Stomach Cancer

Dr. Deepak Chhabra

MS. (Bom), DNB, M.R.C.S. (Edin. UK)

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FAQ

  1. What is cancer
  2. Cancer Risk factors
  3. Stages of Cancer
  4. Early signs of Cancer
  5. Early detection of Cancer

The world knows this man as a consultant oncosurgeon with vast experience in Gastrointestinal and Hepatobiliary-Pancreatic cancers,who specializes in stapled anastomosis for bowel cancers and sphincter saving resections for rectal cancers. In short, he is the person to be contacted for all kinds of cancer related cases.

Richa AgrawalPancreatic Cancer

Thank you Dr Deepak for all you have done for mum, for putting the smile back of her face. I wish you success in all your future endeavors and know that you will continue to touch peoples lives and help them be healthy - the way you have done for my mum….. and me.

Nicola MathiasStomach Cancer

For 67years I've led a very healthy life and thank the "Almighty" for it. However as I said all good things come to an end some time and so be it. Out of the blues was detected the dreadful illness "C" which had shown no signs or symptoms whatsoever..... Time had now come for me to choose a very efficient Oncologist for my treatment.

Patient

My mother was diagnosed of colon cancer, and I was recommended to see Dr Deepak Chhabra for consultation.
The first impression of Dr Chhabra was… he is so young! But after consulting him we realized his level of experience and there was a sense of confidence he spilt over us.We knew we could trust him.....

Neelu GroverColon Cancer
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About Stomach

The stomach is a hollow, muscular organ between the end of the oesophagus and the beginning of the intestines. It sits in the upper left part of the abdomen.

The stomach’s role is to store food that has been swallowed, begin breaking down food, and pass the food into the intestines. Muscles in the stomach mash food. Gastric juices are released from glands in the mucosa, the innermost layer of the stomach. These juices turn the food into a thick fluid. The thick fluid passes into the intestines where digestion continues. Nutrients begin to be absorbed from the broken-down food, through the walls of the intestine, into the bloodstream.

The stomach also makes a chemical that is needed for the body to absorb vitamin B12. This vitamin is needed by the body to help in the making of red blood cells and to keep the nervous system healthy.

What is Cancer of Stomach?

Cancer develops when healthy cells in the stomach become abnormal and grow too quickly. The abnormal cells form a mass in the stomach called a tumor. When a tumor has the ability to spread to other parts of the body, it is called malignant (cancer).

The most common malignant tumors of the stomach, known as adenocarcinoma, develop in cells that line the innermost lining of stomach called the mucosa. Other types of stomach cancer are: lymphoma (cancer of lymphatic tissue), gastrointestinal stromal tumours (cancer of muscle or connective tissue) and carcinoid tumours (cancer of hormone-producing cells). Different patterns of tumor have different treatment.

There are lymph glands around the stomach. The lymph nodes are often the first place that cancer cells spread to when they break away from a tumour. So surgeons often remove them during cancer surgery and send them to the lab where a pathologist examines them to see if they contain any cancer cells.

The presence of cancer cells in the lymph nodes is part of the staging of the cancer. The stage is important because it helps the doctor to decide a suitable treatment for you.

Causes

What are the causes of stomach cancer?

The exact causes of cancer are still undetermined, but there are some known risk factors that can make a person more likely to get this disease.

Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may not have had any known risk factors.

Research has shown that some of these risk factors affect the DNA of cells in the stomach and oesophagus, which can result in abnormal cell growth and may cause tumors to form.

Risk factors for stomach cancer include:
  • Helicobacter pylori infection:
    H. pylori is a bacterium that commonly infects the inner lining (the mucosa) of the stomach. Infection with H. pylori can cause stomach inflammation and ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer.
  • Long-term inflammation of the stomach:
    People who have conditions associated with long-term stomach inflammation (such as the blood disease pernicious anaemia) are at increased risk of stomach cancer. Also, people who have had part of their stomach removed may have long-term stomach inflammation and increased risk of stomach cancer many years after their surgery.
  • Smoking:
    Smokers are more likely than non-smokers to develop stomach cancer. Heavy smokers are most at risk. Family history: Close relatives (parents, brothers, sisters, or children) of a person with a history of stomach cancer are somewhat more likely to develop the disease themselves. If many close relatives have a history of stomach cancer, the risk is even greater.
  • Poor diet, lack of physical activity, or obesity:
    Studies suggest that people who eat a diet high in foods that are smoked, salted, or pickled have an increased risk for stomach cancer. On the other hand, people who eat a diet high in fresh fruits and vegetables may have a lower risk of this disease.

A lack of physical activity may increase the risk of stomach cancer.

Also, people who are obese may have an increased risk of cancer developing in the upper part of the stomach.

Symptoms

What are the symptoms of Stomach cancer?

Symptoms of early stomach cancer include a painful or burning sensation in the abdomen, heartburn or indigestion (dyspepsia).

Other symptoms can occur later, including:
  • A sense of fullness, even after a small meal.
  • Nausea and/or vomiting.
  • Loss of appetite and/or weight loss.
  • Swelling of the abdomen.
  • Unexplained tiredness or weakness.
  • Blood in vomit.
  • Black-coloured stools.

If you have not been diagnosed with stomach cancer and are just looking through this site, please be aware that many of these symptoms occur without any serious disease being present.

However, if you have any of the symptoms for more than two weeks, see your doctor for a check-up.

Tests

What are the tests carried out to diagnose stomach cancer?

This section lists common tests for the cancers. It is not necessary for all the tests to be performed for a patient. Your doctor will select the tests that will assist him / her to have the maximum information about the tumor/ disease. Before referring you for tests, your doctor will take a full medical history and examine you. You may also have a blood test and chest x-ray to check your general health.

Endoscopy / Gastroscopy

In this test, a thin, flexible ‘telescope’ (called an endoscope) will be passed down your throat so that the doctor can examine your oesophagus, stomach and the upper part of your bowel. If anything unusual is seen, the doctor can put instruments down the endoscope and remove tissue to examine under a microscope (biopsy).

Barium swallow and x-ray

This test is less commonly done now that endoscopy is available. If you have this test you will drink thick liquid called barium. This will coat the lining of your oesophagus, stomach and the first part of your bowel. You will lie down on a table and a radiologist will take x-ray pictures of your chest and abdomen. This will show up the lining clearly when x-rays are taken and abnormality in the lining can be detected.

Computerised tomography (CT) scan

A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see more details of a cancer and its relation to the surrounding organs in your body. It also gives information related to cancer spread into the lymph nodes, liver or lungs.

Endoscopic ultrasound scan (EUS)

This is similar to having an endoscopy and may be occasionally for people who may have stomach cancer. For this test, the endoscope has a small ultrasound probe on the end for more detailed information about the local spread of the tumor. It can help the doctor decide whether you should have some other modality of treatment before surgery.

Biopsy

A biopsy is diagnosis made under a microscope by a pathologist using a small bit of tissue removed from a suspicious area or lump that is found to be abnormal. During the endoscopy/EUS, if the doctor sees anything unusual, they can pass small tools into the scope and take out some tissue that can then be examined under a microscope. This gives a confirmation of cancer.

Positron emission tomography (PET) scan

This test is combined with a CT scan by injecting a radioactive material in the body to highlight all areas where the tumor has or can spread. This test may be used to build up more information after an MRI or CT scan. PET-CT scan is not necessary for all patients. Your doctor will decide if you need to undergo this scan.

Diagnostic Laparoscopy

Occasionally, before the surgeon decides to operate on your stomach, they may pass a small tube with a light at the end, through a cut in the wall of your abdomen. This is known as a laparoscopy. This is to help decide whether to remove all or part of the stomach. The laparoscopy is done under general anaesthetic.

Treatment

Treatment Of Stomach Cancer:

Many years of treating cancer patients and testing treatments in clinical trials have helped doctors know what is likely to work for a particular type and stage of cancer. You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for stomach cancer are surgery, and chemotherapy. Your doctors take many factors into account when deciding which treatments are most suitable for you, including the stage of cancer, your age, general health, and your level of fitness.

If your cancer hasn’t spread, you will almost certainly be offered surgery to remove the stomach.

Surgery

Surgery For Stomach Cancer:

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.

If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery. Your blood group will be checked and blood is usually reserved for all major abdominal surgeries.

It is always a good idea to start with deep breathing exercises once you are admitted to the hospital. Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature. The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team

The position of the tumour in the stomach will determine how much of the stomach is removed.
If your cancer is at the lower end of the stomach (that connects with the duodenum) you may have only the lower part of your stomach removed. This is called a partial (distal) gastrectomy. After the operation you will have a much smaller stomach but the valve (cardiac sphincter) between your oesophagus (oesophagus) and stomach will still be there.

If your cancer is in the upper portion of the stomach or at an area where your stomach is joined to your oesophagus, the upper part of the stomach along with a portion of the lower end of the oesophagus is removed as well. This is called Oesophago-gastrectomy or Proximal Partial Gastrectomy. The top portion of your oesophagus will then be joined to your remaining stomach.

If your cancer is in the middle of the stomach you may need to have your whole stomach removed. This operation is called a total gastrectomy with a Roux-en-Y reconstruction. After the operation, your oesophagus is joined directly to your small intestine.

Removal Lymph nodes and other organs close to stomach.

Often, the lymph nodes close to the stomach are removed at the same time to see if the cancer cells have spread into them. Taking them out reduces the risk of your cancer coming back in the future. Depending on the extent of the cancer, some other organs in the area of the stomach may be removed during the operation. These may include the lower part of the oesophagus, the upper part of the small bowel (duodenum), the spleen or part of the pancreas.

Bypass surgery.

Sometimes the cancer may block the passage of food from the stomach to the bowel. If this happens, the surgeon may make a connection between the stomach and the small intestine to allow food to bypass the blockage. This is known as bypass surgery and will not cure the cancer, but can relieve symptoms.

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days. Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place. This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

Drinking and eating after surgery.

After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however, your doctors will tell you when it is appropriate for you to start drinking some fluids. This will be gradually increased after a couple of days until you are able to eat a light diet, usually four or five days after your operation.

Going home.

You will probably be ready to go home in about two weeks after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches. By and large, you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.

Diet after stomach Surgery.

At first, even tiny meals may make you feel uncomfortably full. If you have had part of your stomach removed, it will not stretch as much as it did before. If you have had all your stomach taken away, the small bowel will need to stretch to take larger amounts of food. You will need to eat very small amounts very often at first. Then, gradually increase the amounts and then the time between meals. At first, you may find you need to eat every hour or so in order to get enough nutrition.

There is no restriction on the type of food you eat after a stomach surgery and you should be able to eat all that you did before surgery. Fizzy drinks can make you feel full – it is probably best not to drink with meals at all, as any liquid will fill you up.

Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.

Stomach is an important organ for absorption of iron, calcium and vitamin D. If you have had a stomach surgery, you may not be able to get enough iron, calcium and vitamin D. Try and include food that contains these nutrients in your diet

Calcium is found in milk, cheese and bread. It is also found in eggs, cabbage and broccoli. Vitamin D is added to margarine. It is also found in butter, eggs and oily fish. Many foods contain iron including red meat, liver, fish, soya, wholemeal bread, egg yolk, leafy green vegetables, dried fruit etc.

If you are a vegetarian, you will probably need to take iron tablets. Vitamin C helps you absorb iron from food. So eat an orange, drink fresh orange juice or take vitamin C tablets with iron-rich foods or iron tablets.

Dark green, leafy vegetables and liver also contain folic acid. Folic acid is another vitamin needed to keep your red blood cells healthy. You may need extra folic acid if you have had stomach surgery.

Even if you eat a really healthy diet, you may still need to take supplements. This is because you do not have enough stomach tissue left to be able to absorb particular nutrients properly. Your doctor may suggest multi-vitamin tablets for you to be taken for a long time especially so if you are losing weight after stomach surgery.

How far has my cancer spread?

Your doctor may be able to give you a rough idea of the disease stage on basis of the scans and tests. However, if a surgery has been performed then the pathology report (the main biopsy report) will be the best guide to determine the stage of cancer. Your doctor will be able to give you more accurate information only after the pathology report. This will also decide if there is a need for further treatment after the surgery.

How long can I wait before I decide to go ahead for surgery?

Once you have been diagnosed with cancer and if a surgery is recommended to you, you should try and go ahead with the surgery at the earliest. This does not mean that if the surgery is not performed in a day or two, things will worsen. Only in cases where tumor is causing major symptoms for eg intestine block or jaundice or bleeding, surgery becomes imperative at the earliest.

If I need further treatment what will it is like and when will it begin?

Treatments after surgery will depend on the final pathology report. Your treating doctor may suggest chemotherapy or radiation therapy. It is not necessary for all tumors to be treated with both these modalities. In early stage of cancers surgery may be potentially curable and you may not need any chemotherapy or radiation treatment. In case if some treatment is suggested to you after surgery, the treatment by and large starts after 3 weeks till your wounds have healed completely and you have regained your strength.

How often will my checkups be and what will they involve?

People who have been treated for cancer need regular check-ups. This allows your doctors to keep an eye on your health. It may also help you to feel more confident about your health after treatment. You should see your treating doctor once every 3 months for the first two years. You will be advised some blood tests and scans (ultrasound or CT scan or PET scan) during your visit as felt necessary by the doctor.