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Introduction
Cancer of the stomach is one of the most common cancers in the world. In Singapore it is the 3rd most common cancer in the males and the 5th in the females. It still accounts for a high number of cancer deaths. It is more common in the elderly male. Symptoms The early symptoms of stomach cancer are very vague and commonly dismissed by the patients. They include abdominal pain, nausea, feeling full easily or slight loss of weight. |
 Normal view of cancer of the stomach during gastroscopy |
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As such, patients tend to ignore these and present much later when the disease is more advanced. During this time, the late symptoms include vomiting after meals, vomiting of blood, unable to swallow, severe weight loss or a very bloated tummy. At this stage, the chance of cure from the disease is very much less. Diagnosis To confirm the diagnosis of cancer of the stomach, a gastroscopy has to be done. This procedure is tolerated very well. The lesion can be seen clearly and biopsy of the cancer can be taken to have microscopic visualisation and proof of cancer. This procedure can be carried out by a gastroenterologist or surgeon with an interest in endoscopy. Alternatively, your doctor may send you for a special x-ray called barium meal where you will be given medication called barium to drink and several x-rays of your abdomen will be taken. The barium will outline your stomach and any abnormality will be visible. However, the drawback with this investigation is that you will still have to proceed to doing gastroscopy to obtain tissue for microscopic examination to confirm the cancer and there is a possibility of missing early cancers. Treatment Surgery is the only way to cure cancer of the stomach. Before surgery is carried out, your doctor will have to make sure that the cancer has not spread. Cancer of the stomach spreads by the blood stream to the liver and lung most commonly. At the later stage it may even go to the bones. It also spreads by the lymphatics to the lymph nodes around the stomach. The cancer also invades locally to affect the surrounding structures in the abdomen. To determine the local extent of the cancer and whether it has spread, a CT scan of the abdomen is usually performed. If there is no evidence of spread and the cancer is not locally advance, surgery should be performed. For cancer surgery, the aim is to remove the cancer with clear margins of the stomach and all visible disease if possible. The extent of stomach to be removed depends on the location of the cancer. Usually anywhere between 60 to 100% of the stomach is removed together with the lymph nodes. After removing the tumour at the time of surgery, the continuity of the intestine will be re-established by various methods. This is to ensure that the patient will be able to eat normally after that. However with a smaller stomach or no stomach, obviously the amount taken at each meal will be much smaller. To compensate, the patient will have to take more frequent meals. When the patient has recovered from surgery, the surgeon may refer the patient to a medical oncologist or radiation oncologist for further adjuvant treatment. This is to decrease the possibility of a recurrence of the cancer. When the cancer has already spread, surgery is most often not advisable. This is because the outcome is normally poor and survival is usually around 6 – 12 months only. The patient may be referred to the medical or radiation oncologist for treatment. In such cases, the treatment aims to control the disease and prolong survival but is unlikely to cure the disease. However, in some situations although there has been spread of the disease, surgery is still needed. In these situations, complications of stomach cancer have occurred. Complications include bleeding or complete obstruction to the passage of food. In these cases, surgery will offer the best form of relief of symptoms. Surgery for stomach cancer is safe in the hands of experienced surgeons with an acceptable low rate of complications. Surgical complications include chest infection, wound infection, bleeding and leak at the sites where the intestines join (which fortunately is very rare). Prevention Several factors are associated with the development of gastric cancer. These include:
Early Detection Other than prevention, early detection of the cancer will result in a better outcome as the cancer will be at a much earlier stage. In Japan where they have the highest incidence of stomach cancer, they screen the population for this disease. However in countries where the incidence is much lower, it is not cost effective to perform mass screening of the population. In this instance, it would be better to educate the population of the early symptoms of the disease so that they will seek attention earlier when the disease is potentially curable. If these alarm symptoms are present, the patient should waste no time in seeking medical attention:
Conclusion
Cancer of the stomach is a disease that is usually diagnosed late. If diagnosed early, there is a high chance of cure with surgical treatment. Chemotherapy and radiotherapy has a role in treating the more advanced cases. To be detected early, the population needs to be educated on the disease and its early signs and symptoms, so that they can seek medical attention earlier. |
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