Stomach Cancer

Stomach Cancer

What is the definition of stomach cancer?

Cancer cells in stomach cancer (also known as gastric disease) normally start on the inner lining of the stomach walls and progress deeper into the stomach walls as the cancer progresses. The tumor might spread to adjacent organs such as the liver and pancreas.

Stomach cancer is one of the most frequent cancers in the world, however it is less common in the US. The number of occurrences of stomach cancer has been progressively falling in recent decades, presumably due to the extensive use of refrigeration, which has improved availability to fresh food free of preservatives and bacterial contamination.

What causes stomach cancer ?

A genetic mutation (change) in the cells of the stomach is the major cause of stomach cancer, which causes the cells to proliferate fast and ultimately form a tumor. The following are some of the risk factors that might raise a person's chances of developing stomach cancer:


  • History of the family
  • Smoking \sObesity
  • Helicobacter pylori (H. pylori) bacterium infection
  • A high-sodium diet
  • A diet that is devoid of fruits and vegetables.
  • What are the signs and symptoms of gastric cancer?
  • Vomiting and nausea
  • Swallowing problems
  • Heartburn
  • Appetite loss.
  • Loss of weight
  • I'm exhausted.
  • Bloating
  • Blood in the vomit (in advanced stages)

How can you know if you have stomach cancer?

To diagnose stomach cancer, a variety of tests might be utilized.

If the tumor is big enough, radiologic procedures such as a CT scan, barium swallow, and MRI may assist discover an issue in the stomach.
An upper endoscopy is performed to collect a biopsy (sample) of the lesion in order to establish a diagnosis or to identify early cancer before it becomes big enough to be visible on radiologic testing. An upper endoscopy involves passing a thin tube with a small camera through the mouth and into the stomach, where samples of the tumor are taken.
An endoscopic ultrasound, which employs a specific kind of endoscope with an ultrasonic probe, is used to determine how much of the stomach wall a tumor includes and to assist estimate the "stage" of cancer. Through the mouth, the endoscope is inserted into the stomach. The ultrasound probe can detect how much of the stomach is affected by the tumor by looking through the surface of the stomach lining to the stomach wall beyond.

What are the symptoms of stomach cancer ?

These and other signs and symptoms may be caused by gastric cancer or by other conditions.

In the early stages of gastric cancer, the following symptoms may occur:

  • Indigestion and stomach discomfort.
  • A bloated feeling after eating.
  • Mild nausea.
  • Loss of appetite.

In more advanced stages of gastric cancer, the following signs and symptoms may occur:

  • Bloodin the stool.
  • Vomiting.
  • Weight loss for no known reason.
  • Stomach pain.
  • Jaundice(yellowing of eyes and skin).
  • Ascites(build-up of fluid in the abdomen).
  • Trouble swallowing.

Check with your doctor if you have any of these problems.


What are the stages of Stomach Cancer ?


The following stages are used for gastric cancer:


  • Stage 0 (Carcinoma in Situ)
  • Stage I
  • Stage II
  • Stage III
  • Stage IV

After gastric cancer has been diagnosed, tests are done to find out if cancer cells have spread within the stomach or to other parts of the body.


The process used to find out if cancer has spread within the stomach or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

  • Endoscopic ultrasound(EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
  • CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, or pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan(positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
  • MRI(magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions(cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples to be checked under a microscope for signs of cancer. A solution may be washed over the surface of the organs in the abdomen and then removed to collect cells. These cells are also looked at under a microscope to check for signs of cancer.



What are the main treatments for stomach cancer?


There are different types of treatment for patients with gastric cancer.

Seven types of standard treatment are used:


  • Surgery
  • Endoscopic mucosal resection
  • Chemotherapy
  • Radiation therapy
  • Chemoradiation
  • Targeted therapy
  • Immunotherapy
  • New types of treatment are being tested in clinical trials.
  • Treatment for gastric cancer may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

Stomach cancer may be treated in a variety of ways. An upper endoscopy done by a gastroenterologist may eliminate cancer in the early stages when it is restricted to the superficial (uppermost) layers of the stomach. The tumor is split from the remainder of the stomach wall and removed via the mouth during this surgery (endoscopic submucosal dissection, or ESD).

Once the tumor has spread beyond the stomach's surface layers, surgery to remove the stomach and link the esophagus (the tube through which food flows) to the small intestines will be necessary to allow for digestion.

Radiation treatment kills cancer cells by delivering high-powered beams of radiation. Chemotherapy is a kind of cancer treatment that involves the use of chemicals to destroy cancer cells. In most cases, these therapies are combined.

There are also a number of medications that may be used to treat stomach cancer. Treatment is determined by a doctor following diagnosis and is dependent on the severity of the cancer.

What are the main surgical treatments for gastric cancer ?


Endoscopic resection

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are procedures that can be used to treat some very early-stage cancers, when the tumor is not thought to have grown deeply into the stomach wall and the chance of spread outside the stomach is very low.

These procedures do not require a cut (incision) in the skin. Instead, the surgeon passes an endoscope (a long, flexible tube with a small video camera on the end) down the throat and into the stomach. Surgical tools can be passed through the endoscope to remove the tumor and some layers of the normal stomach wall below and around it. (ESD goes deeper into the stomach wall than EMR.)

Subtotal (partial) gastrectomy

In this operation, only part of the stomach is removed. This is often recommended if the cancer is only in the lower part of the stomach (in which case it is known as a distal gastrectomy). It might also be used for cancers that are only in the upper part of the stomach (in which case it is known as a proximal gastrectomy).

Part of the stomach is removed, sometimes along with part of the esophagus (in a proximal gastrectomy) or the first part of the small intestine (in a distal gastrectomy). The remaining section of stomach is then reattached. Some of the omentum (an apron-like layer of fatty tissue that covers the stomach and intestines) is removed as well, along with nearby lymph nodes. If the cancer has reached the spleen or parts of other nearby organs, these are removed as well.

Eating is much easier after surgery if only part of the stomach is removed instead of the entire stomach.

Total gastrectomy

This operation is done if the cancer has spread widely in the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus.

The surgeon removes the entire stomach, nearby lymph nodes, and the omentum, and may remove the spleen and parts of the esophagus, intestines, pancreas, or other nearby organs if the cancer has reached them. The end of the esophagus is then attached to part of the small intestine. This allows food to move down the intestinal tract. But people who have had their stomach removed can only eat a small amount of food at a time. Because of this, they will need to eat more often.

Surgical approaches to subtotal or total gastrectomy

Most subtotal and total gastrectomies are done through a large incision (cut) in the skin of the abdomen (belly). This is sometimes referred to as an open surgical approach.

In some centers, these operations are done as a laparoscopic gastrectomy, in which long, thin surgical instruments (including one with a small video camera on the end) are inserted into the abdomen through several small cuts. Some surgeons do these operations using robotic-assisted laparoscopic surgery (sometimes just called robotic surgery). In this technique, the surgeon sits at a control panel and moves robotic arms that have laparoscopic instruments on the ends.

Although the laparoscopic approach (including robotic surgery) might result in a shorter hospital stay, less pain after the operation, and a shorter recovery time (because of the smaller incisions), many doctors feel that this technique needs to be studied further before it can be considered a standard treatment for stomach cancer.

No matter which approach is used, it’s important that your surgeon is skilled and experienced with the technique.

Lymph node removal

In either a subtotal or total gastrectomy, the nearby lymph nodes are removed. This is known as a lymph node dissection or lymphadenectomy, and it's a very important part of the operation. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes.

It is recommended that at least 16 lymph nodes be removed (called a D1 lymphadenectomy) when a gastrectomy is done. Surgeons in some East Asian countries (such as Japan and South Korea) have had very high success rates by removing even more lymph nodes near the cancer (called a D2 lymphadenectomy).

Surgeons in Europe and the United States have not been able to equal the results of the East Asian surgeons. It is not clear if this is because East Asian surgeons are more experienced (stomach cancer is much more common in these countries), because their patients tend to have earlier stage disease (because they screen for stomach cancer) and are healthier, or if other factors play a role.

In any event, it takes a skilled surgeon who is experienced in stomach cancer surgery to remove as many lymph nodes as possible. Ask your surgeon about their experience in operating on stomach cancer. Studies have shown that the results are better when both the surgeon and the hospital have had extensive experience in treating patients with stomach cancer.

Palliative surgery for unresectable cancer

For people with stomach cancer that can't be removed completely, surgery can often still be used to help control the cancer or to help prevent or relieve symptoms or complications.

Gastric bypass (gastrojejunostomy)

Tumors in the lower part of the stomach may eventually grow large enough to block food from leaving the stomach. For people healthy enough for surgery, one option to help prevent or treat this is to bypass the lower part of the stomach. This is done by attaching part of the small intestine (the jejunum) to the upper part of the stomach, which allows food to leave the stomach through the new connection.

Subtotal gastrectomy

For some people who are healthy enough for surgery, removing the part of the stomach with the tumor can help treat problems such as bleeding, pain, or the tumor blocking the passage of food through the stomach, even if the surgery does not cure the cancer. Because the goal is not to cure the cancer, nearby lymph nodes and parts of other organs usually do not need to be removed.

Feeding tube placement

Some people with stomach cancer aren’t able to eat or drink enough to get adequate nutrition. A minor operation can be done to place a feeding tube through the skin of the abdomen and into the lower part of the stomach (known as a gastrostomy tube or G tube) or into the small intestine (jejunostomy tube or J tube). Liquid nutrition can then be put directly into the tube.

Endoscopy procedures

In some situations, upper endoscopy procedures can be done to help prevent or relieve symptoms, without the need for more extensive surgery:

  • Endoscopic tumor ablation:In some cases, such as in people who are not healthy enough for surgery, an endoscope (a long, flexible tube passed down the throat) with a laser on the end can be used to vaporize parts of the tumor. This can be done to stop bleeding or help relieve a blockage without surgery.
  • Stent placement:Another non-surgical option to keep a tumor from blocking the opening at the beginning or end of the stomach is to use an endoscope to place a stent (a hollow metal tube) into the opening. This helps keep it open and allows food to pass through it. For tumors in the upper (proximal) stomach, the stent is placed where the esophagus and stomach meet. For tumors in the lower (distal) part of the stomach, the stent is placed at the junction of the stomach and the small intestine.


What is the robotic surgery (da Vinci® Surgical System) in treatment of Stomach cancer ?

Robotic surgery is one of the latest and most effective treatment options for stomach cancer. Combining the benefits of minimally invasive surgery, such as faster recovery times and less scarring (as compared to traditional surgery), with an enhanced level of operative precision, robotic surgery offers a number of potential advantages to patients whose stomach cancer treatment plans include surgery.

We use the da Vinci® Surgical System to assist the following types of robotic stomach cancer surgery:

  • Total gastrectomy
  • Partial gastrectomy
  • Wedge gastric resection
  • Transgastric tumor resection

Despite what it may sound like, robotic surgery is not performed by a robot. Instead, highly experienced surgical oncologists perform the surgery using a computerized console to control a corresponding set of robotic tools to enhance the process. The da Vinci Surgical System’s instruments can bend and rotate in ways that the hands of even the most highly skilled surgeons cannot. Additionally, the system provides a magnified, high-definition view of the tumor that allows the surgeon to visualize tissues and cells that are not visible with the naked eye. For many patients, this translates to a better surgical outcome and a higher quality of life – especially when used as a part of a comprehensive treatment plan.


What can be done to avoid stomach cancer?

The following habits may help you avoid stomach cancer:

Eating a balanced diet rich in fruits and vegetables and low in salt and red meats is the greatest strategy to avoid stomach cancer.
Maintain a healthy weight and engage in regular exercise.
Smoking raises the risk of stomach cancer and a variety of other cancers.

What is the prognosis for stomach cancer patients?

The prognosis for stomach cancer is determined by the stage of the disease. People with stomach cancer who are diagnosed early have a considerably higher chance of survival than those who are diagnosed later:

The five-year survival rate for stomach cancer that is detected early and excised using an endoscope is more than 90%.
The five-year survival rate is 28 percent if the cancer is discovered after it has progressed to the stomach's surrounding tissues.
If cancer has progressed outside the stomach's surrounding regions, the five-year survival rate is just 4%.