Feeling overly full after meals or having trouble swallowing food – these innocuous symptoms could also be early signs of stomach cancer, one of the most common cancers in India.
Three to six persons out of every 100,000 (one lakh) Indians develop stomach cancer every year, with the southern regions showing a higher prevalence than the North, says Dr Amit Yelsangikar, senior consultant and gastroenterologist at Aster CMI Hospital in Bengaluru.
Stomach cancer in its early stages may only affect the superficial layers of the stomach wall, and it can often go unnoticed due to a lack of symptoms. However, as it progresses into stage 2 and 3, it can spread into all layers of the stomach and lymph nodes. By the time it reaches stage 4 and spreads to other organs, it is beyond cure, notes Dr Yelsangikar.
It is crucial to catch and arrest stomach cancer early as it otherwise causes rapid deterioration of the individuals’ health and increases their suffering. Here is what we need to know about the condition.
Symptoms of stomach cancer
- Discomfort in the upper abdomen
- Pain
- Loss of appetite
- Feeling of fullness.
- Bleeding in the stomach
- Unexplained anaemia or weight loss.
- Difficulty in swallowing if it occurs at the junction of stomach and food pipe (oesophagus)
Insidiously, early-stage stomach cancer may only trigger subtle symptoms like stomach pain or nausea. When left undiagnosed, it progresses to more severe symptoms than these.
In advanced stages, tumours can cause blockages in the stomach and prevent food from entering the intestine, explains Dr Yelsangikar. This in turn can lead to discomfort, vomiting, alarming weight loss or severe bleeding in the stomach.
In time, when untreated, cancer cells march deeper through stomach tissue and may also invade adjoining tissues and organs. The bile ducts may become clogged, leading to jaundice. The person may develop a condition called cachexia, which kills appetite and causes dramatic weight loss of up to half a person’s body weight in barely a few months, he adds.
Different types of stomach cancer
Stomach cancer can be of different types. They are:
- Adenocarcinoma: About 90 to 95 per cent of stomach cancers are adenocarcinoma, which begins in the mucous producing cells in the stomach’s innermost lining.
- Lymphoma: Less than 5 per cent of stomach cancers are lymphoma, which involve lymphoid tissues.
- Neuroendocrine tumours: Also known as gastrinoma these are a very rare type of cancer of the stomach. As they grow slowly, the tumours produce excessive acid thereby causing stomach ulcer.
Many other rare tumours can also develop in the stomach such as sarcoma and gastrointestinal stromal tumours (GIST), says Dr Yelsangikar.
The risk factors
Various factors raise stomach cancer risk — infection from Helicobacter pylori, smoking, alcohol use, hereditary factors, obesity and diets high in salt or red meat, besides smoked or preserved foods.
Stomach cancers mainly develop in two locations, explains Dr Yelsangikar. “One is the latter half of the stomach, caused by H. pylori infection [which is also the risk factor for peptic ulcer],” he says.
The other is in the stomach’s upper part near its junction with the oesophagus. This can develop among those who are obese or have a health condition called Barret oesophagus, where a prolonged bout of acid reflux can alter the oesophagus’s lining, ultimately causing cancer at the junction.
An H. Pylori infection can cause drastic changes in the stomach lining through many pre-cancerous stages that eventually lead to cancer.
“Initially, it undergoes atrophy in which stomach lining becomes thin. Then it changes into a different type of lining and finally becomes dysplastic, that is, there is an overgrowth of cells lining the stomach,” says Dr Yelsangikar. This in turn causes ulceration and mass formation in the stomach. And once the tumour outgrows its blood supply, it causes bleeding and invades the lymph nodes and organs that are nearby such as the liver and the lungs, he adds.
Detecting stomach cancer
Catching stomach cancer early improves survival odds, which is why it is important to diagnose it early.
Initially, the clinical history of the person is taken to look for symptoms such as stomach pain, bleeding or weight loss, lifestyle factors or a family history of cancer. Further diagnoses can vary depending on the stage and type of cancer.
- Endoscopy: Early-stage stomach cancer is diagnosed with a screening endoscopy along with a biopsy of a tumour sample for further analysis.
- CT Scan: Advanced stage cancers are diagnosed with CT scans. They can help determine the extent and stage of progress of the cancer, and whether it is confined to the person’s stomach, or spread to other organs.
- PET-CT scan: A PET-CT scan can diagnose even if the cancer has spread very small, i.e. by less than 1 cm, to other organs.
The cancer and its type are confirmed with biopsy. An H. pylori infection can also be seen in the biopsy sample. If the cancer has spread to other organs, then a biopsy is done by a radiologist using ultrasound-guided techniques, explains Dr Yelsangikar.
Management and treatment
Upon early diagnosis, the cancer is treated for the H. pylori infection along with pre-cancer and cancer conditions.
Dr Yelsangikar suggest various modes of treatment depending on the stage of cancer:
- Endoscopic resection: Early-stage or stage 1 cancer can be treated by endoscopic removal of the stomach tumours or pre-cancerous polyps.
- Surgery: The affected part or the entire stomach is removed along with the lymph nodes. Depending on the stage of the cancer, additional treatments such as chemotherapy or radiation therapy are also given. Stage-2 cancers are only treatable with surgery. Stage 3 cancers require a combination of chemotherapy and surgery.
- Chemotherapy: Stage 4 is an incurable advanced stage of cancer. It mainly requires chemotherapy as the cancer has spread in the body. Treatment is done at that time to mitigate the symptoms and ensure quality of life of a person.
- Immunotherapy: It is a recent and exciting field of cancer treatment where the body’s immune system is stimulated to kill cancer cells.
Post-recovery precautions
“After recovery, people need regular follow-up endoscopy and surveillance every three months to look for any recurrence. Those who have undergone surgery need [to get] serial tests like surveillance endoscopy, CT scans or PET scans done annually or once in three years,” says Dr Yelsangikar.
As stomach cancer surgery involves removal of a part of the stomach, the person’s diet is also modified. People need to take smaller portions of meals multiple times in a day. They must increase protein intake to avert developing protein deficiency.
Post-surgery, people may be susceptible for poor absorption of iron and vitamin B12 and require them as supplements for a long period, suggests Dr Yelsangikar.
