Stomach cancer is cancer arising from the lining of the stomach, it can arise near the junction of the oesophagus and stomach and if it crosses to this junction are called gastro-oesophageal or cardio-oesophageal junction cancers.
About 1900 new cases of stomach cancer are diagnosed each year and the incidence is gradually decreasing due to treatment of Helicobacter Pylori, changes in diet and reduction in smoking.
What Are the Causes of Stomach Cancer?
One of the strongest risk factors for developing stomach cancer is infection with Helicobacter pylori which is a bacteria infection of the stomach that can cause stomach ulcers and irritation. Treatment of this infection if found, can reduce the risk of stomach cancer.
Other factors associated with higher risks of stomach cancer includes diets low in fruit and vegetables, a high intake of cured or pickled foods and eating heavily grilled or barbecued meats (charcoaled/burnt areas).
High salt intake has also been associated with an increased risk of developing stomach cancer.
Certain countries have much higher rates of stomach cancer including people from Japan, Korea, China, Chile and Russia.
Some stomach cancer (<5% overall) are associated with certain genetic conditions such as hereditary nonpolyposis colorectal cancer syndrome.
Screening with gastroscopies can potentially detect early cancers in countries with high rates of this cancer (e.g. Japan).
What Are the Symptoms of Stomach Cancer?
Stomach cancer may not cause symptoms until a cancer is more advanced.
Symptoms are usually quite generalised and can include unexplained weight loss, loss of appetite, upper abdominal pain or vomiting.
Some people will present with bright red blood or “coffee ground” vomit which is blood that has been altered by the stomach, problems with swallowing or food getting stuck can also occur particularly with cancers that involve the oesophagus.
What Are the Treatments for Stomach Cancer?
The main curative treatment for stomach cancer is surgical removal of the stomach and surrounding lymph nodes that the cancer can spread to. For patients with “early” stage cancers surgery may be the only treatment they require.
For cancers which are more advanced, (e.g. spread through the whole thickness of the stomach wall or spread to lymph nodes), but have not spread to other organs, then several courses (usually three) of chemotherapy can be given before and after surgery to improve the chance of cure.
Radiation therapy combined with chemotherapy can be given to some patients following surgery if there are features that have a higher risk of recurrence of the cancer in that area (e.g. a cancer reaches the edges of the surgical operative cuts).
Sometimes patients will have an operation for an early cancer but the pathology may show a more advanced cancer and in this setting radiation therapy and chemotherapy may be considered after the operation.
Radiation therapy is usually delivered to the stomach and surrounding lymph node areas. Intensity modulated radiation therapy, (a highly targeted form of radiation therapy) is considered a standard of care within many departments to reduce the risks of side effects.
What Are the Side Effects of Radiation Therapy?
Treatments of stomach cancers may require a multi-modality approach with surgery, chemotherapy and radiation therapy. Each treatment has its own side effects and sometimes the side effects of radiation therapy can worsen side effects from the other treatments.
Common side effects from radiation therapy include:
Nausea can occur in most patients but is usually mild only affecting appetite slightly.
In about 3 in 10 patients the nausea may be more significant requiring additional medications to manage the nausea.
About 3 in 100 patients have more significant vomiting requiring replacement of fluids by drips or admission to hospital.
Diarrhoea, mouth ulcers and changes in blood counts can occur during concurrent chemo-radiation therapy but are usually related to the use of chemotherapy.
Long term side effects from radiation therapy can occur and may include risks for small bowel obstruction, changes to kidney function and a slight increased risk of second cancers.
A recent report on the Intergroup 0116 trial comparing surgery alone to surgery and chemo-radiation therapy showed no significant increase in long term side effects from chemo-radiation therapy.
The best person to discuss radiation therapy for stomach cancer is a radiation oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you.
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