As the name implies, stomach cancer (also called gastric cancer) starts in the wall of the stomach. Unlike many other cancers, the incidence of stomach cancer has decreased dramatically in Finland over the years. This is assumed to be due to reasons such as improved food preservation methods and better hygiene. The general improvement of hygiene has made Helicobacter pylori infections less common, which has also decreased the incidence of stomach cancer.

The tissue type of stomach cancer is determined with a microscope. Most stomach cancers, up to 95 per cent, are so-called adenocarcinomas that originate in glandular tissue. The rest are lymphomas that originate in lymphatic tissue and rare types of cancers, such as carcinoid tumors or GIST tumors. Their treatment is essentially different from the treatment of adenocarcinomas. Usually, when we talk about stomach cancer we mean adenocarcinoma. When detected early, stomach cancer is operable and curable. However, advanced stomach cancer is difficult to treat, and the treatment focuses on slowing down its progress.

Risk of disease

Infections are known to increase the risk of stomach cancer. Other risk factors include obesity, smoking, carcinogen-rich diet and advanced age.

Symptoms

Stomach cancer typically does not present early symptoms. Its symptoms can be deceptively similar to those of benign stomach conditions, such as stomach ulcer or gastritis. Stomach cancer is often not detected until the tumor has spread through the stomach wall or metastasised to nearby lymph nodes or other organs.

Possible symptoms of stomach cancer include stomach pain, vomiting, diarrhoea, loss of appetite, weight loss and various digestive disturbances or swelling of the stomach after a meal. These symptoms are usually related to advanced cancer.

Diagnosis

Stomach cancer is diagnosed by gastroscopy and gastroscopic mucosal biopsy. In gastroscopy, a thin, flexible tube (gastroscope) is passed into the stomach through the mouth and throat. If necessary, the throat is anaesthetised and other medication is administered to make the examination more pleasant for the patient and to help the patient to relax.  If the tumor is completely covered by the mucosal lining, it may be difficult to reach deep enough to obtain a biopsy. In such a case, the appearance and rigidity of the stomach wall can often give rise to suspicion of cancer. When necessary, anomalies of the stomach wall can also be assessed by an endoscopic ultrasound examination. Sometimes, however, the diagnosis cannot be established until surgery is performed. A CT scan of the stomach or entire body is usually also performed prior to surgery.

Stomach cancer typically spreads to surrounding tissues (the pancreas, diaphragm, underside of the liver, abdominal wall and lymph nodes) or through blood circulation to the liver, lungs and bones.

Treatment

The treatment of stomach cancer depends on the type and stage of the cancer and the patient’s general physical condition. There are four types of treatment:

In local stomach cancer, the primary treatment option is always surgery with a curative objective. Depending on the size and location of the tumor, part or all of the stomach may be removed. This is called subtotal or total gastrectomy. In addition, nearby lymph nodes are removed in order to excise cancerous cells that may have spread to the lymph nodes. This also gives important information on the stage of the cancer.

The recurrence risk of a small and superficial stomach cancer tumor is low. Surgery, or even local mucosal resection, is sufficient treatment. Local recurrence of stomach cancer or appearance of metastases is possible, even if the surgery seemed completely successful and no metastases were detected at that time. If the risk of recurrence is estimated to be high, surgery may be supplemented with post- or preoperative chemotherapy or postoperatively administered combination of radio- and chemotherapy.

If stomach cancer has spread to other organs, the patient is treated with chemotherapy. In cancers that involve Her2 gene overexpression, Her2-targeted therapy with trastuzumab is included in the treatment. Stomach cancer often responds relatively well to chemotherapy. Chemotherapy may reduce the size of tumors or arrest their growth for varying lengths of time. Cancer cells cannot usually be completely destroyed by chemotherapeutic agents, which is why it is very unlikely to achieve full recovery with chemotherapy. However, if the tumors respond to chemotherapy well, it can significantly improve the patient’s life expectancy and relieve symptoms. The statistical life expectancy of patients with advanced stomach cancer has continuously increased, albeit rather slowly.

Docrates Cancer Center pays particular attention to individual planning of stomach cancer treatments. We use thorough imaging studies as the basis for tailored treatment, in order to ensure the best possible treatment result and quality of life for the patient.

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