Stomach cancer is the fifth most common cancer and the fourth leading cause of cancer-related deaths globally. In India, it ranks as the fourth most common cancer for both men and women. In the North-Eastern region, it is the third most common cancer among men. Specifically in Nagaland, it is the second most common cancer in men and the third most common in women. The likelihood of developing stomach cancer is highest in this state, with a probability of 1 in 50 for males and 1 in 67 for females. Additionally, stomach cancer is the leading cause of cancer-related deaths in both genders in Nagaland.
Symptoms
Stomach cancer often does not present symptoms in its early stages. When symptoms do occur, they may include indigestion and upper abdominal pain. Advanced stages of stomach cancer can cause more severe symptoms such as extreme fatigue, unintentional weight loss, vomiting blood or food particles, jaundice, and black stools.
Risk Factors
- H. pylori Infection: Chronic infection of the stomach’s mucosal layer with Helicobacter pylori is a significant risk factor. This bacterium spreads through direct contact with saliva, vomit, or stool. While many individuals with chronic H. pylori infections are asymptomatic, some may develop stomach ulcers or atrophic gastritis. Atrophic gastritis can progress to more severe changes in the stomach lining, potentially leading to stomach cancer.
- Chronic Atrophic Gastritis: Thinning of the stomach lining due to long-term inflammation.
- Pernicious Anemia: This condition results from a deficiency in intrinsic factor (IF), which is crucial for vitamin B12 absorption. A lack of IF can lead to vitamin B12 deficiency, impacting red blood cell production and increasing the risk of stomach cancer.
- Obesity
- Gastroesophageal Reflux Disease (GERD): A condition where stomach acid frequently flows back into the esophagus.
- Genetic Mutations or Family History: Conditions like Lynch syndrome, Li-Fraumeni syndrome, Peutz-Jegher syndrome, and Gastric Adenoma and Proximal Polyposis of the Stomach (GAPPS) increase risk.
- Diet: Consuming large amounts of salted foods, such as salted fish and meat, and pickled vegetables can increase the risk. Regular consumption of processed, grilled, or charcoaled meats is also linked to higher risk. Conversely, a diet rich in fresh fruits (especially citrus) and raw vegetables may lower the risk.
- Smoking and Alcohol Use
- Environmental or Occupational Exposure: Work in industries such as rubber or coal, or exposure to high levels of radiation.
- Blood Type: For unknown reasons, people with type A blood have a higher risk of stomach cancer, according to the American Cancer Society.
Diagnosis
Diagnosis typically starts with an endoscopy to examine the upper gastrointestinal tract. If a suspicious growth is detected, a biopsy is performed to confirm cancer. Staging is determined through imaging techniques such as a CT scan.
Treatment
- Stage I: Cancer is confined to a small area in the stomach. Surgery is the primary treatment, though some institutions may recommend chemotherapy based on their protocols.
- Stage II and III: Cancer has spread to nearby lymph nodes. Treatment usually involves surgery followed by chemotherapy. Radiation therapy may be used if the cancer has not been fully removed or if lymph node removal is inadequate.
o Partial Gastrectomy: Removal of a portion of the stomach along with nearby lymph nodes and fatty tissues.
o Total Gastrectomy: Removal of the entire stomach, surrounding lymph nodes, and fatty tissue. The esophagus is connected directly to the intestines, and a new “stomach” or pouch is created from a section of the intestines for digestion. - Stage IV: Cancer has spread to distant sites such as the lungs, liver, or bones. Treatment is palliative, focusing on relieving symptoms with chemotherapy and immunotherapy. Radiation therapy and surgery may be used for palliative purpose (bleeding, pain etc).
Dr. Vishala Varghese
Radiation Oncologist, CIHSR