Involve. Supporting you. Supporting your patients with cancer
As a healthcare provider, you participate in every aspect of care for patients facing a cancer diagnosis. Use this section to refresh your knowledge of gastric cancer or share the information with patients who are facing a gastric cancer diagnosis.
- Facts and Statistics
- Risk Factors
- Screening and Early Detection
- Diagnosis and Staging
- Gastric Cancer Treatment Options
Facts and Statistics
According to the American Cancer Society:
- In 2009, approximately 21,130 new cases of gastric cancer likely will be diagnosed among American men and women.
- An estimated 10,620 deaths due to gastric cancer are expected in 2009.
- Gastric cancer is primarily a disease of the elderly, with an average age at time of diagnosis of 71 years.
- The lifetime risk of developing stomach cancer is 1 in 100, with the risk slightly higher in men than in women.
Risk Factors
While some risk factors for gastric cancer are unavoidable, such as family history, other risk factors, such as poor eating habits and obesity, are within your control.
- Stomach Infection: A stomach infection due to Helicobacter pylori is a major risk factor of gastric cancer. Long-term infection with H. pylori may cause damage to the stomach's inner lining and eventually lead to gastric cancer.
- Obesity: Being very overweight or obese has a possible cause of cancer of the cardia, but, the strength of this link is not yet clear.
- Poor Eating Habits: Consuming a lot of salted fish, meats, smoked foods, and pickled vegetables may increase the risk of gastric cancer.
- Smoking: Smoking may increase the risk of gastric cancer. Smokers have nearly double the risk of gastric cancer than nonsmokers.
- Stomach Surgery: A previous stomach surgery, such as removal of part of the stomach to treat ulcers, may increase the risk of gastric cancer.
- Gender and Age: Men are more likely to develop gastric cancer as women. The risk of gastric cancer increases greatly after age 50, with most gastric cancers occurring in people in their late 60s, 70s, and 80s.
- Ethnicity: Gastric cancer is most common in Asians and Pacific Islanders. Black and Hispanic people are more likely to develop gastric cancer than non-Hispanic white people.
- Geography: Gastric cancer occurs most often in Japan, Southern and Eastern Europe, China, and Central and South America.
- Vitamin B12 Deficiency: B12 deficiency, either due to poor intake or poor absorption, maybe increase the risk of gastric cancer.
- Ménétrier Disease (Hypertrophic Gastropathy): This rare disease, in which large folds develop in the stomach due to hyperproduction of acid, may increase the risk of gastric cancer.
- Family History: A person with several close relatives who have been diagnosed with gastric cancer may be at increased risk for developing the disease.
- Genetics: Certain genetic disorders, such as nonpolyposis colorectal cancer and other gene mutations, may increase the risk of gastric cancer.
- Stomach Polyps: The presence of polyps in the stomach lining, particularly adenomas, may increase the risk of gastric cancer.
- Epstein-Barr Virus: There may be a link between the Epstein-Barr virus and certain gastric cancers.
- Type-A Blood: For reasons unknown, having type-A blood may increase the risk of gastric cancer.
Screening and Early Detection
Since gastric cancer is not common in the United States, there are no established screening programs. However, those at an increased risk of gastric cancer should discuss screening with their healthcare provider.
Diagnosis and Staging
Several tests are available to help with the diagnosis of gastric cancer:
- Endoscopy: Endoscopy is the typical method used to diagnose gastric cancer, specifically upper endoscopy. During an upper endoscopy, a flexible, skinny tube with a light is inserted down the throat, allowing visualization of the esophagus, stomach, and upper part of the small intestine. If abnormal tissue is noted, a biopsy will be taken to confirm the presence of cancer.
- Upper Gastrointestinal Series/Barium Radiograph: A barium radiograph comprises ingestion of a barium solution, after which several X-rays are taken. The barium allows visualization of the esophagus, stomach, and the upper part of the small intestine.
- Endoscopic Ultrasound: Using sound waves, the stomach and other areas are visualized. An endoscopic ultrasound typically is used to see if, and how far, gastric cancer has metastasized. A small probe is inserted through the mouth or nose and then guided down to the stomach, and images are displayed on a computer screen.
- Computed Tomography (CT) Scan: A CT scan allows visualization of the stomach and aids in pinpointing the location of gastric cancer. A CT scan also may aid in determining if the cancer has spread.
- Positron Emission Tomography (PET): A PET scan uses radioactive sugar, injected intravenously, to identify cancerous tissue. PET scans typically are used to pinpoint cancer that may have spread outside of the stomach.
- Magnetic Resonance Imaging (MRI): An MRI uses strong magnets and radio waves to locate abnormalities in the stomach. An MRI may be ordered when not enough information was obtained from a CT scan.
- Chest X-Ray: X-rays of the chest may be used to determine if gastric cancer has spread to the lungs. Chest X-rays also may be used to check for serious heart and lung conditions.
Once gastric cancer is diagnosed, the disease is staged:
| Gastric Cancer Stages | |||
|---|---|---|---|
| Stage | Primary Tumor (T) |
Lymph Nodes (N) |
Metastasis (M) |
| 0 | Tis | N0 | M0 |
| IA | T1 | N0 | M0 |
| IB | T1 | N1 | M0 |
| T2a/b | N0 | M0 | |
| II | T1 | N2 | M0 |
| T2a/b | N1 | M0 | |
| T3 | N0 | M0 | |
| IIIA | T2a/b | N2 | M0 |
| T3 | N1 | M0 | |
| T4 | N0 | M0 | |
| IIIB | T3 | N2 | M0 |
| IV | T4 | N1-3 | M0 |
| T1-3 | N3 | M0 | |
| Any T | Any N | M1 | |
| Gastric Cancer TNM Staging Guide | |
|---|---|
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ: intraepithelial tumor without invasion of lamina propria |
| T1 | Tumor invades lamina propria or submucosa |
| T2 | Tumor invades muscularis propria or subserosa |
| T2a | Tumor invades muscularis propria |
| T3 | Tumor penetrates serosa (visceral peritoneum) without invasion of adjacent structures* |
| T4 | Tumor invades adjacent structures* |
| *The adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum. | |
| Gastric Cancer TNM Staging Guide | |
|---|---|
| Regional Lymph Nodes (N) | |
| NX | Regional lymph node metastases cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in 1 to 6 regional lymph nodes |
| N2 | Metastasis in 7 to 15 regional lymph nodes |
| N3 | Metastasis in >15 regional lymph nodes |
| Gastric Cancer TNM Staging Guide | |
|---|---|
| Distant Metastases (M) | |
| MX | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present |
Gastric Cancer Treatment Options
As a healthcare provider, you may find yourself educating patients about their treatment options. The following is a brief summary of common therapies used to treat gastric cancer that may be helpful to you and your patients.
- Surgery: The only curative treatment for gastric cancer is surgery. Surgical resection typically includes the smallest amount of surgery possible while still removing all cancerous tissue. Surgery may be used for early-stage disease, but also to relieve the pain or discomfort from advanced disease. There are several types of surgery for gastric cancer, including gastrectomy (removal of the entire stomach) and partial gastrectomy.
- Radiation Therapy: Radiation therapy kills or shrinks cancer cells by using high-energy rays. Typically, external beam radiation is used to treat gastric cancer. Radiation may be used after surgery or to help relieve the pain or discomfort of gastric cancer.
- Chemotherapy: Chemotherapy is the use of drugs to help kill cancer cells. Chemotherapy may be administered orally or intravenously. While chemotherapy may be indicated at any stage of cancer, it is typically chosen for metastatic disease. Chemotherapy may be given during or after radiation.
- Clinical Trials: Clinical trials give patients access to investigational approaches and treatments that often are not otherwise available. There are both benefits and drawbacks to participation in clinical trials that patients and healthcare providers should discuss.
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