Stomach cancer
Stomach cancer | |
---|---|
Other names | Gastric cancer |
Diagnostic method | Biopsy done during endoscopy[1] |
Prevention | Mediterranean diet, not smoking[2][5] |
Treatment | Surgery, chemotherapy, radiation therapy, targeted therapy[1] |
Prognosis | Five-year survival rate: < 10% (advanced cases),[6] 32% (US),[7] 71% (Japan)[8] |
Frequency | 968,350 (2022)[9] |
Deaths | 659,853 (2022)[9] |
Stomach cancer, also known as gastric cancer, is a
The most common cause is infection by the
A Mediterranean diet lowers the risk of stomach cancer, as does not smoking.[2][5] Tentative evidence indicates that treating H. pylori decreases the future risk.[2][5] If stomach cancer is treated early, it can be cured.[2] Treatments may include some combination of surgery, chemotherapy, radiation therapy, and targeted therapy.[1][13] For certain subtypes of gastric cancer, cancer immunotherapy is an option as well.[14] If treated late, palliative care may be advised.[2] Some types of lymphoma can be cured by eliminating H. pylori.[15] Outcomes are often poor, with a less than 10% five-year survival rate in the Western world for advanced cases.[6] This is largely because most people with the condition present with advanced disease.[6] In the United States, five-year survival is 31.5%,[7] while in South Korea it is over 65% and Japan over 70%, partly due to screening efforts.[2][8]
Globally, stomach cancer is the fifth-leading type of cancer and the third-leading cause of death from cancer, making up 7% of cases and 9% of deaths.
Signs and symptoms
Stomach cancer is often either
Early cancers may be associated with
Gastric cancers that have enlarged and invaded normal tissue can cause
These can be symptoms of other problems such as a
Risk factors
Gastric cancer can occur as a result of many factors.[27] It occurs twice as commonly in males as females. Estrogen may protect women against the development of this form of cancer.[28][29]
Infections
Smoking
Smoking increases the risk of developing gastric cancer significantly, from 40% increased risk for current smokers to 82% increase for heavy smokers. Gastric cancers due to smoking mostly occur in the upper part of the stomach near the esophagus.[34][35][36]
Alcohol
Some studies show increased risk with alcohol consumption as well.[4][37]
Diet
Dietary factors are not proven causes, and the association between stomach cancer and various foods and beverages is weak.
Fresh fruit and vegetable intake,[44] citrus fruit intake,[44] and antioxidant intake are associated with a lower risk of stomach cancer.[4][34] A Mediterranean diet is associated with lower rates of stomach cancer,[45] as is regular aspirin use.[4]
Obesity is a physical risk factor that has been found to increase the risk of gastric adenocarcinoma by contributing to the development of gastroesophageal reflux disease (GERD).[46] The exact mechanism by which obesity causes GERD is not completely known. Studies hypothesize that increased dietary fat leading to increased pressure on the stomach and the lower esophageal sphincter, due to excess adipose tissue, could play a role, yet no statistically significant data have been collected.[47] However, the risk of gastric cardia adenocarcinoma, with GERD present, has been found to increase more than two times for an obese person.[46] There is a correlation between iodine deficiency and gastric cancer.[48][49][50]
Genetics
About 10% of cases run in families, and between 1 and 3% of cases are due to
A genetic risk factor for gastric cancer is a genetic defect of the
The
Heavy metals
Heavy metals, such as arsenic, are commonly found in groundwater and have been linked to gastric cancers. There is a positive and significant relationship between arsenic concentration in groundwater and gastric cancer mortality.[56]
Other
Other risk factors include
In addition,
In a human retrospective study, biliary reflux was found to be a likely risk factor for gastric cancer and precancerous lesions.[62]
Diagnosis
To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical examination, and may order laboratory studies.[63] The patient may also have one or all of these exams:
- fibre optic camera into the stomach to visualise it.[37]
- Upper GI series(may be called barium roentgenogram)
- Computed tomography or CT scanning of the abdomen may reveal gastric cancer. It is more useful to determine invasion into adjacent tissues or the presence of spread to local lymph nodes. Wall thickening of more than 1 cm that is focal, eccentric, and enhancing favours malignancy.[64]
In 2013, Chinese and Israeli scientists reported a successful
Abnormal tissue seen in a gastroscope examination is
Various gastroscopic modalities have been developed to increase yield of detected mucosa with a dye that accentuates the cell structure and can identify areas of dysplasia. Endocytoscopy involves ultra-high magnification to visualise cellular structure to better determine areas of dysplasia. Other gastroscopic modalities such as optical coherence tomography are being tested investigationally for similar applications.[69]
A number of
Various blood tests may be done, including a
Histopathology
- Gastric signet-ring cells.[citation needed]
- Around 5% of gastric cancers are lymphomas.extranodal marginal zone B-cell lymphomas (MALT type)[75] and to a lesser extent diffuse large B-cell lymphomas.[76] MALT type make up about half of stomach lymphomas.[15]
- Carcinoid and stromal tumors may occur.[citation needed]
-
Poor to moderately differentiated adenocarcinoma of the stomach. H&E stain.
-
Gastric signet ring cell carcinoma. H&E stain.
-
Adenocarcinoma of the stomach and intestinal metaplasia. H&E stain.
Staging
If cancer cells are found in the tissue sample, the next step is to
Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for examination by a pathologist.[citation needed]
The clinical stages of stomach cancer are:[78][79]
- Stage 0 – Limited to the inner lining of the stomach, it is treatable by endoscopic mucosal resection when found very early (in routine screenings), or otherwise by gastrectomy and lymphadenectomy without need for chemotherapy or radiation.
- Stage I – Penetration to the second or third layers of the stomach (stage 1A) or to the second layer and nearby 5-fluorouracil) and radiation therapy.
- Stage II – Penetration to the second layer and more distant lymph nodes, or the third layer and only nearby lymph nodes, or all four layers but not the lymph nodes, it is treated as for stage I, sometimes with additional neoadjuvant chemotherapy.
- Stage III – Penetration to the third layer and more distant lymph nodes, or penetration to the fourth layer and either nearby tissues or nearby or more distant lymph nodes, it is treated as for stage II; a cure is still possible in some cases.
- Stage IV – Cancer has spread to nearby tissues and more distant lymph nodes, or has metastasized to other organs. A cure is very rarely possible at this stage. Some other techniques to prolong life or improve symptoms are used, including laser treatment, surgery, and/or stents to keep the digestive tract open, and chemotherapy by drugs such as 5-fluorouracil, cisplatin, epirubicin, etoposide, docetaxel, oxaliplatin, capecitabine, or irinotecan.[13]
The TNM staging system is also used.[80]
In a study of open-access endoscopy in Scotland, patients were diagnosed 7% in stage I, 17% in stage II, and 28% in stage III.[81] A Minnesota population was diagnosed 10% in stage I, 13% in stage II, and 18% in stage III.[82] However, in a high-risk population in the Valdivia Province of southern Chile, only 5% of patients were diagnosed in the first two stages and 10% in stage III.[83]
Prevention
Getting rid of H. pylori in those who are infected decreases the risk of stomach cancer.
Management
Cancer of the stomach is difficult to cure unless it is found at an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made.[90]
Treatment for stomach cancer may include surgery,[91] chemotherapy,[13] or radiation therapy.[92] New treatment approaches such as immunotherapy or gene therapy and improved ways of using current methods are being studied in clinical trials.[93]
Surgery
Surgery remains the only curative therapy for stomach cancer.
Those with metastatic disease at the time of presentation may receive palliative surgery, and while it remains controversial, due to the possibility of complications from the surgery itself and because it may delay chemotherapy, the data so far are mostly positive, with improved survival rates being seen in those treated with this approach.[6][96]
Chemotherapy
The use of chemotherapy to treat stomach cancer has no firmly established
Targeted therapy
Recently[
Radiation
Radiation therapy (also called radiotherapy) may be used to treat stomach cancer, often as an adjuvant to chemotherapy and/or surgery.[6]
Lymphoma
MALT lymphomas are often completely resolved after the underlying H. pylori infection is treated.[15] This results in remission in about 80% of cases.[15]
Prognosis
The prognosis of stomach cancer is generally poor, because the tumor has often metastasized by the time of discovery, and most people with the condition are elderly (median age is between 70 and 75 years) at presentation.[99] The average life expectancy after being diagnosed is around 24 months, and the five-year survival rate for stomach cancer is less than 10%.[6]
Almost 300 genes are related to outcomes in stomach cancer, with both unfavorable genes where high expression is related to poor survival and favorable genes where high expression is associated with longer survival times.
Epidemiology
In 2018, stomach cancer was the fifth most frequently diagnosed cancer worldwide, representing 5.7% of all cancer cases, and the third leading cause of death from cancers, being responsible for 8.2% of all cancer deaths.[103] Among men, 683 754 cases were diagnosed, accounting for 7.2% of all cancer cases, and among women, stomach cancer was diagnosed in 349 947 cases, accounting for 4.1% of all cancer cases.[103]
In 2012, stomach cancer was the fifth most-common cancer with 952,000 cases diagnosed.[16] It is more common both in men and in developing countries.[104][105] In 2012, it represented 8.5% of cancer cases in men, making it the fourth most-common cancer in men.[106] Also in 2012, the number of deaths was 700,000, having decreased slightly from 774,000 in 1990, making it the third-leading cause of cancer-related death (after lung cancer and liver cancer).[107][108]
Less than 5% of stomach cancers occur in people under 40 years of age, with 81.1% of that 5% in the age-group of 30 to 39 and 18.9% in the age-group of 20 to 29.[109]
In 2014, stomach cancer resulted in 0.61% of deaths (13,303 cases) in the United States.[110] In China, stomach cancer accounted for 3.56% of all deaths (324,439 cases).[111][unreliable source?] The highest rate of stomach cancer was in Mongolia, at 28 cases per 100,000 people.[112][unreliable source?]
In the United Kingdom, stomach cancer is the 15th most-common cancer (around 7,100 people were diagnosed with stomach cancer in 2011), and it is the 10th most-common cause of cancer-related deaths (around 4,800 people died in 2012).[113]
Incidence and mortality rates of gastric cancer vary greatly in Africa. The GLOBOCAN system is currently the most widely used method to compare these rates between countries, but African incidence and mortality rates are seen to differ among countries, possibly due to the lack of universal access to a registry system for all countries.[114] Variation as drastic as estimated rates from 0.3/100000 in Botswana to 20.3/100000 in Mali have been observed.[114] In Uganda, the incidence of gastric cancer has increased from the 1960s measurement of 0.8/100000 to 5.6/100000.[114] Gastric cancer, though present, is relatively low when compared to countries with high incidence like Japan and China. One suspected cause of the variation within Africa and between other countries is due to different strains of the H. pylori bacteria. The trend commonly seen is that H. pylori infection increases the risk for gastric cancer, but this is not the case in Africa, giving this phenomenon the name the "African enigma".[115] Although this bacterial species is found in Africa, evidence has supported that different strains with mutations in the bacterial genotype may contribute to the difference in cancer development between African countries and others outside the continent.[115] Increasing access to health care and treatment measures have been commonly associated with the rising incidence, though, particularly in Uganda.[114]
Other animals
The stomach is a muscular organ of the
A carcinogenic interaction was demonstrated between bile acids and Helicobacter pylori in a mouse model of gastric cancer.[117][118]
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External links
- "Gastric cancer treatment guidelines". National Cancer Institute. 14 October 2022.