Stomach cancer

How common is stomach cancer?

The incidence of stomach cancer has declined in recent decades, but it remains one of the most common cancers worldwide. It most commonly affects men (twice as often as women) and people >55 years of age.

Who are more likely to get stomach cancer?

Its aetiology is unknown, but genetic, environmental and infectious factors have been implicated. The main risk factors for stomach cancer include: infection with Helicobacter pylori (H. pylori), consumption of preserved foods (rich in salt, nitrosamines and nitrites), consumption of smoked foods or grilled meats (which produce polycyclic hydrocarbons), various stomach diseases (e.g. atrophic gastritis, malignant anaemia, gastric polyps), advanced age, smoking, family history (which may be associated with specific gene mutations) and blood type A.

Are there any symptoms indicative of stomach cancer?

In the early stages the disease has no symptoms or has very mild and atypical symptoms, which often leads to late diagnosis. There is anorexia and meat aversion, nausea, abdominal pain, vomiting and dysphagia (especially in cases where the tumour is located in the cardio-oesophageal junction, i.e. the area where the stomach joins the oesophagus). In some cases where the tumour bleeds very suddenly, haematemesis (vomiting with blood) or melena (black stools) occurs, while when there is continuous, minor bleeding from the tumour the patient is anaemic due to the gradual loss of blood which is not noticed. In more advanced stages there is weight loss, ascites (fluid collection in the abdomen), weakness and tiredness.

What tests does a patient with suspected stomach cancer undergo?

The test of choice for the diagnosis of stomach cancer is endoscopic gastroscopy, which, in addition to an overview of the inside of the stomach, allows for simultaneous biopsies to be taken from suspicious lesions. An alternative less invasive method is barium meal (simple oesophago-stomach x-ray after ingestion of barium), which has the disadvantage that 10-30% of tumours in early stages cannot be detected and does not allow simultaneous biopsies to be taken.

How is stomach cancer diagnosed?

The final diagnosis is made by histological examination of samples taken from the mouth during gastroscopy or from another organ in the case of metastatic cancer.

After a diagnosis of stomach cancer, what happens next?

To stage the disease, imaging with CT scans of the abdomen and chest will be needed to investigate whether the cancer is confined to the stomach, whether it is spreading to neighbouring structures or whether there are distant metastases.

What are the treatments available today?

At the initial stage of the disease and if the patient’s health condition allows it, surgical treatment of the tumour with total or partial removal of the stomach (gastrectomy) is chosen.

What options are available if the disease cannot be treated surgically?

Stomach cancer is usually diagnosed in advanced stages, in which surgical resection is not possible. Available treatment options include chemotherapy, radiotherapy and targeted therapies, and the effectiveness of immunotherapy is being studied.