Stomach Cancer What you need to know ~ for outpatient visits ~
Figure 2A: Cancer in proximal stomach
Figure 1: Anatomy of Stomach
Figure 2B: Cancer in distal stomach
What is Stomach Cancer?
Stomach is one of the important parts of the upper digestive tract. Stomach cancer which is also known as gastric cancer is the cancer arising from the lining of the stomach. Stomach Cancer in Singapore Cancer of the stomach is the seventh most common cancer in men and the ninth most common cancer in women in Singapore. Stomach cancer ranked 4th for cancer deaths of men and 5th for cancer deaths of women in Singapore. (1)
What are the Risk Factors?
• Helicobacter pylori infection (a type of bacteria that can live in the digestive tract) • Nitrates and nitrites are nitrogen based chemicals that are added to certain foods such as ham and bacon, hot dogs and deli meats. • Red meats and salted, pickled or smoked foods • Tobacco and alcohol use • Males have double the rate of stomach cancer compared to women • Stomach polyps • Previous stomach surgery • Family History • Obesity • Pernicious anaemia (2)
What are the Presenting Symptoms? • Weight loss • Upper abdominal pain • Sense of fullness / discomfort after a small meal • Heart burn or indigestion • Loss of appetite
• Nausea • Dysphagia • Vomiting • Black stool • Early satiety • Anaemia
These symptoms may or may not be caused by the stomach cancer however if you have these symptoms it is advisable to see your doctor to rule out stomach cancer.
How is it Diagnosed? • Upper gastrointestinal Endoscopy: Examination of the upper gastrointestinal tract including esophagus, stomach and duodenum using a long, thin flexible tube with camera and light to view the lining as well as to take the biopsy to detect cancer.
Figure 3: Upper Gastrointestinal Endoscopy,
• Computed tomography: A special X-ray imaging technology to detect the spread of the cancer in the body (Staging of the cancer) • Endoscopic Ultrasound: An ultrasound probe is attached to the endoscopy (a thin flexible tube with camera at the tip) to detect how much depth the cancer is invaded and also to detect the nearby lymph node enlargement. • Diagnostic laparoscopy: It is the surgical procedure using the laparoscope (thin tube with the camera) through a small incision to detect any spread of the cancer in the abdominal cavity.
Stomach Cancer What you need to know
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Stomach Cancer Treatment Options
Endoscopic Mucosal Resection/ Endoscopic Submucosal Dissection An endoscopic procedure meant for very early and small stomach cancer, confined to the innermost lining of the stomach. Depending on the size of the Tumour, the surgeon may perform a dissection which may or may not require minor resection.
Gastrectomy Gastrectomy is a surgical procedure where all or part of the stomach is removed. It is the mainstay of treatment to achieve cure in early stomach cancer. Nearby lymph nodes are also removed as part of the clearance of the tumour. The remnant stomach or oesophagus is then joined back to the small intestine to reconstruct the rest of the digestive tract. Surgery can be done laparoscopically (keyhole approach) in case of early stomach cancer. Traditional open approach (non-keyhole) can be chosen in the case of an advanced stage stomach cancer.
Figure 4A: Subtotal Gastrectomy
Figure 4B: Total Gastrectomy
Chemotherapy Chemotherapy refers to the use of drugs (chemotherapeutic agents) through veins or by mouth to kill the cancer cells in the body. Chemotherapy can be given before or after surgery with or without radiation therapy. It is also used for those patients who are not suitable for surgery.
Radiation therapy Radiation therapy or radiotherapy is the use of ionisation radiation to kill or control the growth of cancer cells. This is usually given together with chemotherapy after surgery to kill the remnants of the cancer which cannot be seen and removed during the surgery. Also, it can be used to control the symptoms in patients with advanced stage stomach cancer.
Figure 5: Stomach Cancer staging Stomach Cancer What you need to know
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Sources: (1) Singapore Cancer Registry, Interim Annual Report, Trends in Cancer Incidence in Singapore 2010-2014, by the National Registry of Disease Office (NRDO) (2) “Stomach Cancer”, article by Health Promotion Board, Singapore, URL (http://hpb.gov.sg/HOPPortal/dandc-article/588) Illustration Copyright© 1998-2003 by The Johns Hopkins Health System Corporation and The Johns Hopkins University; used with permission from the Johns Hopkins Division of Gastroenterology and Hepatology (www.hopkinsmedicine.org/gi). Illustration created by Mike Linkinhoker.
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