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Stomach cancer

Stomach cancer (gastric cancer) is a lump (tumour) created by an abnormal and uncontrolled growth of cells that starts in your stomach.

Your stomach is a muscular bag in your abdomen (tummy) that digests the food you eat. The lining of your stomach produces a strong acid to help break down food.

Stomach cancer develops within the lining of your stomach or stomach wall. If you don't get treatment for stomach cancer, it can spread through the lining of your stomach into neighbouring organs, such as your bowel. Sometimes the cancer can spread to other parts of your body through your blood or lymphatic system. Your lymphatic system is made up of tissues and organs that produce and store cells that fight infection and disease. The spread of cancer through the body is called metastasis.

In 2011, about 7,000 people were diagnosed with stomach cancer in the UK. It mostly affects people over 55 and is more common in men.

Types of stomach cancer

About nine in 10 stomach cancers are a type called adenocarcinoma. This starts in the lining of your stomach, in cells that produce stomach juices.

Other, rarer types of stomach cancer include:

  • lymphomas, where the cancer starts in your lymphatic system
  • gastrointestinal stromal tumours (GIST), where the cancer starts in connective tissue in your stomach wall
  • carcinoid tumours, where the cancer starts in your neuroendocrine system (which produces hormones)
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How cancer develops
Cells begin to grow in an uncontrolled way
Image showing the digestive system

Details

  • Symptoms Symptoms of stomach cancer

    Symptoms of stomach cancer may include persistent:

    • indigestion
    • feeling of bloating
    • pain in your abdomen
    • loss of appetite
    • difficulty swallowing
    • weight loss

    You may also get a swelling or lump in your stomach area.

    If you have any of these symptoms, see your GP.

    Other symptoms of stomach cancer may include:

    • feeling sick or vomiting – you may vomit blood
    • blood in your faeces (stools), which can look black

    If you have these symptoms, contact your GP immediately.

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  • Diagnosis Diagnosis of stomach cancer

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may give you a blood test, which will assess your general health.

    Your GP may refer you to a gastroenterologist. This is a doctor who specialises in identifying and treating conditions that affect the digestive system. You may then be recommended more tests, which may include the following.

    • Gastroscopy and biopsy. This is a procedure used to look inside your stomach. Your doctor will use a narrow, flexible, tube-like telescopic camera called an endoscope to do this. He or she may remove a small sample of tissue from your stomach during a gastroscopy, which is called a biopsy. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.
    • Barium swallow and meal. In this test, you will be asked to swallow a liquid that contains barium (a substance which shows up on X-rays). X-ray images of your stomach then show any unusual growths more clearly.

    If you're found to have stomach cancer, you may need to have other tests to find out how advanced it is. This process, known as staging, takes into account whether the cancer has spread and how big it is. You will usually be advised to have scans, such as an ultrasound, MRI or CT, to check your stomach, liver and lymphatic system.

  • Treatment Treatment of stomach cancer

    Your treatment will depend on the type of stomach cancer you have and how far it has spread. Your doctor will discuss your treatment options with you.

    Surgery

    Surgery involves removing the affected tissue from your stomach and usually a small amount of the surrounding healthy tissue.

    You may have a partial gastrectomy, which means that your surgeon will remove part of your stomach. Alternatively, you may have a total gastrectomy. This means your surgeon will remove all of your stomach. Your surgeon may also remove the lymph nodes around your stomach to check whether the cancer has spread to them.

    It may be possible for you to have laparoscopic (keyhole) surgery rather than open surgery. This means your surgeon will make several smaller cuts in your abdomen instead of one larger one. Speak to your surgeon for more information.

    You may need to have chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

    Non-surgical treatment

    Your doctor may advise you to have one of the following treatments, either as well as surgery, or on its own.

    • Chemotherapy. This uses medicines to destroy cancer cells. Chemotherapy may be given through a drip (a tube inserted into a vein in your arm or hand) directly into your bloodstream (intravenous chemotherapy). Alternatively you may be given tablets or capsules that you swallow.
    • Biological therapy. This uses a substance that stimulates your body to attack or control the growth of cancer cells. If your stomach cancer has spread, you may be offered a medicine called trastuzumab (Herceptin) alongside chemotherapy. It works by targeting cancer cells that have a particular protein on their surface. Trastuzumab isn’t suitable for everyone – ask your doctor if it's an option for you.
    • Radiotherapy. This uses radiation to destroy cancer cells and may be used alongside chemotherapy.

    You may be asked to be part of a clinical trial of a new treatment. Ask your doctor for advice and further information.

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  • Causes Causes of stomach cancer

    The exact reasons why you may develop stomach cancer aren't fully understood at present. However, you're more likely to develop it if you:

    • are over 55
    • are a man (men are twice as likely to develop stomach cancer as women)
    • get infected with the bacterium Helicobacter pylori
    • have acid reflux, also known as gastro-oesophageal reflux disease (GORD)
    • have pernicious anaemia – where your body doesn't absorb enough vitamin B12 from your diet
    • have a family history of the disease
    • smoke
    • drink too much alcohol
    • are overweight
    • eat too much salt or preserved foods, such as cured or pickled foods
    • don't eat many fruit and vegetables
  • Prevention Prevention of stomach cancer

    If you make some changes to your lifestyle, it may reduce your risk of getting stomach cancer. For example:

    • eat a healthy diet with at least five portions of fruit and vegetables a day
    • cut down on processed and pickled foods
    • reduce the amount of salt you eat
    • don't smoke
    • drink alcohol in moderation
    • maintain a healthy weight

    Talk to your GP for further advice and information.

  • FAQs FAQs

    How will the treatment of my cancer be decided?

    Answer

    Your doctor will base the advice he or she gives you about treatment for stomach cancer on your individual circumstances. Your doctor will take into account your wishes, your general health, the type of cancer you have and how far it has spread.

    Explanation

    If stomach cancer is diagnosed early, it can be easier to treat. Surgery will be your main option to remove all of the cancer and reduce the risk of it spreading. Whenever possible, your surgeon will remove only part of your stomach rather than all of it, which may lead to fewer complications after your operation. You may also be offered chemotherapy or radiotherapy before and after surgery to help increase the chance of your treatment being successful.

    A team of health professionals can help you to decide which treatment is best for you. This will include a surgeon, an oncologist (a doctor who specialises in cancer care) and cancer nurses. When you see your doctor, it may be helpful to ask family members or friends to come with you. They can help you remember what has been said and talk through your options. You may also want to write down any questions that you have before you see your doctor so you don't forget them.

    What is gastric dumping syndrome?

    Answer

    Gastric dumping syndrome is a side-effect of stomach surgery. It's caused by the sudden movement of food into your small bowel. This can cause unpleasant symptoms straight after you eat a meal or a few hours later.

    Explanation

    Gastric dumping syndrome can start soon after you have had stomach surgery, but often settles down on its own over a few months. There are two types of gastric dumping syndrome – early and late.

    Early gastric dumping syndrome happens because food moves out of your stomach into your small bowel more quickly than before your surgery. This sudden amount of food in your bowel draws fluid from other parts of your body, which causes your blood pressure to drop. This can cause uncomfortable symptoms straight after a meal, including:

    • feeling dizzy
    • a fast heart rate (palpitations)
    • feeling faint
    • pain in your abdomen (tummy) or feeling bloated
    • diarrhoea

    You can ease these symptoms by:

    • eating small meals often (have about six meals a day)
    • resting for 30 minutes after meals by sitting or lying down
    • cutting down on processed carbohydrates and cutting out sugary foods as they can make your symptoms worse
    • drinking fluids between meals rather than during them

    Late gastric dumping syndrome happens between one and three hours after you eat a meal. The symptoms are similar to early dumping and happen when sugary and starchy food passes from your stomach and into your small bowel. This causes a sudden rise in your blood sugar level as your body absorbs the sugar. Your body responds by releasing a sudden rush of a hormone called insulin into your bloodstream. The levels of insulin continue to rise even when the level of sugar in your blood starts to fall. This causes the symptoms of dumping syndrome.

    Follow the same advice as for early gastric dumping. If this doesn’t help, speak to your surgeon for more information.

    Will I need to change my diet and eating habits after surgery for stomach cancer?

    Answer

    Yes, you may need to make some changes to your diet. To begin with, you may need to change the amount you eat. Your surgeon will give you advice you about what to do after your surgery.

    Explanation

    Treatment for stomach cancer often means having an operation to remove part, or all, of your stomach. This means that in the first few days after your operation, you won’t be able to eat or drink as you usually would. To help you get the nutrients your body needs, you will be fed through a tube that is put straight into your bowel.

    You will usually be able to start eating small amounts of food a few days after your operation. As you recover, you may need to make some changes to your diet and the amount you eat. For example, you may feel full after small amounts of food. This may be because your stomach is smaller, or because the food is going straight into your small bowel, which is known as gastric dumping syndrome. For more information, see our FAQ: What is gastric dumping syndrome?

    Some nutrients, including calcium, iron, vitamin D and vitamin B12, are usually absorbed through your stomach. If you have had part, or all, of your stomach removed, your body may not get enough of these. Try to eat more foods that contain these nutrients.

    • Dairy products, sardines and broccoli are good sources of calcium.
    • Beans, dried fruit and brown rice are good sources of iron.
    • Fortified cereals (where nutrients are added during manufacture) and oily fish like herring and salmon are good sources of vitamin D.

    Your doctor may refer you to a dietitian for advice.

    If you have had your whole stomach removed, you will need to have injections of vitamin B12 for the rest of your life. If only part of your stomach has been removed, you will need regular blood tests. These will check if you’re getting enough vitamin B12 and iron from your diet. You may need to take vitamin and mineral supplements.

  • Resources Resources

    Further information

    Sources

    • Stomach cancer. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published April 2010
    • Stomach cancer. British Society of Gastroenterology. www.bsg.org.uk, accessed 10 February 2014
    • Gastritis. National Digestive Diseases Information Clearinghouse (NDDIC). www.digestive.niddk.nih.gov, published January 2010
    • Gastric cancer. Medscape. www.emedicine.medscape.com, published 16 September 2013
    • What you need to know about stomach cancer. National Cancer Institute. www.cancer.gov, published 15 October 2009
    • Lymphatic system anatomy. Medscape. www.emedicine.medscape.com, published 19 September 2013
    • Capecitabine for the treatment of advanced gastric cancer. National Institute for Health and Care Excellence (NICE), July 2010. www.nice.org.uk
    • Stomach cancer – at a glance. World Cancer Research Fund. www.wcrf-uk.org, published October 2013
    • Waddell T, Verheij M, Allum W, et al. Gastric cancer: ESMO–ESSO–ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(6):vi57–vi63. doi:10.1093/annonc/mdt344
    • Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60:1449–72. doi:10.1136/gut.2010.228254
    • Gastric carcinoma. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 January 2012
    • Upper GI cancer – suspected. Map of Medicine. www.mapofmedicine.com, published 16 October 2013
    • Anaemia – B12 and folate deficiency. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2013
    • Diaz-Nieto R, Orti-Rodríguez R, Winslet M. Post-surgical chemotherapy versus surgery alone for resectable gastric cancer. Cochrane Database of Systematic Reviews 2013, Issue 9. doi:10.1002/14651858.CD008415.pub2
    • Trastuzumab for the treatment of her2-positive metastatic gastric cancer. National Institute for Health and Care Excellence (NICE), November 2010. www.nice.org.uk
    • Stomach cancer. American Cancer Society. www.cancer.org, published 15 February 2013
    • Calcium. Food Standards Agency. www.eatwellscotland.org, accessed 23 December 2013
    • Iron. Food Standards Agency. www.eatwellscotland.org, accessed 23 December 2013
    • Vitamin D. British Dietetic Association. www.bda.uk.com, published February 2013
    • Upper GI cancer – management. Map of Medicine. www.mapofmedicine.com, published 9 December 2013
    • Dumping syndrome. Medscape. www.emedicine.medscape.com, published 5 March 2013
    • Dietary problems after surgery for stomach cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 January 2013
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    Produced by Rachael Mayfield-Blake, Bupa Health Information Team, February 2014.

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