Stomach & Oesophageal Cancer
Introduction :
Stomach Cancer
With stomach cancer — also called gastric cancer — cancer cells grow out of control in your stomach. Cancer can form anywhere in your stomach.
Oesophageal Cancer
Esophageal cancer — or oesophageal cancer, starts in the tissues in your esophagus, the long muscular tube that moves food from your throat to your stomach.
Stomach Cancer
Stomach cancer doesn’t typically cause symptoms during the early stages. Even the most common early signs of stomach cancer — often unexplained weight loss and stomach pain — don’t usually show up until the cancer is more advanced.
Symptoms of stomach cancer include:
- Loss of appetite.
- Trouble swallowing.
- Fatigue or weakness.
- Nausea and vomiting.
- Unexplained weight loss.
- Heartburn and indigestion.
- Black stool (poop) or vomiting blood.
- Feeling bloated or gassy after eating.
- Stomach pain, often above your belly button.
- Feeling full even after eating a small meal or snack.
Oesophageal Cancer
Tumors caused by oesophageal cancer may not cause noticeable symptoms until the cancer has spread.
Difficulty swallowing is the first symptom people may notice. Other symptoms include:
- Pain in your throat or back, behind your breastbone or between your shoulder blades.
- Vomiting or coughing up blood.
- Heartburn.
- Hoarseness or chronic cough.
- Unintentional weight loss.
Stomach Cancer
Stomach cancer forms when there’s a genetic mutation (change) in the DNA of your stomach cells. DNA is the code that tells cells when to grow and when to die. Because of the mutation, the cells grow rapidly and eventually form a tumor instead of dying. The cancer cells overtake healthy cells and may spread to other parts of your body (metastasize).
Researchers don’t know what causes the mutation. Still, certain factors seem to increase the likelihood of developing stomach cancer. They include:
- Family history of stomach cancer.
- Helicobacter pylori (H. pylori) infection.
- Gastroesophageal reflux disease (GERD).
- Gastritis.
- Epstein-Barr virus infection.
- History of stomach ulcers or stomach polyps.
- A diet high in fatty, salty, smoked or pickled foods.
- A diet that doesn’t include many fruits and vegetables.
- Frequent exposure to substances like coal, metal and rubber.
- Smoking, vaping or chewing tobacco.
- Drinking too much alcohol.
- Obesity.
- Autoimmune atrophic gastritis.
Several genetic conditions are associated with increased gastric cancer risk, including:
- Lynch syndrome.
- Peutz-Jeghers syndrome.
- Li-Fraumeni syndrome.
- Familial adenomatous polyposis.
- Hereditary diffuse gastric cancer.
- Common variable immunodeficiency (CVID).
Stomach cancer is more common in people with Type A blood, although researchers aren’t sure why.
Oesophageal Cancer
Healthcare providers don’t know the exact cause, but they’ve identified risk factors that increase the chance of developing oesophageal cancer, including:
- Tobacco use: This includes smoking and using smokeless tobacco.
- Alcohol use: Chronic and/or heavy use of alcohol increases the risk of esophageal cancer.
- Obesity: Being overweight or having obesity may cause inflammation in your esophagus that could become cancer.
- Barrett’s esophagus and chronic acid reflux: Barrett’s esophagus is a change in the cells at the lower end of your esophagus that occurs from chronic untreated acid reflux. Even without Barrett’s esophagus, people with long-term heartburn have a higher risk of esophageal cancer.
- Human papillomavirus (HPV): HPV is a common virus that can cause tissue changes in your vocal cords and mouth and on your hands, feet and genitals.
- History of cancer: People who’ve had cancer of the neck or head have a greater risk for esophageal cancer.
- Other disorders: Esophageal cancer is linked to some rare and/or inherited conditions. One isachalasia, an uncommon disease that makes it hard for you to swallow. Another disorder is tylosis, a rare, inherited disorder in which excess skin grows on the palms of your hands and the soles of your feet.
- Occupational exposure to certain chemicals: People exposed to dry cleaning solvents over a long time are at higher risk of developing esophageal cancer.
Stomach Cancer
Your provider will review your medical history, ask about your symptoms and perform a physical exam that may involve feeling for a mass in your stomach. They may order several tests to diagnose and stage stomach cancer.
Staging allows your provider to assess how much the cancer has spread. With stomach cancer, staging ranges from 0 (zero) to IV (four). Stage 0 means the cancer hasn’t spread beyond your stomach lining. Stage IV means that it’s spread to other organs.
- Upper endoscopy is commonly used to diagnose stomach cancer. During the procedure, your provider inserts a thin tube with a tiny camera at its tip (endoscope) into your mouth until it reaches your stomach. Small surgical instruments can pass through the endoscope, allowing your provider to remove a tissue sample (biopsy). The sample can be tested in a lab for cancer cells.
- Endoscopic ultrasound is a special kind of endoscopy that can help stage the cancer. The endoscope used has an ultrasound probe attached at its tip, that can take pictures of your stomach. It can show if the cancer’s spread from your stomach lining to your stomach wall.
- Radiologic tests, including a CT scan, barium swallow and MRI, can help identify tumors and other abnormalities that may be cancer-related. During a barium swallow, you drink a substance that makes your stomach lining more visible on an X-ray. A PET scan can show if cancer has spread throughout your body.
- Blood tests can offer information about how your organs are functioning. Poor organ function may indicate that cancer has spread to that organ.
- Laparoscopy is a type of surgery that allows your provider to assess cancer spread when less invasive methods, like imaging, haven’t provided enough information. During laparoscopy, your provider inserts a tiny camera into small cuts in your abdomen so they can see your organs directly.
Oesophageal Cancer
A healthcare provider will ask questions about your symptoms and medical history. They may do the following tests to diagnose the condition:
- Barium swallow: Healthcare providers look at your esophagus through a series of X-rays. It’s called a barium swallow because people drink a liquid with barium. Barium makes it easier for healthcare providers to see your esophagus on the X-ray.
- Computed tomography (CT) scan: This test helps healthcare providers determine if tumors have spread to your chest and abdomen (belly).
- Esophagogastroduodenoscopy (EGD):Healthcare providers use a thin flexible tube called an endoscope to look at the inside of your esophagus.
- Esophageal endoscopic ultrasound: Sound waves create images of the inside of your esophagus. Healthcare providers may do this test as part of an EGD.
- Biopsy: During the EGD, healthcare providers may remove a small piece of tissue to examine under a microscope to see if there are any cancer cells.
Stomach Cancer
Treatment depends on how far your cancer’s spread, your health and treatment preferences. It often involves a care team that includes your primary care provider, a cancer specialist (oncologist) and a gastrointestinal specialist (gastroenterologist). They can advise you on treatment options.
Surgery
Depending on how much the cancer’s spread, your provider may recommend surgery to remove precancerous cells, a tumor, or all or part of your stomach.
- Upper endoscopy. In the early stages, when the cancer is limited to your stomach’s superficial (uppermost) layers, the cancer can be removed through an upper endoscopy. In this procedure (endoscopic submucosal dissection or endoscopic mucosal resection), a gastroenterologist cuts the tumor from your stomach wall and removes it through your mouth.
- Gastrectomy. Once the tumor spreads beyond your stomach’s superficial layers, you’ll need surgery to remove all or part of your stomach. Subtotal gastrectomy removes the part of your stomach affected by the cancer. Total gastrectomy removes your entire stomach. Your provider will connect your esophagus to your small intestine so that you can still eat following total gastrectomy.
Other treatments
Additional treatments attack cancer cells directly.
- Chemotherapy (chemo) uses drugs to shrink cancer cells, making them easier to remove before surgery. Chemotherapy can also kill the remaining cancer cells after surgery. It’s usually used in combination with radiation. Chemo may be used with targeted drug therapy, too.
- Radiation uses targeted energy beams like X-rays to destroy cancer cells. Radiation alone isn’t effective in treating stomach cancer, but it may be used alongside chemo before and after surgery. Radiation can also help relieve symptoms.
- Targeted drug therapy zeroes in on weaknesses in cancer cells, causing them to die. It’s often used with chemo in cancer that recurs (comes back) or that’s advanced.
- Immunotherapy helps your immune system identify and destroy cancer cells that may be hard to detect. It’s most commonly used in recurring or advanced cancer.
Oesophageal Cancer
Oesophageal cancer treatment depends on the cancer stage and grade. Treatment options include:
- Surgery: An esophagectomy is the most common treatment for early-stage esophageal cancer. It involves removing some or most of your esophagus and surrounding tissue. Surgeons create a new esophagus by pulling up part of your stomach into your chest and neck.
- Radiation therapy: Radiation kills or damages cancer cells by aiming a radiation beam at the tumor. Healthcare providers may use radiation as adjuvant therapy before or after surgery.
- Chemotherapy: Chemotherapy kills cancer cells or stops them from growing.
- Endoscopic submucosal dissection (ESD):Surgeons may use ESD to treat very early-stage esophageal cancer.
- Endoscopic mucosal resection (EMR): Surgeons use this procedure to remove tumors in the mucous lining of your esophagus.
- Endoscopic laser therapy: This treatment eases symptoms when tumors may block your esophagus, making it hard for you to swallow.
- Photodynamic therapy (PDT):Photodynamic therapy destroys tumors with drugs called photosensitizers. Light activates these drugs and creates a chemical reaction that kills cancer.
- Targeted therapy: Some esophageal cancer cells carry an unusually high amount of the HER2 protein. This protein helps cancer cells grow. In targeted therapy, healthcare providers treat esophageal cancer with drugs targeting HER2 proteins.
- Immunotherapy: This treatment involves immune checkpoint inhibitors. These drugs help restore your immune system’s response to esophageal cancer cells.
The stage wise 5-year survival percentages
Stomach (Gastric) Cancer
- Stage 1: ~68%
- Stage 2: ~40%
- Stage 3: ~15–25%
- Stage 4: ~5%
Esophageal Cancer
- Stage 1: ~45%
- Stage 2: ~30%
- Stage 3: ~20%
- Stage 4: ~5%
Stomach Cancer
You can’t prevent stomach cancer, but you can reduce your risk if you:
- Treat H. pylori infection if you test positive. H. pylori infection is a significant risk factor for developing stomach cancer.
- Treat ulcers, gastritis and other stomach conditions promptly. Untreated stomach conditions, especially those caused by H. pylori bacteria, increase your risk of stomach cancer.
- Eat healthy. Eating a healthy diet that’s high in fruits and vegetables and low in salts and red meats can reduce your stomach cancer risk. Foods high in vitamin C, beta-carotene and carotenoids, such as citrus fruits, leafy green vegetables and carrots, are good sources of key nutrients.
- Avoid smoking and using tobacco products. Tobacco use increases your risk of stomach cancer and many other cancers.
- Maintain a healthy weight. What counts as a healthy weight varies from person to person. Ask your provider what a healthy weight means for you.
Providers don’t screen for stomach cancer because it’s so rare. Still, if you have a condition that increases your risk, your provider may recommend regular procedures like an upper endoscopy to detect cancerous changes.
Oesophageal Cancer
You may be able to reduce your risk by eating well so you’re at a weight that’s right for you and that you can maintain. You may also reduce your risk by avoiding activities such as using tobacco, frequently drinking lots of alcohol or working around certain solvents. Having an HPV infection is a risk factor for oesophageal cancer. Ask your healthcare provider if you should receive the HPV vaccine.
There isn’t a recommended way to screen for esophageal cancer. But if you have Barrett’s esophagus or certain other conditions, your healthcare provider may recommend screening. Your healthcare provider may do an EGD to do this screening.