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Stomach cancer

From MayoClinic.com

Stomach (gastric) cancer is a cancer that starts in the stomach and is the growth of abnormal cells in the lining and wall of the stomach. It occurs mainly in men over 40 years of age.

Stomach cancer is difficult to detect in its early stages because it causes few or no symptoms.

Several factors play a role in the development of stomach cancer. Among these is infection with a type of bacterium called Helicobacter pylori (H. pylori), a leading cause of stomach irritation and ulcers. Countries such as China and Colombia, where at least half the children are infected with H. pylori, have a correspondingly high prevalence of stomach cancer. Heavily salted, smoked and pickled foods also are known to cause stomach cancer, and the disease is more common in countries where these foods form a large part of the diet. When refrigeration replaces salting and pickling as a way of preserving food, the incidence of stomach cancer declines significantly.

Stomach cancer is more readily treated when caught early. Unfortunately, by the time it's diagnosed the disease is often at an advanced stage and may have spread beyond the stomach to nearby lymph nodes or to other organs such as the liver, pancreas and colon.

When possible, the most common treatment for stomach cancer is an operation that removes part or all of your stomach. Chemotherapy or radiation also may be used, especially to help relieve symptoms in the later stages of the disease.

The encouraging news about stomach cancer is that you can greatly reduce your risk by eating a varied and healthy diet, and by receiving prompt treatment for any H. pylori infection.

• chemotherapy

Signs and symptoms

The most common early sign of both noncancerous (benign) and cancerous (malignant) stomach tumors is microscopic internal bleeding, which is usually only detected by tests that check your stool for blood. Sometimes you may feel tired if the bleeding causes you to lose too many healthy red blood cells (anemia).

When the cancer is more advanced, you may experience signs and symptoms such as:

• Discomfort in the upper or middle region of your abdomen that may not be relieved by food or antacids. In the early stages of stomach cancer, pain often may be alleviated by the acid-buffering effect of food or antacids.

• Abdominal discomfort aggravated by eating.

• Black, tarry stools.

• The vomiting of blood.

• Vomiting after meals.

• Weakness, fatigue and weight loss.

• Full feeling after meals, even when eating less than normal.

Having one or more of these signs and symptoms doesn't necessarily mean you have stomach cancer. Other conditions, especially peptic ulcers, can cause similar problems.

• fatigue

• Peptic ulcer

• vomiting

Causes

Your stomach is a muscular sac located on the upper left-hand side of your abdomen, just below your ribs. If you're an average adult, it's about the size of a small melon, but can stretch at the sides to hold nearly 1 gallon of food and liquid. Your stomach folds in on itself when it's empty and expands when you eat or drink.

Although your stomach plays a major role in digestion, the digestive process really begins in your mouth, where your saliva begins breaking down carbohydrates, sugars and fats. From there, food passes into your esophagus, a tube approximately 10 inches long that connects your throat and stomach. At the end of your esophagus is a muscle valve (lower esophageal sphincter) that relaxes to allow food to pass into your stomach.

The walls of your stomach are lined with three layers of powerful muscles that churn food into smaller pieces and mix it with enzymes and acids produced by glands in the stomach's inner lining. Under normal conditions, your stomach produces 2 to 3 quarts of gastric juices every day. One of these juices, hydrochloric acid, is so corrosive it can dissolve iron nails. Your stomach's delicate tissues are protected from this powerful acid by a thick, jelly-like mucus that coats the stomach lining.

Once the food in your stomach is thoroughly broken down and mixed, muscular contractions push it toward the pyloric valve, which leads into the upper portion of your small intestine (duodenum). The valve opens just enough to release barely an eighth of an ounce of food at a time. It may take three to four hours for your stomach to empty after you eat, depending on your diet. Foods high in fat increase the amount of time it takes for your stomach to empty.

The great majority of stomach cancers start in the glandular cells in the stomach lining (adenocarcinomas). Occasionally, tumors may also develop in the stomach's lymphatic tissue (lymphoma) or muscle (sarcoma). About 3 percent of stomach cancers are carcinoid tumors that originate in the stomach's hormone-producing cells. Carcinoid tumors spread (metastasize) less frequently than do other stomach cancers, which often spread throughout the stomach or grow into the esophagus or small intestine. They may also extend through the stomach wall to nearby lymph nodes and eventually spread to other organs such as the liver, pancreas and colon.

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What causes stomach cancer?

Healthy cells grow and divide in an orderly way. This process is controlled by DNA — the genetic material that contains the instructions for every chemical process in your body. Some of the genes in your DNA promote cell division and some slow cell division or program cells to die at the right time. Still other genes control processes that help repair DNA. When DNA is damaged, these genes may not function properly, causing cells to grow out of control and eventually form a tumor — a mass of malignant cells.

Although the causes of many types of cancer aren't clear, researchers have made real progress in pinpointing factors that damage DNA in stomach cells and in understanding how that damage leads to cancer. These factors include:

• H. pylori infection. Nearly two-thirds of the world's population is infected with corkscrew-shaped bacteria called Helicobacter pylori (H. pylori) that live deep in the mucous layer that coats the lining of the stomach. Although it's not entirely clear how the bacteria are transmitted, it's likely they spread from person to person through the oral-fecal route or are ingested in contaminated drinking water. H. pylori infection frequently occurs in childhood and can last throughout life if not treated. It's now known to be the primary cause of stomach ulcers, accounting for at least 80 percent of all cases. It may also be the main cause of stomach cancer.

• Nitrates and nitrites. Nitrates are naturally occurring chemical compounds that form when bacteria in the soil break down nitrogen. Millions of tons of these compounds — mainly from large-scale use of nitrogen fertilizers and from livestock and poultry farming — find their way into surface water and groundwater every year. Nitrates are also added to many processed meats to preserve color and enhance flavor. In your stomach, certain bacteria, including H. pylori, convert nitrates into nitrites, another nitrogen-based chemical. Nitrites are also added to certain foods, especially cured meats such as ham and bacon. The nitrites then combine with other nitrogen-containing substances in your stomach to form N-nitroso compounds — powerful carcinogens that are known to cause stomach cancer.

• Salted, smoked or pickled foods and red meat. Before the advent of refrigeration, food was commonly preserved by salting, smoking or pickling. Preserved foods often contain large amounts of nitrites and nitrates, which can be converted in your stomach into cancer-causing compounds. Countries where consumption of salted meat and fish and pickled vegetables is high — Japan is a notable example — tend to have correspondingly high rates of stomach cancer. Eating a diet high in red meat, especially when the meat is barbecued or well done, has also been linked to stomach cancer.

• Tobacco and alcohol use. Both can irritate the stomach lining and are especially likely to cause cancer in the upper part of the stomach closest to the esophagus.

• Low socioeconomic level. Low-income children and adults are more likely to develop stomach cancer than are those with higher incomes. Researchers believe this may be due to the rapid spread of H. pylori in crowded living conditions. In addition, breastfeeding can help protect infants against H. pylori, but low-income mothers are more likely to bottle-feed their babies.

• Alcohol addiction

• Nicotine dependence

Risk factors

Having H. pylori infection makes you two to six times as likely to develop stomach cancer as someone who isn't infected. Even so, most people with H. pylori don't get stomach cancer, and researchers believe that genetic factors make some people more susceptible to the disease. Studies show that having both H. pylori and a form of a gene that causes low stomach acid greatly increases your risk of stomach cancer.

Other risk factors for stomach cancer include:

• Sex. Stomach cancer is twice as common in men as it is in women.

• Age. Most people who develop stomach cancer are between the ages of 50 and 70. The disease rarely occurs in people younger than 40.

• Diet. A diet high in foods preserved by smoking, salting or pickling increases your risk of stomach cancer. So do foods that contain nitrites and nitrates, such as bacon, ham and processed meats. Eating large amounts of red meat — particularly if it's barbecued or well done — also increases your risk. On the other hand, using plenty of fruits and vegetables, especially those that are red or deep yellow, such as tomatoes, carrots and sweet potatoes, helps protect against stomach cancer.

• Alcohol and tobacco use. Drinking in moderation, which is generally defined as no more than one drink a day for women and two for men, may have certain health benefits. But drinking more can cause a number of problems, including irritation of the stomach and esophagus that may lead to cancer. Smoking has also been implicated in stomach cancer. Men who smoke are more than twice as likely to die of stomach cancer as are those who don't smoke, and rates are even higher for men who have smoked longer or who have a history of ulcers and heartburn. Women who smoke also have about a 50 percent increased risk of stomach cancer.

• Previous stomach surgery. The risk of stomach cancer may increase in people who have had part of their stomach and their pyloric valve removed — usually as a treatment for peptic ulcers. After stomach surgery, bile and sometimes pancreatic juices can back up, causing irritation and inflammation of the stomach lining (gastritis). This can lead to stomach cancer in some people. In general, the risk is greatest about 20 years after the initial surgery.

• Stomach polyps. These are small growths in the lining of your stomach. Most are benign, but adenomatous polyps — especially those larger than 1 centimeter in diameter — are often precancerous.

• Familial cancer syndromes. These include hereditary nonpolyposis colon cancer and familial adenomatous polyposis, inherited disorders that slightly increase your risk of stomach cancer.

• Hereditary diffuse gastric cancer is a rare form of stomach cancer associated with mutations in a gene called CDH1. A parent with the defective gene has a 50 percent chance of passing it on to each child. Because nearly three-fourths of people who inherit the gene eventually develop stomach cancer, doctors once recommended surgery to remove all or part of the stomach for all children of parents with the gene. Now, however, DNA testing can determine exactly who is at risk. If you have a family history of diffuse gastric cancer, your doctor or a genetic counselor can answer your questions about DNA tests.

• Family history. You're two to four times as likely to develop stomach cancer if you have a parent or sibling with the disease.

• Pernicious anemia. This condition, which is often associated with atrophic gastritis, occurs when your body lacks enough vitamin B-12 to produce healthy red blood cells. Although pernicious anemia is easily treated with B-12 injections, having the disease slightly increases your risk of stomach cancer.

• Type A blood. Your blood type is determined by the presence or absence of two proteins — A and B — that occur on red blood cells. For unknown reasons, people with type A blood have a somewhat higher risk of stomach cancer than do people with other blood types.

• Country of origin. Stomach cancer is more common in some parts of the world — especially Japan, Korea, parts of eastern Europe, and Latin America — than it is in the United States. These differences are likely related to diet and H. pylori infection. Stomach cancer occurs most often in countries where large amounts of meat or smoked, heavily salted or pickled foods are consumed or where refrigeration isn't readily available.

• Environmental exposure. Certain workplace contaminants, including coal dust, asbestos and nickel, have been linked to an increased risk of stomach cancer.

• Obesity. Men weighing 25 to 30 pounds more than their ideal weight may be at increased risk of stomach cancer.

• Colon cancer

• Gastritis

• heartburn

• Nicotine dependence

• Peptic ulcer

• Obesity

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