would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body.

Types of stomach cancer
The cells that form the tumor determine the type of stomach cancer. The type of cells in your stomach cancer helps determine your treatment options. Types of stomach cancer include:

  • Cancer that begins in the glandular cells (adenocarcinoma). The glandular cells that line the inside of the stomach secrete a protective layer of mucus to shield the lining of the stomach from the acidic digestive juices. Adenocarcinoma accounts for more than 90 percent of all stomach cancers.

  • Cancer that begins in immune system cells (lymphoma). The walls of the stomach contain a small number of immune system cells that can develop cancer. Lymphoma in the stomach is rare.

  • Cancer that begins in hormone-producing cells (carcinoid cancer). Hormone-producing cells can develop carcinoid cancer. Carcinoid cancer is rare.

  • Cancer that begins in nervous system tissues. A gastrointestinal stromal tumor (GIST) begins in specific nervous system cells found in your stomach. GIST is a very rare form of cancer.

Because the other types of stomach cancer are rare, when people use the term "stomach cancer" they generally are referring to adenocarcinoma.

Risk Factors

You're likely to start by seeing your family doctor or a general practitioner. If your doctor suspects you may have a stomach problem, you may be referred to a doctor who specializes in gastrointestinal diseases (gastroenterologist). Once stomach cancer is diagnosed you may be referred to a cancer specialist (oncologist) or a surgeon who specializes in operating on the digestive tract.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do Stomach pain

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

  • Write down key personal information, including any major stresses or recent life changes.

  • Make a list of all medications, as well as any vitamins or supplements, that you're taking.

  • Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For stomach cancer, some basic questions to ask your doctor include:

  • What type of stomach cancer do I have?
  • How advanced is my stomach cancer?
  • What other kinds of tests do I need?
  • What are my treatment options?
  • How successful are the treatments?
  • What are the benefits and risks of each option?
  • Is there one option you feel is best for me?
  • How will treatment affect my life? Can I continue to work?
  • Should I seek a second opinion? What will that cost, and will my insurance cover it?
  • Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Screening and diagnosisCT Scan of the human liver

Tests and procedures used to diagnose stomach cancer include:

  • A tiny camera to see inside your stomach (upper endoscopy). A thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can look for signs of cancer. If any suspicious areas are found, a piece of tissue can be collected for analysis (biopsy).

  • Imaging tests. Imaging tests used to look for stomach cancer include computerized tomography (CT) and a special type of X-ray sometimes called a barium swallow.

Determining the extent (stage) of stomach cancer
The stage of your stomach cancer helps your doctor decide which treatments may be best for you. Tests and procedures used to determine the stage of cancer include:

  • Imaging tests. Tests may include CT, positron emission tomography (PET) and X-ray.

  • Exploratory surgery. Your doctor may recommend surgery to look for signs that your cancer has spread beyond your stomach within your abdomen. Exploratory surgery is usually done laproscopically. This means the surgeon makes several small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room.

Other staging tests may be used, depending on your situation.

Stages of stomach cancer
The stages of adenocarcinoma stomach cancer include:

  • Stage I. At this stage, the tumor is limited to the layer of tissue that lines the inside of the stomach. Cancer cells may also have spread to nearby lymph nodes.

  • Stage II. The cancer at this stage has spread deeper, growing into the muscle layer of the stomach wall. Cancer may also have spread to the lymph nodes.

  • Stage III. At this stage, the cancer may have grown through all the layers of the stomach. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.

  • Stage IV. This stage of cancer extends beyond the stomach, growing into nearby structures. Or it is a smaller cancer that has spread to distant areas of the body.

Treatment

Your treatment options for stomach cancer depend on the stage of your cancer, your overall health and your preferences. Treatment for the adenocarcinoma type of stomach cancer may include:

Surgery
The goal of surgery is to remove all of the stomach cancer and a margin of healthy tissue, when possible. Options include:

  • Removing early-stage tumors from the stomach lining. Very small cancers limited to the inside lining of the stomach may be removed using endoscopy. The endoscope is a lighted tube with a camera that's passed down your throat into your stomach. The doctor uses special tools to remove the cancer and a margin of healthy tissue.

  • Removing a portion of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes only the portion of the stomach affected by cancer.

  • Removing the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system.

  • Removing lymph nodes to look for cancer. The surgeon examines and removes lymph nodes in your abdomen to look for cancer cells.

  • Surgery to relieve signs and symptoms. Removing part of the stomach may relieve signs and symptoms of a growing tumor in people with advanced stomach cancer. In this case, surgery can't cure stomach cancer, but it can make you more comfortable.

Surgery carries a risk of bleeding and infection. If all or part of your stomach is removed, you may experience digestive problems, such as diarrhea, vomiting and dumping syndrome, which occurs when the small intestine fills too quickly with undigested food.

Radiation therapy
Radiation therapy uses high-powered beams of energy to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table.

Radiation therapy can be used before surgery (neoadjuvant radiation) to shrink a stomach tumor so it's more easily removed. Radiation therapy can also be used after surgery (adjuvant radiation) to kill any cancer cells that might remain around your stomach. Radiation is often combined with chemotherapy. In cases of advanced cancer, radiation therapy may be used to relieve side effects caused by a large tumor.

Radiation therapy to your stomach can cause diarrhea, indigestion, nausea and vomiting. Chemotherapy

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach.

Chemotherapy can be given before surgery (neoadjuvant chemotherapy) to help shrink a tumor so it can be more easily removed. Chemotherapy is also used after surgery (adjuvant chemotherapy) to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Chemotherapy may be used alone in people with advanced stomach cancer to help relieve signs and symptoms.

Chemotherapy side effects depend on which drugs are used. The type of stomach cancer you have determines which chemotherapy drugs you'll receive.

Clinical trials
Clinical trials are studies of new treatments and new ways of using existing treatments. Participating in a clinical trial may give you a chance to try the latest treatments. But clinical trials can't guarantee a cure. In some cases, researchers might not be certain of a new treatment's side effects.

Ask your doctor whether you may be eligible for a clinical trial. Together you can discuss the benefits and risks.

Coping skills

A cancer diagnosis can be overwhelming and frightening. Once you start to adjust after the initial shock of your diagnosis, you may find it helps to stay focused on tasks that help you cope. For example, try to:

  • Find out everything you can about stomach cancer. Ask your doctor to write down the details of your cancer; the type, stage and your treatment options. Use those details to find more information about stomach cancer and the benefits and risks of each treatment option. Good sources of information include the Canadian Cancer Society, National Cancer Institute and the American Cancer Society.

  • Get involved in your treatment decisions. Take an active role in your treatment decisions. Discuss your concerns and preferences about treatments with your doctor. Together you can decide what treatments are best for you. Although you may feel tired and discouraged, don't let others {including your family or your doctor} make important decisions for you.

  • Connect with other cancer survivors. Sometimes it feels as if people who don't have cancer can't understand what you're going through. At those times, it may help to turn to other cancer survivors for support. Ask your doctor about support groups in your area. Or go online and connect with cancer survivors on message boards, such as those run by the American Cancer Society. You may also find that you develop deep and lasting bonds with people who are going through the same things you are.

  • Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work part time. In fact, many people find that continuing to work can be helpful.

  • Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or limit what you do.

  • Stay active. Being diagnosed with cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. Stay involved as much as you can.

Prevention

It's not clear what causes stomach cancer, so there's no way to prevent it. But you can take steps to reduce your risk of stomach cancer by making small changes to your everyday life. For instance, try to: Healthy foods

  • Eat more fruits and vegetables. Try to incorporate more fruits and vegetables into your diet each day. Choose a wide variety of colorful fruits and vegetables.

  • Reduce the amount of salty and smoked foods you eat. Protect your stomach by limiting these foods. Experiment with herbs and other ways of flavoring foods that don't add sodium.

  • Stop smoking. If you smoke, quit. If you don't smoke, don't start. Smoking increases your risk of stomach cancer, as well as many other types of cancer. Quitting smoking can be very difficult, so ask your doctor for help.

  • Ask your doctor about your risk of stomach cancer. Some medical conditions increase your risk of stomach cancer, such as anemia, gastritis and stomach polyps. If you've been diagnosed with one of these conditions, ask your doctor how this affects your stomach cancer risk. Together you may consider periodic endoscopy to look for signs of stomach cancer. There are no guidelines to determine who should undergo screening for stomach cancer in the United States. But in some cases, you and your doctor may decide your risk is high enough that the benefits of screening outweigh the potential risks.

Complementary and alternative medicineAcupuncture

Alternative treatments may help control pain in people with advanced lstomach cancer. Your doctor will work to control pain with treatments and medications. But sometimes your pain may persist or you may want to avoid the side effects of pain medications.

Ask your doctor about alternative treatments that may help you cope with pain, such as:

  • Acupressure
  • Acupuncture
  • Deep breathing
  • Listening to music (music therapy)
  • Massage

Supplementation
A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat diseases in general. Some supplements show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved in human clinical trials.

Although some complementary treatments can be a good addition to your regular treatment, take some precautions first:

  • Don't stop taking your prescribed medications or skip therapy sessions. Complementary medicine is not a substitute for regular medical care.

  • Be honest with your doctors and health providers. Tell them exactly which complementary treatments you practice or would like to explore. There have been many cases {based on patients test results} where doctors have reduced or stopped medications due to the benificial effects from natural health products.

  • Be aware that some complementary treatments can interfere with your regular treatment. Even over-the-counter or so-called natural supplements may interfere with your prescribed medications. When purchasing a health product; look for information that may be found in small print that would indicate drug interactions or product warnings.

  • Natural remedies that lower inflammation can also be very beneficial; when indicated they may be preferred over some medications that have adverse effects with prolonged usage. Although long-term use of NSAIDs in high doses can provide great benefit in terms of anti-inflammatory effects, pain relief and cardioprotective effects, there is an increased risk of gastrointestinal complications ranging from stomach pain to ulcers, hemorrhage, and severe and potentially deadly gastrointestinal problems. Each year in the US, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths.

  • Tumeric is a spice that comes from the root Curcuma longa, a member of the ginger family, Zingaberaceae. Curcumin has historically been safely used in Ayurveda for its medicinal properties for various indications. Curcumin has demonstrated some anti-inflammatory activity. Several studies were identified on the antioxidant, anti-inflammatory, antiviral, and antifungal properties of curcuminoids.

  • Mangosteen. Mangosteen has been demonstrated to exhibit potent anti-oxidant, anti-inflammatory and anti-tumor properties. Natural remedies that lower inflammation can be very beneficial in the prevention or treatment of disease. It has been suggested by the American Cancer Society that mangosteen juice can be used as an effective adjunct with standard cancer therapies to reduce many of the side effects and helps to speed up recovery.

    Xanthones, which are unique to the mangosteen, as a class of phytonutrients are polyphenolic bioflavonoids. Over 60 research papers show anti-tumor, antiproliferative, antimicrobial, antihistamine, anti-inflammatory, anti-oxidant and gastrointestinal protective effects. Mangosteen has been used successfully for microbial (Viral, Bacterial and Fungal) conditions for centuries throughout Southeast Asia.

    When indicated; mangosteen juice, consumed daily, may be preferred over some medications that have adverse effects with prolonged usage. Mangosteen juice from the whole fruit puree has successfully been used as an adjuctive therapy to treat Esophageal and Stomach Cancer.

    Recent Invivo studies have demonstrated cytotoxic properties against three human cancer cell lines. The flow cytometric analysis indicated that this compound induced apoptosis in time-and concentration-dependent manners. Alpha-mangostin (One of the many xanthones found in the pericarp of the mangosteen fruit} showed the features of the mitochondrial apoptotic pathway such as mitochondrial membrane depolarization and cytochrome c release. Furthermore, alpha-mangostin inhibited the sarco(endo)plasmic reticulum Ca(2+)-ATPase markedly.

    In some cases, people using mangosteen for the first time may experience a healing crisis or detoxifying effect {an increase or outbreak of some symtoms that may last from 4 to 10 days} in the earliest stages of use. Once the body is cleared of the toxins that exasperate the condition, the healing process can get underway. This is normal and should be expected when using a quality natural product. Results will vary with individuals but the long term benefits are well worth the short term discomfort as mangosteen juice has been effective with many types of cancer.

    Mangosteen juice from the whole fruit puree consumed daily, has successfully been used to treat inflammatory conditions and has demonstrated numerous additional benefits over other natural products. More mangosteen research is needed, but current scientific studies have demonstrated promising results in regards to benefiting patients with Esophageal and Stomach Cancer. Mangosteen Science

Lacking scientific evidence
A few herbal and dietary products claim to help cure or prevent cancer. There's no scientific evidence that these products work, and some may be dangerous. Three popular "cancer-fighting" supplements include:

  • Chaparral. Also known as creosote bush or greasewood, chaparral (Larrea tridentata) comes from a desert shrub found in the southwestern United States and Mexico. Research hasn't shown that the herb effectively treats cancer, and it can lead to irreversible liver failure.

  • PC-SPES. This mixture contains eight herbs that have been used for hundreds of years in traditional Chinese medicine to treat prostate issues and other health problems. Some studies show it may reduce cancer growth, but it can also cause side effects. It was sold as a dietary supplement, but is no longer being manufactured because some batches were found to contain prescription drug ingredients. While the individual herbs are still available, the PC-SPES mixture has not been reintroduced because further studies are needed to determine whether it's safe.

  • Shark cartilage. Shark cartilage contains a protein that has some ability to inhibit the formation of new blood vessels within tumors in sharks. Shark cartilage therapy is based on the theory that capsules containing shark cartilage will do the same in humans; stop and shrink cancerous tumors. However, these benefits haven't been shown in humans.

Talk with your doctor first
Because it's not always easy to tell which products may be unsafe, interact negatively with other medications or affect your overall cancer treatment, it's best to talk with your doctor before you take any dietary or herbal product.

 

Source - Phytoscience Research Group, Mayo Clinic, American Cancer Society, National Library of Medicine.

Updated 03 Jul 2009