GASTRIC CANCER
Sections of the stomach
Stomach is part of the digestive system. It is just below the diaphragm (muscle layer just below the lungs). The upper part of the stomach is connected to the esophagus (esophagus). The other end of the stomach is connected to the first part of the small intestine (duodenum). Stomach consists of three main parts. The upper part is called the us fundus.. The middle part is called the body of the stomach. The lower part is called “antrum” or “pylor”. Each end of the stomach has a valve called sphincter. The valve between the esophagus and the upper part of the stomach is called a cardiac sphincter. The valve between the lower part of the stomach and the duodenum is called a pyloric sphincter. The stomach has various functions.
How does the stomach mix and decompose food?
Stomach is a muscular bag. Its main task is to mix the eaten food and begin to shred it for easy digestion. These contractions mix food and make it a dense liquid. This facilitates digestion in the duodenum.
Initiation of protein digestion
The inside of the stomach is covered with glands that secrete gastric juice. Gastric juice contains a digestive enzyme called pepsin and acid. As soon as we see or smell this enzyme food, it starts to secrete even before the food enters the stomach. This enzyme begins to break down proteins in food so that the body can absorb them. Acid is necessary for the proper functioning of the enzyme. It also helps to kill bacteria that may be in food and thus protects against food poisoning.
There are other glands that form a thick mucus layer in the stomach lining. Bumukusmide lining helps prevent acid and proteins in stomach water from being damaged by digestive enzymes.
Absorption of vitamin B12
The stomach produces another chemical necessary to absorb vitamin B12. The body needs this cell for the production of red blood cells and for the health of the nervous system. Where the food goes after the stomach
Where foods go after stomach
After about two hours in the stomach, this semi-liquid, partially digested food passes into the duodenum to continue digestion. The digested food then moves to the small intestine for the absorption of nutrients into the body. The remaining wastes move to the large intestine. In the first part of the colon, water is absorbed and the waste material solidifies and becomes feces.
Risk and causes of stomach cancer
This section deals with possible risk factors and causes of stomach cancer. Some factors increase the risk of stomach cancer while others lower it. Read on for more information.
How common is stomach cancer?
Approximately 7500 cases are diagnosed each year. There are 2 gastric cancer diagnoses (2%) for every 100 cancer diagnoses. Men are almost twice as likely to be diagnosed as women.
Age
Just like other types of cancer, gastric cancer is more common with age. About 95 out of 100 cases (95%) are diagnosed in people aged 55 and over.
Nutrition
The incidence of stomach cancer varies from country to country worldwide. This increases the cancer risk in a diet with a high proportion of saline. The rate of gastric cancer is very high in Japan, where very salty brine foods are popular.
An intense diet of some canned and processed foods can also increase your risk of stomach cancer. Several studies and a large ongoing study called EPIC have found a small increase in the risk of gastric cancer in people who consume a lot of processed meat. Processed meats include bacon, sausage, sausage and ham. These meats contain chemicals called nitrosamines. Nitrosamines have been linked to gastric cancer. A Canadian study has shown that the risk is highest in people infected with Helicobacter pylori bacteria. Consuming lots of pickled foods can also increase your risk.
A recent study showed that vegetarians may have a lower risk of stomach cancer than meat-eaters. The EPIC study showed an increased risk of gastric cancer for people who consume red meat too often and excessively. But we need more work to confirm this.
A diet that consumes a lot of fresh fruits and vegetables seems to reduce the risk of stomach cancer. This may be because these foods contain high levels of antioxidant vitamins. Especially vitamin C, along with other ingredients in fresh foods, is thought to help prevent cancer-causing stomach lining wear. Vitamin A is also thought to help protect against stomach cancer. One study suggests that vitamin B6 may have a protective effect. Research shows that antioxidant vitamins will play the most role in the protection of undernourished and malnourished people. Although the protective effects of antioxidant vitamins are seen in well-fed people, this effect will be slightly less. This may be the reason why some recent studies in America and Europe do not find a relationship between consumption of fruits and vegetables and the risk of stomach cancer.
In the UK, only 1 in 3 adults consumes enough fruit and vegetables (at least 5 servings per day). That's why there's so much you can do with nutrition in your journey of wellness. If you are worried about cancer or heart disease, you can review and improve your diet.
Helicobacter pylori infection
Helicobacter pylori is a highly researched bacterial infection in the last few years. This bacterial infection increases the risk of cancer in the lower part of the stomach about 6 times. A particular type of infection called cagA positive Helicobacter pylori may increase the risk of cancer.
Millions of people are infected with this bacterium, but most of them do not have cancer, so we can say that other factors are involved in the development of stomach cancer. Nutrition and smoking may cause cancer when interacting with HP bacteria. In addition, this bacterium can cause severe chronic atrophic gastritis (SCAG), which can cause stomach cancer. Patients with SCAG have a risk of gastric cancer in both the lower and upper parts of the stomach.
Helicobacter pylori infection can be diagnosed by blood test or breath test. It can usually be treated quite easily with a range of antibiotic treatments. But we are not sure how useful it is to treat HP. HP can protect against a particular type of esophageal cancer called esophageal adenocarcinoma. A meta-analysis study of HP treatment showed that HP treatment slightly reduced the risk of stomach cancer, but was most effective in people with peptic ulcer or pre-cancerous changes. Even if you are being treated, you have a chance to be re-infected because it is so common. Therefore, your doctor may not treat you unless you have stomach pains (a sign of peptic ulcer).
Tobacco and alcohol
Cigarette smoke contains many chemicals that cause cancer. If you breathe cigarette smoke, you will inevitably sigh one amount at a time. Smoking in this way can increase the risk of stomach cancer. It is thought that smoking causes about 1 in 5 gastric cancer cases in England (20%).
Smokers are twice as likely to have mid-cancer as non-smokers. If you quit smoking, the risk is reduced. If a person has a HP infection, he has a 10-fold higher risk of non-HP infection and non-smokers.
A Swedish study showed that the use of chewing tobacco called us snus d increases the risk of stomach cancer by at least 50% compared to smoking.
Recent research shows that alcohol consumption is unlikely to increase the risk of stomach cancer.
Other medical reasons
Acid reflux is the return of gastric acid to the esophagus. This may cause esophagitis. Acid reflux may increase the risk of cancer in the stomach (gastric cardia) closest to the esophagus.
Some diseases and surgical procedures have been shown to reduce the amount of acid produced in the stomach and increase the risk of cancer in the stomach. Low acid levels cause more bacteria to produce, and bacteria can produce more nitrite and nitrosamines, which can increase the risk of stomach cancer. Such diseases and surgical procedures include:
Malicious anemia
Removal of a part of the vagus nerve (vagotomy)
Removal of a part of the stomach (partial gastrectomy)
Anti-inflammatory drugs
An overview of published studies shows that regular use of non-steroidal anti-inflammatory drugs reduces the risk of stomach cancer to some extent. These drugs are called NSAIDs. Examples include Aspirin, ibuprofen and Nurofen. In 2010, researchers conducted several tests to determine whether daily aspirin use protects humans from disease. They found that taking aspirin every day could reduce the risk of dying of stomach cancer. However, further research is needed because regular NSAID use can increase the risk of developing stomach or twelve-finger ulcers.
Family history
Family history is seen as a risk factor for gastric cancer. The incidence of gastric cancer in siblings and children of people with stomach cancer increases. It is not yet known whether this is due to genetic or shared risk factors such as Helicobacter pylori infection.
Having cancer
Statistically there is a slight increase in the risk of men having stomach cancer if they have had prostate cancer, breast cancer, bladder cancer or testicular cancer before. If women have had ovarian cancer, breast cancer or cervical cancer, the risk of stomach cancer increases. For both sexes, esophageal cancer, non-melanoma skin cancer, bowel cancer, non-Hodgkin's lymphoma or thyroid cancer has had an increased risk of stomach cancer.
Radiation exposure
Those exposed to the effects of the atomic bomb in World War II were more likely to have stomach cancer because of the radiation they were exposed to. We have known for many years that there is a greater risk of people receiving radiotherapies to the spine because of the so-called ankylosing spondylitis.
In the past, gastric cancer has been associated with exposure to medical X-ray (X-ray). However, in today's technology, the amount of X-ray radiation exposed to x-rays is much lower than before. However, we know that some other medical methods, such as CT (Computed Tomography) scans, contain significant amounts of radiation. This is not harmful to you if BT shots are used only when you need them. Describes the reluctance of doctors to use CT for routine screening.
Weakened immune system
People who have been immunocompromised by infection with HIV, AIDS, or drugs taken after organ transplants are seen to have twice the risk of stomach cancer compared to other people. Such conditions may increase the risk of infection, such as Helicobacter pylori.
Occupational chemicals
The International Agency for Research on Cancer (IARC) says there is evidence that working in the rubber manufacturing industry increases the risk of stomach cancer. There may also be a connection with asbestos exposure.
Hormone replacement therapy (HRT)
Women receiving hormone replacement therapy (HRT) have a reduced risk of gastric cancer. However, HRT increases the risk for some types of cancer, including breast cancer.
Physical mobility
Some recent research has shown that the risk of stomach cancer is reduced by half in people who have a high amount of physical activity in their work and leisure time.
Symptoms of stomach cancer
Symptoms of gastric cancer can be quite vague and general.
Indigestion, acidity and belching
Early signs of stomach cancer are usually acidity and belching. Many people diagnosed with stomach cancer have had such symptoms for years. But they can also be symptoms of other stomach problems. Most people have indigestion for many years and do not have cancer. 1 or less of every 50 people who visit a doctor with symptoms of indigestion and belching are cancer.
Feeling Full
Another early symptom may be too saturated (feeling full) earlier than usual when eating. If this condition persists for a while, you will start to lose a lot of weight.
Bleeding and feeling tired or panting
Even early gastric cancer can cause bleeding into the stomach. Losing blood over an ongoing period can make you anemic. This means your red blood cell count is very low. Anemia makes you look pale and makes you feel tired. If you are very anemic, you may also feel constantly panting. Vomiting blood is not a common early symptom, but it can be seen as well. In this case, the blood may not be clearly visible. If you vomit bright red blood, it means that the bleeding is fresh. If blood has remained in the stomach for some time, it may appear dark brown like coffee grounds.
Blood clots
People with stomach cancer are more likely to have a blood clot. If there is pain or swollen leg, or sudden chest pain and shortness of breath, there may be a blood clot in the leg or lung. In such a case, you should immediately contact your doctor as you will need medications to prevent blood clotting.
Other symptoms
More than half of people diagnosed with stomach cancer feel pain, nausea or difficulty swallowing. The area in which the pain is felt may vary from person to person. It is usually the upper part of the stomach. Or it may be just below or slightly below the sternum.
Symptoms of advanced stage gastric cancer
The following symptoms are among the symptoms of advanced gastric cancer:
Anorexia and weight loss
Liquid in the abdomen
Blood in the stool
Anorexia and weight loss
Anorexia and weight loss are usually later symptoms and may indicate that stomach cancer may be advanced. However, some early stage gastric cancer patients may also lose their appetite.
Liquid in the abdomen
In an advanced cancer case, the doctor may feel a lump in the abdomen. Some people with advanced stomach cancer may accumulate fluid in their abdomen. This is called acid.
Blood in the stool
Some stomach cancers cause bleeding but do not vomit. In this case, the blood passes through the digestive tract. In this case the stool appears black, like tar.
Types of Stomach Cancer
Adenocarcinoma of the stomach
Adenocarcinoma is the most common type of gastric cancer. More than 95 (95%) of every 100 stomach cancer diagnoses are adenocarcinomas. Cancer begins in the stomach lining cells. The lining of the stomach gland cells produce mucus and gastric juice.
Squamous cell cancers
Squamous cells were skin cell-like cells between the gland cells that formed the stomach lining. These cancers are treated in the same way as adenocarcinoma.
Gastric lymphoma
Lymphoma is completely another type of cancer. This is a very rare type of cancer.
Gastrointestinal stromal tumors (GIST)
Gastrointestinal stromal tumors (GIST) can be benign or malignant (cancer). These rare tumors develop in connective tissue cells supporting the digestive (gastrointestinal) system organs. They are most commonly seen in the stomach.
Neuroendocrine tumors (NETs)
Neuroendocrine tumors (NETs) can be benign or malignant (cancer). They usually grow in tissues that produce hormones in the digestive tract. They are rare but the most common are carcinoid tumors.
Stomach Cancer Tests
What your doctor will do
Your doctor will ask you about your symptoms. He will ask you what symptoms you have experienced, when they have appeared, and whether you have noticed the good and bad effects of what you are doing.
Your doctor will ask you to lie down for a physical examination and examine your abdomen. You may feel sensitivity or your doctor may feel a mass. After your examination, your doctor may refer you to a hospital or specialist for tests such as endoscopy.
At hospital
Your specialist will ask you about your medical history and symptoms. He will then examine your abdomen. You may require blood tests and chest films to check your overall health. He can then organize other outpatient tests.
Endoscopy
Endoscopy is the most commonly used test to diagnose gastric cancer. The endoscope is a long tube with an illuminated camera. You swallow a part of the pipe so that the doctor or nurse can see your esophagus, your stomach, and the first part of the duodenum. Small samples (biopsies) are taken from abnormally visible parts.
You can take this test as an outpatient. But you must take someone with you to bring you back home. You will not eat or drink 8 hours before the test so that your stomach and small intestine are empty. When you go to the clinic, the nurse will ask you to wear a patient's gown. You will be given a relaxing needle when you lie down on the bed.
When you are relaxed and numb enough, the doctor will insert the endoscope tube through your throat into your stomach and examine your stomach walls to see if there are any abnormal states. With this examination, gastric ulcer can be seen in addition to gastric cancer, if any. If there are abnormal areas, your doctor will take a biopsy and send it to the laboratory. A pathologist in the laboratory will examine the biopsy with a microscope to see if they have cancer cells.
Sometimes there is an ultrasonic fish at the end of the endoscopy tube so that ultrasound of the stomach and its surroundings can be obtained. This is called endoscopic ultrasound.
After the test, you should take some rest. You might not remember anything when the test is over because you're drugged. You can go home on the same day, but you shouldn't drive because the drugs will be silly.
Barium stomach radiography
Barium stomach radiography is a special type of X-ray examination. This test is not commonly used for stomach cancer. This is an outpatient test. You cannot eat or drink for 6 hours before the test.
When you go to the X-ray department, the nurse will ask you to wear a patient's gown. You will be given a needle to relax your digestive system muscles and drink the given white liquid.
The white liquid given is barium. This is the white liquid that will appear on the X-ray. After drinking the barium you will be asked to lie down on the x-ray table. As the barium passes through your stomach and duodenum, the doctor will monitor the x-ray screen. Any growth or ulcer will appear on the screen. The X-ray table will be moved at various angles to allow the barium to flow to your doctor's place.
The whole test takes about an hour. You can go home immediately after the test. However, some people may experience discomfort and nausea after the test. Barium can sometimes constipate. As your body evacuates the removed barium, your stool may be white for a day.
After tests
When the tests are completed, a hospital appointment should be arranged to see your specialist. It may take some time for the test results to appear and you may experience stress. Therefore, it may be helpful to ask the attendant who will be available when your test results will be available.
It might be good to talk to a close friend or relative about your feelings while waiting for your results. Or it may be helpful to contact someone who has had a similar experience or a cancer support group.
Advanced Tests for Stomach Cancer
Why do we need more tests?
You may need further tests to determine the stage of the cancer and check if it has spread. These tests also help your doctor determine the best treatment for you. Some of these tests may have been performed at the time of diagnosis, in such cases there is no need to repeat these tests.
Computed Tomography (CT)
CT is a computerized test using X-rays. Your abdomen and chest can be scanned. The size and location of the cancer is determined by this imaging method. CT can also determine whether the cancer has spread to your lungs, lungs or lymph nodes.
Laparoscopy
Laparoscopy is a small procedure performed under general anesthesia. When it is anesthetized, the doctor inserts a tube with a light and a camera at the end into your stomach with a small incision and checks whether the cancer has dissipated. A small incision remains with a few small stitches. In some cases, the camera can be inserted from multiple points, in which case you may have more than one cut.
Endoscopic Ultrasound
This test uses an endoscope and an ultrasound device, as the name implies. It is almost identical to endoscopy for the patient. However, the endoscopy tube also has an ultrasound cap and the patient is over-anesthetized. This test helps doctors determine the stage of cancers in the upper part of the stomach and in the part where the stomach joins the esophagus.
Blood tests and chest x-ray
In addition to tests that check your general health, your doctor may order tumor marker tests. These markers are chemicals that can be seen in your blood in some types of cancer. The CEA marker (carcinoembryonic antigen) is sometimes seen in gastric cancers (also seen in other cancers). However, half of the patients with stomach cancer do not have high CEA in their blood.
You may also be asked to take other blood tests to determine if your kidney is working well.
MRI
MRI uses the effect of magnetism to form a picture of the inner part of the body. MRI can be preferred by your doctor as it can show soft tissue more clearly than CT.
PET-CT Shooting
In PET-CT, both CT and PET are taken together. The location of active cancer cells is determined by using low amounts of radioactive glucose in PET extraction. With this shot, cancers in the upper part of the stomach are sometimes seen.
Kidney ultrasound shoot
This shot displays your kidney using sound waves. This method examines whether your kidney has spread to the cancer.
After tests
If you are diagnosed with stomach cancer, a qualified clinical nurse will take care of you. Nurses are an important part of the team of medical specialists who will assist you in the next treatment process.
Treatment of stomach cancer
In this section you will find information about the treatment of gastric cancer. You can get information about staging of stomach cancer, how doctors choose treatment protocol, surgical methods, radiotherapy, chemotherapy and stomach cancer research.
Methods Used in Gastric Cancer Treatment
How to plan your treatment
As with many types of cancer, the main treatment options are surgery, chemotherapy and radiotherapy. You can only have surgery, or chemotherapy and / or radiotherapy. Your doctor plans your treatment with the following in mind:
How cancer grows and spreads (stage of cancer)
Your general health
Age and fit
As with many types of cancer, the earlier the gastric cancer is diagnosed, the more likely it is to be controlled and perhaps fully cured. If cancer is diagnosed without spreading to the body, it is most likely taken by surgical intervention. Gastric cancer surgery is a very comprehensive operation. Therefore, your doctor should see that you are strong enough to handle the surgery.
Surgery to remove the tumor
When the stomach cancer is treatable, the whole or most of the stomach is removed. How much of the tumor is removed depends on the exact location of the tumor. During surgery, the surgeon will thoroughly examine your stomach and its surroundings. It can take the lymph nodes around the stomach and part of the outer membrane of the stomach. These samples are sent to the laboratory and checked to see if they contain cancer cells.
Surgery to improve symptoms
Even if the cancer cannot be cured completely, surgery may be preferred to improve symptoms and provide a better quality of life for a longer period of time. If the tumor is blocking the entry or exit of the stomach, a tube called stent is most likely inserted and chemotherapy is applied. Another option is to connect the stomach to the small intestine directly from the upper part of the obstruction by bypass surgery. Sometimes laser surgery can be used to shrink tumors that obstruct the stomach.
Chemotherapy
Chemotherapy alone or in combination with surgery can be used to treat stomach cancer. If cancer is advanced and scattered throughout the body, chemotherapy is most likely used alone. With this treatment, symptoms can be alleviated and the tumor may be reduced or at least reduced in growth rate.
Gastric cancers that have spread to nearby tissues but have not yet infected another organ are called locally advanced cancers. Sometimes these cancers are so advanced that they may not be able to remove them completely by surgical intervention. In such a case, chemotherapy may be applied before surgery to reduce the tumor. In some cases, these types of tumors can be minimized by chemotherapy so that the surgeon can completely remove it.
If the cancer is Stage 2 or Stage 3, chemotherapy is likely to be administered before and after surgery. Chemotherapy reduces the risk of recurrence.
Radiotherapy
Radiotherapy is not routinely used in the treatment of stomach cancer. In some cases, radiotherapy may be used to prevent cancer from returning after surgery.
In gastric cancer, radiotherapy is not used as often as chemotherapy. However, radiotherapy can be used to shrink the tumor. Radiotherapy can also be used to control pain or bleeding.
Biological treatment
Trastuzumab (Herceptin) is a biological treatment that can be used in the treatment of patients with gastric adenocarcinoma, which in some cases has spread. This type of treatment works only if cancer cells have Herceptin (HER2 positive cancer) receptors.
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