3 December 2019
The stomach is the vital organ of our digestive system where the ingested food is churned & partially digested. The stomach is a food reservoir & gives a sense satisfaction when it is filled.
In 1507 Antonio described a case where a patient was vomiting old retained food. Upon death they found that opening of stomach had closed. It was considered captain of death, but now stomach cancer is the third most common cause of death by cancer. In the world
These days, incidence of stomach cancer cases has been significantly reduced due to better food preservation. However cases of gastric cancer of the upper part of stomach are on the rise, more men are affected as compared to women.
It is a highly aggressive tumor , virtually incurable if detected at late stages especially when patients come with vomiting or swelling in the tummy. This situation can be easily overlooked unless carefull analysis of the earlier complaints are done. Affected patients will feel debilitated as it affects the Food Bag itself.
What causes Stomach Cancer ?
- Food high in salt
- Salt preserved meat
- Smoked fish.
- Lack of vegetables
- Lack of vitamin C & A
- Rubber & coal mine workers.
- Low socioeconomic status—lower stomach cancer
- Higher status-upper stomach cancer.
- Runs in family in 10% of cases
- Blood group A.
- A residual gastric pouch of more than 15 years old.
- Gastric polyps/adenomas
- Genetic diseases.
- Helicobacter pylori infection increases risk to 6 times.
- Non healing gastric ulcers
- Radiation exposure, e.g survivors of atomic bomb blasts
What are the symptoms ?
There are usually no symptoms during the early stages.
INDIGESTION is the most common symptom experienced by patients but is easily ignored by all.
In 95% anorexia & weight loss is the earliest complaint which is missed by many. Unfortunately many have no symptoms till later stage.
- Nausea & vomiting is caused by obstruction.
- Difficulty to swallow.
- Stomach feels full after consuming even small amount of food.
- Dislike for meat.
- Blood vomiting seen in 15% of cases
- Passing out dark sticky pungent smelling stools
- Some patients cancer may burst, inside.( perforates)
- Pain is very late & uncommon.
- Distended tummy-abdomen.
- 50% of cases come with swelling in the abdomen .
- Inanition from starvation or cachexia of tumor origin
- Liver enlargement with jaundice
- Lower tummy (pelvic) pain & constipation.
- Swellings in the umbilicus/neck & arm pit.
Which part of the stomach are affected ?
Any part of the stomach can be affected
- Body & fundus
- Esophagus junction.
- Poor nutrition
- Chronic wasting cachexia; death.
- Liver lung metastasis.
- Patients can die by-their own saliva especially when they can’t swallow it.
HOW TO FIND OUT ?
Gold standard test is to pass a camera (GASTROSCOPE) into the stomach and see the mucosa & take biopsy from the interior of stomach.
Special features of gastroscopy are Narrow Band Imaging & Chromo Endoscopy which increase chances of finding very early cancers. Patients not responding to gastric medication-must undergo Oesophago Gastric Duodenoscopy.
SURGERY- Complete /partial removal of the stomach with lymph nodes is the best primary treatment.
HOW DONE ?
- Laparascopic –minimal access surgery
- Regular open surgery
- Increased consumption of fresh fruits /food, vegetables & vitamin C
- Decreased intake of salt
- Practice a healthy lifestyle.
- Eradication of helicobacter pylori infection.
- Abstain from gastric irritants as smoking/alcohol.
Screening Programme; Gastroscopic surveillance
Not routinely recommended EXCEPT;
- Family with history of gastric cancer
- Previously treated case of gastric neoplasia
- Those who had severe pan-gastritis, gastritis of the stomach’s body, or severe atrophy
- Chronic gastric acid inhibition for more than a year.
- People who are/have exposed themselves to environmental risk factors for gastric cancer (eg, heavy smoking; high exposure to dust, coal, quartz, cement; work in quarries)
Article by: Dr. Anantha Kumar Chinnaswamy, Consultant General Surgeon