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Stomach Cancer

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What is Stomach Cancer?

Stomach cancer, also known as gastric cancer in Singapore, is the 4th most common cancer and the 2nd most common cause of cancers deaths worldwide. In Singapore, stomach cancers are the 4th and 5th commonest cause of cancer deaths in males and females respectively.

The stomach has 5 layers, and the stage of stomach cancer depends on which layers and organs around the stomach are affected.

The 5 layers are:
  • Mucosa: this is the innermost layer of the stomach and also where the stomach acid and other digestive enzymes are produced. It is also the most common place where stomach cancer starts.
  • Muscularis Mucosa: just below the mucosal layer.
  • Submucosa: this is the 3rd layer of the stomach. It contains the blood vessels, lymphatic vessels, glands, and nerves. If the cancer invades this space, it could spread via the blood or lymphatic system, to the rest of the body.
  • Muscularis Propria: this is the 4th layer and muscular layer of the stomach. It helps to move and mix food around.
  • Serosa: the final layer of the stomach. It is the outer membrane of the stomach.
As the cancer infiltrates the deeper layers of the stomach, the treatment options and prognosis changes. The deeper it penetrates the more aggressive your treatment will have to be. Hence, early diagnosis is the best chance of a complete cure.

Stomach cancers develop over many years and often are asymptomatic at the early stages. There are also different types of stomach lesions: 

Adenocarcinomas: 

  • Most common cancer of stomach accounting for 90-95% of cases
  • Develop from the glands in the mucosa
  • Two types: intestinal and diffuse

Other lesions in the stomach include:

  • Malt tumours (related to lymphomas)
  • Gastrointestinal stomal tumours (GIST) - tumours that arise from the muscle layer of the stomach
  • Neuroendocrine tumours (NETs) - tumours from the cells that sometimes secrete hormones
  • Benign lesions - lipomas (fatty lumps), fundic gland polyps (swollen glands)

What are the common causes of Stomach Cancer in Singapore?

Cancer cells are cells that multiply out of control due to a genetic defect or mutation, when this happens, they grow to form either a cancerous (malignant) tumour or a non-cancerous (benign) tumour. But how do cells become defected or mutated? There are a number of ways this happens, for example4:
  • Inherited: sometimes genetic defects are inherited and passed down through generations
  • Smoking: cigarette smoke can cause our normal cells to mutate into cancer cells
  • Bacterial infection: the Helicobacter Pylori (H.Pylori) bacteria have been known to change substances in our food into chemicals that can mutate the DNA of the cells in the stomach
  • Alcohol: excessive consumption of alcohol can mutate our normal cells into cancer cells

The main cause of stomach cancer is still unknown but there are several risk factors that make you more susceptible to it. We will learn more about the risk factors later.

What are the symptoms of Stomach Cancer?

The early-stages of stomach cancer usually do not cause any symptoms or if they do cause symptoms, the effects are so mild that they tend to be ignored. Symptoms of early-stage stomach cancer include5:

  • Indigestion
  • Mild nausea
  • Heartburn
  • Loss of appetite
  • Bloated after meals

Once obvious symptoms appear, the cancer is most likely in the advanced stages and symptoms include4,5:

  • Melena (Bleeding)
  • Vomiting
  • Unexplained weight loss
  • Abdominal pain
  • Difficulty swallowing
  • Weakness or fatigue
  • Yellowish eyes or skin
  • Heartburn 
  • Swelling or fluid retention in the abdomen

If you notice any of the symptoms, make an appointment to see a gastroenterologist. Like all diseases, especially cancer, early intervention is the key to survival.

Is Stomach Cancer painful?

Yes, it can be painful especially in the later stages where you might experience pain in the abdomen and heartburn.

Who is at risk of Stomach Cancer in Singapore?

Although cancer is not entirely preventable, there are certain things that make you more susceptible to it, such as4,6,7:

  • Age and gender: while anyone of any age and gender can get stomach cancer, it is more common in older men 
  • Family history: genetically this makes you more at risk of stomach cancer
  • Unhealthy diets: a diet high in processed, salty, and smoked food, and low in fruits and vegetables increases your risk of stomach cancer
  • Gastroesophageal disease (GERD): also known as chronic reflux
  • Bacterial infection: an infection by the H.Pylori bacteria has been shown in studies to be directly linked to stomach cancer
  • Obesity: being obese has been linked to an increased risk of cancers of the upper part of the stomach near the oesophagus
  • Smoking: cigarette smoke can cause our normal cells to mutate into cancer cells
  • History of stomach surgery: individuals who have had surgery to remove part of their stomach or to remove an ulcer from their stomach have a higher risk of developing stomach cancer
  • Presence of polyps: polyps are precancerous growths that start out benign (non-cancerous) but may progress to become malignant (cancerous)
  • Other medical conditions: certain disorders such as hereditary diffuse gastric cancer, Lynch syndrome, juvenile polyposis syndrome, Peutz-Jeghers syndrome and familial adenomatous polyposis

How is Stomach Cancer diagnosed?

Stomach cancer is not very common, and its incidence has been declining over the past few years. However, if you have any of the risk factors above, early diagnosis and treatment is important. The first step in the diagnosis of stomach cancer is a physical examination. Be sure to alert the gastroenterologist if you have any symptoms or if you have any of the risk factors above. The following tests will be conducted to check for stomach cancer4,8:

  • Laboratory blood tests: checks for the presence of tumour markers in your body. Tumour markers are produced by the tumours or by your body in response to the presence of a tumour.
  • Gastroscopy: a thin, flexible tube is inserted into your mouth and led down through your oesophagus and into your stomach and duodenum (upper part of the small intestine). If there are any suspicious looking growths or lesions, they will either be removed, or some samples will be taken for a biopsy.
  • Upper gastrointestinal scans: also known as a Barium swallow, you will be given a liquid containing barium to drink. The barium coats your gastrointestinal tract, making any tumours visible.
  • Computed-tomography scan (CT-Scan): A CT-scan is a non-invasive diagnostic imaging tool that uses a combination of x-rays and computer technology to produce cross-sectional, horizontal, or axial images of our body.

What are the treatment options for Stomach Cancer in Singapore?

The treatment of stomach cancer depends on the stage at diagnosis; these treatment options are4,8:

  • Endoscopy: endoscopic techniques can successfully treat early gastric cancers without the need for surgery or chemotherapy
  • Surgery: this may be done to remove the tumour and part/all of the stomach
  • Chemotherapy: drugs used to kill rapidly dividing cells, such as cancer cells
  • Radiotherapy: radiation used to kill rapidly dividing cells, such as cancer cells
  • Targeted drug therapy: drugs used to target the weak parts of a cancer cell, resulting in its death
  • Immunotherapy: drug treatment that helps your own immune system fight the cancer

These treatments can either be used by itself or in combination with each other.

Frequently asked questions

Can ultrasound detect stomach cancer?
An endoscopic ultrasound can check if the cancer has spread through the layers of the stomach.

References:

  1. National Cancer Centre Singapore. (2022, September 26). Cancer Screening. Retrieved from National Cancer Centre Singapore: https://www.nccs.com.sg/patient-care/cancer-types/pages/cancer-screening.aspx
  2. Hermann Brenner, D. R. (2009). Epidemiology of Stomach Cancer. In J. M. Walker, Methods in Molecular Biology (pp. 467-477). Springer.
  3. Macmillan Cancer Support. (2022, June 30). The Stomach. Retrieved from Macmillan Cancer Support: https://www.macmillan.org.uk/cancer-information-and-support/stomach-cancer/the-stomach
  4. The American Cancer Society medical and editorial content team. (2021, January 22). What is stomach cancer? Retrieved from American Cancer Society: https://www.cancer.org/cancer/stomach-cancer/about/what-is-stomach-cancer.html
  5. Bernstein, S. (2021, October 1). Stomach Cancer. Retrieved from WebMD: https://www.webmd.com/cancer/stomach-gastric-cancer
  6. Boeing, H. (1991). Epidemiological research in stomach cancer: progress over the last ten years. Journal of Cancer Research and Clinical Oncology.
  7. Kimberly Venneman, I. H. (2018). The epidemiology of Helicobacter pylori infection in Europe and the impact of lifestyle on its natural evolution toward stomach cancer after infection: A systematic review. Helicobacter.
  8. Cleaveland Clinic Medical Professional. (2022, May 17). Stomach Cancer. Retrieved from Cleaveland Clinic: https://my.clevelandclinic.org/health/diseases/15812-stomach-cancer

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