Health @ Heart
Stomach Cancer
What is the usual type of stomach cancer?
The most common variety is adenocarcinoma, usually found in the body of the stomach and in the area between the esophagus (foodpipe) and the stomach. The word adeno stands for "glandular" cell type as seen by the pathologist on the microscope.
How prevalent is stomach cancer?
This varies among countries and by sex. Per 100,000 Japanese population, for example, it is about 80 men and 30 women, white American men, 11, white American women, 7, British men, 18 and British women, 10. There has been a impressive decline in incidence in North America, New Zealand and Australia since 1930 but the reduction has been slower in Europe. The incidence also seems higher among those with Type A blood. In the USA, cancer of the stomach is relatively more common among Japanese American and Hispanic groups. The death rate in the USA for gastric cancer is between 14,000 to 15,000 a year. Sixty to 70 cases of these are men.
Is this cancer related to stomach ulcers?
Lifelong stomach ulcer caused by infection with Helicobacter pylori appears to be strongly associated with cancer of the stomach, and so with poor intake of antioxidant vitamins A, C and E, (and folic acid and calcium also), and vegetables and fruits. The chronic inflammation in H. pylori infection may also be a contributing factor in the formation of gastric cancer among these patients.
What are the other etiologic factors?
Smoking is strongly related to cancer of the proximal portion of the stomach. This is one unhealthy habit people should stay away from because cigarettes are deadly one, killing hundreds of thousands slowly and "softly". This type of gastric malignancy is also associated with obesity, gastro-esophageal reflux, high fat intake, and seen more among the more affluent people. Those in the lower socio-economic bracket has been seen to be more prone to distal stomach cancer.
Does eating spicy food cause stomach cancer?
There is no scientific evidence to prove that ingesting spicy food causes stomach cancer. There were some speculations that perhaps eating very hot food and drinking hot beverages (as most Chinese do) day in and day out may increase the risk for the development of cancer of the stomach. The jury is still out there on this issue. But it is prudent to allow hot food or drink to simmer down a bit before ingesting them. The caveat in almost everything is "moderation."
How about eating smoked or salted fish?
Eating dried salted fish and smoked foods (or the nitrates in them) have been suspected to increase the risk of stomach cancer. There seems to be a higher incidence in Asia, particularly in Japan. Currently, however, we find no absolute proof in the medical literature that confirms this, but I would still advise caution here. As far as a good daily dietary regimen is concerned, there is nothing better and safer than fresh fish, vegetables, fruits, high fiber foods, and abstaining from red meat and eggs, which are high in cholesterol and fats and low in fiber. Red meat has been implicated as a causative factor in colon cancer and other cancers.
What are the symptoms to watch for?
They vary from person to person. Most do not even have obvious symptoms before they are discovered. The symptoms could be a sense of indigestion, upper stomach discomfort, gassy bloating feeling, loss of appetite or pain on eating, loss of weight, tarry (blood in) stools, anemia, weakness and fatigue, depending on the stage of the cancer. But any of these symptoms may also be caused by other illnesses, which may not be as serious and are curable. This is the reason why a regular medical check-up and seeing the doctor early are important practices to pread before it is diagnosed. In the USA, greater than 50% of patients recently diagnosed already have metastasis (spread) to regional lymph glands or to other vital organs.
What is the survival rate?
In the United States, the 5-year survival rate (the number of patients alive after 5 years) is 90% (nine out of ten) among those where the tumor is confined to the mucosa (stomach lining only) and 20% (one in five) among those with large tumor and lymph node spread.
Is it true the survival rate is higher in Japan?
The 5-year survival rate in Japan for gastric cancer is about 50% for those with advanced stage of the disease, compared to 20% in the USA as stated above. The reason is unclear. It is postulated that the stomach cancer of those who were born and lived in Japan might be a "different" kind of pathology, and that there are other unexplained factors as well. But what is interesting is that the type of stomach cancer among Japanese who were born and have been in the United States for a while behaves like the gastric cancer among white Americans. Obviously environmental factors do play a role.
What is upper GI endoscopy?
This is an examination of the foodpipe and stomach, using a flexible fiberoptic lighted and magnified scope (about the caliber of the little finger), that is passed through the mouth, down the throat, the esophagus and to the stomach, to view any pathology, and do a biopsy, if needed. Endoscopic Ultrasound is another recent diagnostic tool and is very helpful in assessing the condition of the esophagus and stomach, and also for any lymph node or regional spread of the cancer.
What is the treatment?
When stomach cancer is diagnosed, complete surgical excision is the best option, if maximal survival rate is to be achieved. But this is not always feasible, depending on the stage and anatomy of the disease. Subtotal gastrectomy (removing part of the stomach involved in the cancer) has been found to have the same survival rate benefit compared to removing the entire stomach. No difference in the 5-year survival rate or postoperative mortality.
How about chemotherapy? alone. It also found that those who had adjuvant chemotherapy had much more postoperative complications. There are various current chemotherapeutic agents that have not been fully evaluated thus far. But ongoing researches continue. Hopefully, some day soon, the "perfect" regimen will come along. Better yet, a vaccine to prevent gastric cancer. In the meantime, let us stay away from unhealthy habits and prevent diseases from coming our way, especially deadly cancers.
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The main objective of this column is to educate and inspire people to live a healthier lifestyle to prevent illnesses and disabilities, and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.
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Dr. Philip S. Chua is Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, and is the Chairman of Cardiovascular Surgery of the Cebu Doctors' University Hospital in Cebu City. He is also the Vice-President for Far East Operations of the Cardiovascular Hospitals of America, a hospital builder in Wichita, Kansas. His column appears in 8 newspapers, 3 magazines and 9 websites on the internet. His email address is scalpelpen@gmail.com