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Stomach cancer, the majority (85%), originates from the part of the stomach that we call the mucosa that covers the inner surface of the stomach and is called adenocarcinoma. The stomach is located in the upper part of the abdomen between the esophagus and the duodenum.
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Squamous carcinomas, lymphomas (cancers that develop from lymphatic tissue) and tumors that develop from the muscle layer (sarcomas, leiomyomas, etc.) are less common.
About 40% of stomach cancers originate in the lower parts of the stomach (antrum), near the exit area of the stomach, 40% in the middle part of the stomach (corpus), and 15% in the upper part of the stomach (cardia), which is the connection part with the esophagus.
In a small percentage of patients (10%), tumors may occur in more than one region of the stomach at the same time. Stomach cancers can spread to neighboring organs such as esophagus, small intestine, pancreas, lymphatic way to lymph nodes and other parts of the body through blood.
Gastric cancers are classified according to their macroscopic appearance as polypoid (type 1), ulcerated type (type 2), ulcero-infiltrative (type 3) and diffuse infiltrative (type 4). This classification is known as the Bormann classification.
It is also possible to divide stomach cancers into two groups as intestinal and diffuse types (Lauren classification).
It seems to be related to intestinal type nutrition habits and leads to cancer formation by passing through superficial gastritis, atrophic gastritis, intestinal metaplasia, dysplasia and in situ cancer stages, respectively.
The diffuse type, on the other hand, is seen at a younger age and is less related to environmental factors, genetic factors are more prominent.
Stomach cancer is the second most common cancer among the digestive system cancers. It is the second most common cause of cancer-related death worldwide.
While gastric cancer is a primary health problem for countries with low socioeconomic status, Japan is a developed country where gastric cancer is frequently encountered.
The frequency of the disease is highest in Japan, South America, Eastern Europe, and the Middle East. Gastric cancer is more common in men than in women and is more common over the age of 55.
There is an increase in cancers originating from the entrance part of the stomach (cardia cancers) due to reflux and obesity.
In our body, healthy cells divide and grow regularly. This process is controlled by the genetic material called DNA, which is found in every cell.
Some genes in DNA regulate that the cell divides at the right time and dies at the right time when necessary. Sometimes structural changes (mutations) can occur in these genes that lead to excessive cell proliferation.
A number of genes, on the other hand, undertake the task of ensuring the repair of this DNA material when necessary (repair genes).
When the function of these repair genes is insufficient, uncontrolled cell division and proliferation may occur, since DNA repair cannot be performed in any way.
This leads to the development of a tumor, a mass of malignant cells.
Some factors that are thought to lead to the development of cancer by causing genetic and structural changes in the cells in the stomach are as follows;
In those who have surgery for the treatment of peptic ulcer (it is rarely practiced today), the lower part of the stomach is removed and the stomach and intestines are connected to each other, which causes the bile from the intestines to reach the stomach directly. Chronic irritation caused by bile in the stomach can lead to the formation of cancer. Generally, the risk of developing cancer is greatest in the first 20 years.
Gastric polyps are among the risk factors for gastric cancer disease.
Hereditary colon cancer and familial adenomatous polyposis syndrome are inherited diseases that increase the risk of gastric cancer. These patients also have an increased risk of developing breast and ovarian tumors.
Those with a family history of stomach cancer are at higher risk of developing stomach cancer. However, two types of gastric carcinoma should be distinguished from each other here: One is primarily the limited growing intestinal type and the other is the diffuse type, which is more malignant and rapidly envelops the surrounding tissues. While nutritional factors are more prominent in the intestinal type, genetic factors are held responsible in the diffuse type.
This disease is usually associated with a condition called atrophic gastritis, where the stomach cannot produce the protein called intrinsic factor (IF), which ensures the absorption of acid and vitamin B12. Although pernicious anemia is easily treated with vitamin B12 injections, there is an increased risk of gastric cancer in these patients.
A large part of the world’s population is infected with this bacterium. Bacteria live under the mucus layer that surrounds the inside of the stomach. It is transmitted from person to person through the mouth and feces. Long-term infection of the bacteria in the stomach can lead to a chronic inflammation of the gastric mucosa, causing changes that can turn into cancer.
Nitrates and nitrites are especially high in salted and smoked meat products (salami, sausage and pickled foods) and are carcinogenic to the stomach. Before the refrigerator was used, people preserved food by salting and smoking it.
However, since these foods contain large amounts of nitrites and nitrates, they can lead to cancer formation. The incidence of gastric cancer is high in countries such as Japan and Korea, where salted meat and fish products are frequently consumed. Poor diet from vegetables and fruits, deprivation of vitamins A and C and not using a refrigerator increase the risk of stomach cancer.
The incidence of gastric cancer in smokers is 2 times higher than in non-smokers. It has been observed that the risk of stomach cancer increases with the use of large amounts of alcohol.
It is 2 times more common in men. The risk of developing stomach cancer increases after the age of 55.
Although the cause is not clear, the risk of stomach cancer is higher in people with A blood group than other blood groups.
Those who are overweight have an increased risk of stomach cancer as well as other cancers.
The symptoms of stomach cancer are insidious and not specific to stomach cancer. This leads to delayed diagnosis in most patients.
One of the early findings in gastric cancer is the positive fecal occult blood search tests due to light bleeding (microscopic hemorrhages) in the tumor. Anemia due to bleeding can be detected in routine blood tests.
In the early stages, symptoms such as indigestion and mild pain can be confused with other diseases. As the disease progresses, loss of appetite and weight loss become evident.
Feeling of discomfort and bloating increased with food, early satiety, nausea and vomiting, fatigue can be seen. There may be black stools due to bleeding from the tumor. Pain is not a common finding in gastric cancer.
Having one or more of these symptoms does not necessarily mean that you have stomach cancer. Other more common diseases, such as peptic ulcers, can cause similar symptoms.
Diagnosis of gastric cancer is based on history, physical examination and laboratory methods.
Fecal occult blood test; It is used to detect microscopic bleeding from a tumor in the stomach or intestines.
Complete blood count; It is used to detect a possible anemia.
Gastroscopy; A thin, bendable tube with a light and camera on the end is lowered into the stomach through the mouth through the esophagus, and the stomach is examined. This method allows both direct visualization of the stomach and taking a tissue sample (biopsy).
Endoscopic ultrasonography; This method is especially used to show the depth and spread of early stage gastric cancer in the stomach wall. Methods such as computed tomography, ultrasound, positron emission tomography (PET) are mostly used to investigate metastases.
Gastric cancer treatment depends on the size, location and spread (stage) of the tumor, as well as the general health and age of the patient. The aim of early gastric cancer is to treat the disease.
If gastric cancer treatment is not possible in advanced stages, the aim is to increase the quality of life by reducing pain and providing nutrition (palliative treatment). Surgery is the only treatment option. Chemotherapy and radiation therapy are used in addition to surgery or for palliative purposes.
For early gastric cancer, the tumor and surrounding tissue can be removed by making a mucosal incision with endoscopy. Removal of the stomach (gastrectomy) is the most common procedure for stomach cancer treatment. In this procedure, all or part of the stomach is removed.
A part of the organs adjacent to the stomach (spleen) may also be removed. In most cases, the lymph nodes around the stomach are also removed. In upper stomach cancers, part of the stomach and esophagus is removed.
Following removal of the entire stomach, the esophagus is connected directly to the small intestine. If the stomach is partially removed, the stomach is connected to the esophagus or small intestine, depending on the situation.
Connections are called anastomosis. Since a large incision is made in the body in this surgery, most patients experience post-operative pain, weakness, fatigue and loss of appetite.
The recovery process varies depending on the patient’s age, general health status, stage of the disease and the type of surgery. Removing all or most of the stomach will cause changes in eating habits.
Patients should eat small amounts of meals at frequent intervals and reduce their sugar intake. They should increase their fat and protein intake and avoid drinking while eating.
If a small part of the small stomach is removed, patients can return to their old eating habits after a short time.
These patients may also enter into a condition known as dumping syndrome, which is known as dumping syndrome, which is characterized by symptoms such as sweating, dizziness, weakness, success, and flushing, as a result of the rapid passage of food into the intestine. Other long-term complications include iron and vitamin B-12 deficiency, esophageal inflammation, osteoporosis, and immunosuppression.
Chemotherapy:
Chemotherapy is the process of destroying cancer cells using drugs. This procedure is used to destroy cancer cells left behind after surgery or to prevent their recurrence.
The drugs are given to the patient by mouth or intravenously. Side effects such as diarrhea, weakness, hair loss, tendency to infection, loss of appetite, nausea, vomiting and anemia can be seen.
Radiotherapy:
By using high-energy X-rays with radiation, the cancer cells left behind after surgery are tried to be destroyed. Radiotherapy can sometimes be used during the operation. Fatigue, intestinal inflammation and skin irritation are the main side effects.
Life expectancy in gastric cancer varies depending on the stage of the disease. Metastases to distant organs are present in most of the cases (80%), which shortens the life expectancy after diagnosis.
In countries such as Japan where gastric cancer is diagnosed at an early stage, the 5-year survival rate is 50% on average, while this rate is around 5-15% in the United States and other western countries.
Consume Vegetables and Fruits: A diet rich in fresh fruits and vegetables, especially those containing vit.C and beta carotene, is protective against stomach cancer. Particular attention should be paid to the consumption of green vegetables and fruits, citrus fruits, broccoli and cauliflower from the cabbage family.
Avoid Smoking: Tobacco increases the risk of cancer, especially in the esophagus and the junction of the stomach and esophagus.
Limit Alcohol: Alcohol can cause changes in cells that can lead to stomach cancer
Beware of Red Meat: Excessive consumption of red meat (especially barbecue, barbecue) increases your risk of stomach cancer. Opt for fish and small animal meat instead.
Avoid Nitrite and Nitrate: These nitrogen compounds are especially abundant in cured meats (salami, sausage) and salted smoked meats (ham).
Consult your doctor when you have an ulcer-like complaint. 1. If your relatives (mother, father and siblings) have stomach cancer, get under the control of a doctor after the age of 30.
