The symptoms of stomach cancer and duodenal cancer are caused by uncontrolled cell growth.
Benign tumors of the stomach and duodenum are rare, representing only 5-10% of all stomach tumors and 10-20% of all duodenal tumors.
However, these benign growths can become malignant in some cases.
The elderly and people over the age of 55 are most frequently affected.
If a stomach tumor is diagnosed early, there are good prospects of recovery.
If the third and fourth or final stages of the disease have already been reached (the cancer has grown and spread throughout the body), the chances of curatively treating the tumor are lower.
However, treatment can slow the progression of the cancer.
For 50 years, a decrease in the incidence and mortality of stomach cancer has been observed, about 1% per year.
Types of stomach cancer
There are several types of stomach tumors, including:
- Adenocarcinoma of the stomach – this is 90-95% of all stomach tumors. Carcinoma develops from the cells of the mucosa, the inner lining of the stomach.
- Gastric lymphomas – they represent 4% of stomach tumors. The cancerous cells that form in the lymphoid tissue are sometimes located in the stomach wall. The lymphatic tissue drains fluid and fights infections.
- Gastrointestinal stromal tumor (GIST) – these rare tumors form in the muscle or connective tissue of the stomach wall (cajal cells). These tumors can also be benign and occur in other areas of the digestive tract.
- Neuroendocrine tumors (NETs) – the cancer cells accumulate and form tumors in the endocrine (hormone-producing) cells, usually in the digestive tract (including the stomach). This form of stomach cancer is rare. The most common form is carcinoma.
- Other very rare forms of stomach cancer include: squamous cell carcinoma, small cell carcinoma and leiomyosarcomas.
How does stomach cancer make itself felt? Symptoms of a stomach tumor
Stomach cancer can cause numerous symptoms.
They often resemble the symptoms caused by other, less serious diseases, such as stomach ulcers; therefore, stomach cancer is often difficult to detect and diagnosis is only made when the disease is already advanced.
The first signs of stomach cancer include:
- persistent indigestion
- trapped air and frequent eructations
- bitter taste in the mouth
- Feeling of fullness that quickly sets in when eating
- Feeling of pressure after eating
- Stomach pain or pain in the upper abdomen
- Swallowing disorders (dysphagia)
- Vomiting (also blood)
All-forming symptoms of a stomach tumor
It is important to have symptoms that may indicate stomach cancer tested as soon as possible.
The health authority has identified a number of symptoms and alarm signs for people with an increased risk of stomach cancer, the occurrence of which should be seen as soon as possible by a doctor:
Digestive problems in combination with emaciation, malaise or anaemia (a reduced number of red blood cells leads to tiredness and shortness of breath).
Age over 55 years and constant digestive problems.
Indigestion plus medical history that includes any of the following:
1. A case of stomach cancer in the family.
2. Previous interventions for stomach ulcers.
3. Barrett’s esophagus – this is where abnormal cells develop in the inner wall of the esophagus.
4. Pernicious anemia – in this condition, the stomach is unable to absorb vitamin B12 from food.
5. Dysplasia – malformation of cells that are not yet real cancer cells, but may represent a precancerous stage.
6. Gastritis – inflammation of the gastric mucosa.
7. Jaundice – eyes and skin turn yellow.
8. Formation of a considerable, plump mass in the upper abdomen
Advanced stomach cancer
symptoms of advanced stomach cancer:
- blood in the stool or black stool,
- loss of appetite,
- weight loss,
- accumulation of fluid in the stomach,
Causes of stomach cancer
When the doctor diagnoses stomach cancer, one naturally wonders what could have caused the condition. But no one knows the exact causes of stomach cancer. Doctors rarely know why one suffers from stomach cancer and another does not.
There are certain risk factors that increase the likelihood of developing stomach cancer.
Based on studies, the following risk factors for stomach cancer could be identified:
Infection by Helicobacter pylori
H. pylori is a bacterium that often causes an infection of the gastric mucosa. Infection by H. pylori may be responsible for stomach inflammation and stomach ulcers.
The risk of stomach cancer also increases, but only a small proportion of infected people develop it.
In this case, young people or pregnant women may also be affected.
Chronic stomach inflammation
Those who suffer from stomach inflammation for a long time (such as pernicious anemia or chronic gastritis) have a higher risk of developing stomach cancer.
Even in people who have had parts of the stomach removed, the risk is increased for many years after the procedure.
Smokers are more likely to develop stomach cancer than non-smokers. With heavy smoking, the risk increases.
Predisposition Close relatives (parents, siblings
, children) of stomach cancer patients are more likely to develop stomach cancer themselves.
If they have ever had stomach cancer themselves, the risk is even greater.
Poor diet, lack of exercise or obesity
Studies suggest that a diet rich in smoked, salty or cured foods increases the risk of stomach cancer. On the other hand, eating plenty of fresh fruits and vegetables can reduce the risk of this disease.
Lack of exercise can increase the likelihood of stomach cancer.
Even severely overweight people have an increased risk of cancer in the upper stomach area.
However, most people belonging to these risk groups do not develop stomach cancer; e.g.: many people with Helicobacter pylori infection do not develop stomach cancer.
On the other hand, stomach cancer can occur in people who have none of the known risk factors.
Diagnosis of a stomach tumor
- Gastroscopy – a tube inserted through the mouth can be used to examine the stomach, esophagus and upper section of the intestine.
- Biopsy – as part of an endoscopy, the doctor takes a small sample of tissue from the stomach and examines it under a microscope.
- X-ray examination with barium – barium-containing contrast agent indicates changes in the stomach during an X-ray examination of the stomach and digestive system.
- Ultrasound examination – the ultrasound machine uses sound waves to create images of the stomach.
- Blood test – this also includes the examination of the tumor marker CEA (carcinoembryonic antigen). CEA is produced in larger quantities by some tumor cells.
This is the case in about half of stomach cancer patients.
If the suspicion of stomach cancer is confirmed, further tests will follow to determine whether the cancer has spread. This is done with the help of:
Computed tomography (CT) – a special X-ray examination that creates a three-dimensional image of the body from different angles. A dye can be used to highlight the internal organs.
Magnetic resonance imaging (MRI) – similar to a CT, three-dimensional images are created, but instead of X-rays, a strong magnet and a magnetic field are used.
Positron emission tomography (PET) – the doctor injects a weakly radiolabeled glucose solution. The scanner can detect the radioactive substance. The cancer cells are represented as ‘warm spots’ (where the glucose was absorbed).
Stomach cancer patients must undergo a thorough stage examination prior to surgery so that the best form of treatment can be determined.
The spread can be local, lymphatic, hematic or extend beyond the abdominal cavity and, for example, reach the ovaries (Krukenberg tumor).
Metastases form predominantly in the liver, bones, lungs and – less often – in the brain.
For initial assessment and staging, a CT scan of the chest and abdomen should be performed to determine whether metastases have formed or not.
If no metastases are present, the operability is preferably evaluated by endoscopic ultrasound.
Means of staging include X-ray examination of the chest region, transabdominal ultrasound, magnetic resonance, bronchoscopy and laparoscopy.
Expansion of tumor (T), lymph node involvement (N) and metastases (M) (TNM classification)
TX, NX and MX mean “no statement possible”.
T0 – no signs of a primary tumor.
TIS – Carcinoma in situ (intraepithelial tumor).
T1 – Tumor infiltrates lamina propria or Submukosa (early carcinoma).
T2 – Tumor infiltrates muscularis propria or subserosa.
T3 – penetration of the visceral peritoneum, but not yet infiltration of neighboring structures.
T4 – Infestation of neighbouring organs (spleen, colon, etc.).
N0 – no local lymph nodes affected.
N1 – involvement of 1-6 lymph nodes.
N2 – involvement of 7-15 lymph nodes.
N3 – involvement of more than 15 lymph nodes.
M0 – no distant metastases.
M1 – distant metastases, in the mesenteric lymph nodes, in the retroperitoneal space or further away.
What are the treatment options for stomach cancer?
Treatment options include: surgery, chemotherapy, and sometimes radiotherapy.
Which form of treatment is suitable is individually different and depends on various factors, such as cancer stage (size and spread of the tumor) and general condition.
It is important to eat sufficiently; a nutritionist should be consulted to create an appropriate diet plan.
It is advisable to consult with a specialist who is familiar with the case.
The doctor can inform the patient about the pros and cons, the chances of success, possible side effects and other aspects with regard to the treatment options of this form of cancer.
Treatment goals should also be discussed.
Some forms of stomach cancer can be cured, especially if treated in the early stages.
Or treatment may be aimed at controlling the tumor.
If the therapy cannot cure the tumor either, growth and spread can be restricted. In this way, the progression of the cancer is stopped and the symptoms are stopped for a while.
Or the treatment may be used to relieve symptoms.
If the tumor is also not curable, the therapy can help to reduce the size of the tumor and thus relieve symptoms and pain.
If the tumor has progressed, dietary supplements, painkillers or other measures can be used to relieve pain and symptoms.
When does surgery have to be performed? Surgical intervention
A curative therapy option is the surgical removal of the tumor in the early stages. In most cases, the affected part of the stomach is removed.
Sometimes a complete stomach removal is performed, which is possible as a laparoscopic procedure.
Even if the tumor is advanced and cannot be cured, some surgical techniques can help relieve symptoms; in the case of an occlusion, for example, the removal of a stomach part by laser surgery or bypass surgery can provide relief.
Chemotherapy This treatment with anticancer drugs causes cancer cells to die or impress their division, although it causes numerous side effects, such as diarrhoea, reduced red blood cell counts, white blood cells and platelets, hair loss and fatigue.
If it is used in combination with surgery, it is referred to as adjuvant chemotherapy.
Chemotherapy can be used, for example, after surgery.
It is designed to kill all tumor cells that can spread from the primary tumor. Sometimes chemotherapy is used to shrink a large tumor before surgery (neoadjuvant) to make the procedure easier.
This form of treatment may be recommended by the doctor if the tumor is inoperable.
uses high-energy beams of radiation that are concentrated on the tumor tissue.
In this way, the cancer cells are killed or their multiplication is prevented.
Radiation therapy is rarely used for stomach cancer.
It is sometimes used to reduce the part of the tumor that causes symptoms.
In some cases, the combination of chemotherapy and radiotherapy – radiochemotherapy for short – is used together with surgical treatment.
What are the prognosis, survival rate and life expectancy?
Without treatment, stomach cancer can grow and spread throughout the body.
With early diagnosis and treatment (before the tumor spreads outside the stomach wall or affects lymph nodes and other parts of the body), there are good chances of recovery with surgical treatment.
Unfortunately, in most cases, diagnosis is not made at an early stage.
If the tumor is only detected when it has already developed beyond the stomach wall and spread to other parts of the body, the prospect of healing is less likely (final stage).
Nevertheless, treatment with chemotherapy drugs can often delay the progression of the cancer.
If the tumor is limited to the submucosa of the stomach and has not formed metastases, the 5-year survival rate is 90%.
In advanced stages of cancer, it drops drastically to about 25%.
Can stomach cancer be prevented?
Yes and no.
The experts do not know one hundred percent what causes stomach cancer, there is no vaccination and therefore no safe form of prevention.
Alternative treatments to reduce the risk factors that favor the onset of the disease include a cancer diet and a healthy diet.
Fruits and vegetables: Those who eat a lot of fruits and vegetables are less likely to develop stomach cancer than other people.
Salty and smoked foods: Salty and smoked foods should be avoided.
Smoking: Those who do not smoke reduce the risk of stomach cancer.
Doctor’s consultation: Discuss with the doctor whether a particular disease can increase the likelihood of stomach cancer. Regular check-ups may be considered.