Stomach Cancer: What You Should Know

Stomach cancer, also known as gastric cancer, is one of the most common cancers around the world. It used to be the leading cause of cancer death until the 1980s, when it was overtaken by lung cancer.

Although the worldwide incidence of stomach cancer has declined over the last few decades due to recognition and treatment of risk factors, it remains the 7^th most common cancer among males and the 9^th most common cancer among females in Singapore.

Stomach cancer occurs when normal cells in any part of the stomach start changing and growing abnormally. There are many different types of stomach cancer, depending on the types of cells and part of the stomach involved.

Risk factors of stomach cancer

In Singapore, stomach cancer is more common in men, and in individuals between the age of 50 – 70 years old. Two important risk factors for stomach cancer are helicobacter pylori (H. pylori) infections and a family history of stomach cancer. H. pylori is a bacteria which can infect the stomach and intestines. If left untreated, a H. pylori infection can lead to stomach cancer.

Other known risk factors of stomach cancer include:

• Obesity
• A diet high in salt and salt-preserved foods such as salted fish, cured meats and salted vegetables
• High consumption of fried food, processed meat and alcohol; and low intake of vegetables, fruits, milk and vitamin A
• Smoking and exposure to tobacco smoke
• Epstein-Barr virus infection
• Cancer survivors who had received abdominal exposure to radiation
• Hereditary syndromes such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (Lynch syndrome)
• Stomach-related conditions such as chronic gastric atrophy, pernicious anaemia, partial gastrectomy, and stomach polyps

Symptoms of stomach cancer

Symptoms may not be present in the early stages of stomach cancer. However, as the disease progresses, common symptoms experienced by patients include persistent abdominal pain and unexplained weight loss.

Other stomach cancer symptoms include:

• Difficulty swallowing
• Loss of appetite, or easily feeling full
• Nausea
• Bleeding (with dark tarry stools or blood in the vomit) which can lead to anaemia
• Presence of a mass or lump in the abdomen

Screening and testing for stomach cancer

Although there has been a steady decline in gastric cancer mortality, early detection is important so that patients may seek treatment promptly for a better prognosis or treatment outcome.

Apart from going for annual health screenings to check for potential health concerns, patients may also consider specific screening tests for stomach cancer, such as:

• Gastroscopy, where a doctor will insert a long thin tube with a camera at the end to look into the upper digestive track. A biopsy may also be necessary should any abnormal masses be detected along the upper gastrointestinal track.
• Imaging studies, such as a computed tomography (CT) scan.
• Blood tests (tumour markers) such as GASTROClear. This test has a sensitivity and specificity of about 89% and 68% respectively, and is available at all Parkway Shenton clinics.

Staging for stomach cancer

Patients who have been clinically diagnosed with stomach cancer should undergo a staging evaluation. Knowing the stage of the disease will help guide the treatment process and enable the doctors to recommend the most suitable treatment option(s) and predict the treatment outcomes.

This is usually done following investigations through one or more of the following:

• CT scan of the chest, abdomen and pelvis
• Positron emission tomography (PET) or CT scans
• Laparoscopy to detect spread of the cancer to the peritoneum

Stomach cancer treatment

Treatment options for stomach cancer will depend on the stage of the cancer. This is determined by the size, location and extent of the tumour, as well as the general health status of the patient. Treatment for stomach cancer may include a combination of any of the following:

• Surgery to remove part, or even all, of the stomach
• Chemotherapy using medicines to kill or stop cancer cells from growing
• Radiation therapy to kill cancer cells
• Immunotherapy with medicines that make use of the body's immune system to stop the cancer's growth

Prevention of stomach cancer

Healthy lifestyle practices can be adopted to reduce the risk of developing stomach cancer. Some recommendations include:

• Eat more fruits and vegetables, as the fibre, vitamins and minerals present in these foods can help protect the body against stomach cancer
• Reduce consumption of salted and preserved foods
• Avoid smoking
• Exercise regularly
• Maintain a healthy weight

Should you have any questions or notice anything amiss with your health, do consider a health screening or make an appointment to see your family doctor for a discussion on your condition and what can be done to address it. You can find a Parkway Shenton clinic near you here.