Stomach cancer, also known as gastric cancer, represents a significant health problem worldwide due to its high incidence and mortality. This type of cancer is particularly lethal in its advanced stages, when treatment options are limited and the survival rate decreases dramatically. Early detection of gastric cancer is crucial to improve treatment outcomes and increase survival rates.
What is gastric cancer?
Stomach cancer is a malignant neoplasm that originates in the lining of the stomach. This type of cancer is characterized by slow development over several years.
In 2023, it was estimated that approximately 6,932 new cases of gastric cancer were diagnosed in Spain. Although it is not the most common type of cancer, it is still a significant concern. Compared to other types of cancer such as colon, breast or lung cancer, gastric cancer ranks sixth in frequency in the country. The incidence of this cancer is approximately 16.4 cases per 100,000 inhabitants, according to figures from the Spanish Society of Medical Oncology (SEOM).
Types of gastric cancer
Gastric cancer encompasses a variety of types that originate in different cells of the stomach, each with specific characteristics in terms of their development, behavior and treatment possibilities. The main types are:
- Adenocarcinoma: this is the most common type of gastric cancer, accounting for approximately 90-95% of cases. It originates in the glandular cells of the stomach’s inner lining (mucosa). There are two main subtypes:
- Intestinal type: tends to have a slightly better prognosis and the cancer cells are more likely to have certain genetic changes that may allow for targeted treatment.
- Diffuse type: grows and spreads more rapidly, is less common and is usually more difficult to treat.
- Lymphomas– these cancers originate in immune system cells called lymphocytes. Although lymphomas usually start in other parts of the body, some may originate in the stomach wall.
- Gastrointestinal stromal tumors (GIST): these are rare tumors that arise from very early forms of cells in the stomach wall called interstitial cells of Cajal. Although they can occur anywhere in the digestive tract, most begin in the stomach.
- Neuroendocrine tumors (including carcinoids) begin in the cells of the stomach that act as nerve and hormone-producing cells. Most of these tumors grow slowly and do not spread to other organs, although some may do so rapidly.
Importance of recognizing symptoms
One of the main reasons for early detection is that stomach cancer can go undetected in its early stages. Initial symptoms are often nonspecific and may include mild abdominal discomfort, loss of appetite and fatigue, causing many people to not seek medical attention until the disease has progressed.
Main symptoms of gastric cancer
- Abdominal discomfort or pain: pain in the stomach area is a common symptom of gastric cancer. This pain may be persistent and not necessarily related to food intake. It is often described as a vague discomfort or a dull ache in the upper abdomen.
- Unexplained weight loss and lack of appetite: weight loss for no apparent reason and lack of appetite are significant symptoms. These can severely impact the patient’s digestive and overall health, leading to decreased energy and ability to perform daily activities.
- Nausea, vomiting and fullness: these symptoms affect the digestive process, especially after eating large meals. The feeling of fullness may occur even after eating small amounts of food, which may lead to a reduction in food intake and contribute to weight loss.
- Jaundice (in advanced stages): Jaundice, which is yellowing of the skin and eyes, can occur if the cancer spreads to the liver and causes biliary obstruction. This symptom indicates an advanced stage of the disease and requires immediate medical attention.
- Anemia and fatigue: slow bleeding from the tumor into the stomach can lead to anemia, resulting in a decrease in red blood cells. This can cause fatigue, weakness and a general feeling of tiredness, affecting the patient’s quality of life.
Risk factors associated with gastric cancer
- Helicobacter pylori infection: this bacterium is one of the main causes of gastric cancer. Chronic H. pylori infection can cause inflammation and damage to the stomach lining, which can lead to precancerous changes and eventually cancer. Infected individuals have a 3- to 6-fold increased risk of developing gastric cancer.
- Smoking and excessive alcohol consumption: smoking doubles the risk of gastric cancer, especially in the upper part of the stomach. Excessive alcohol consumption is also associated with an increased risk of gastric cancer, particularly in people who drink three or more drinks a day.
- Diet high in processed and salty foods: consuming large amounts of salty, smoked and processed foods increases the risk of gastric cancer. These foods may contain compounds that damage the stomach lining and promote the development of cancer.
- Family history: having first-degree relatives (parents, siblings or children) with gastric cancer significantly increases the risk of developing this disease. In some cases, this is due to specific hereditary syndromes that predispose to various types of cancer.
- Previous health conditions: some health conditions, such as chronic atrophic gastritis, intestinal metaplasia, pernicious anemia, and gastric adenomatous polyps, increase the risk of gastric cancer. These conditions can cause changes in the stomach lining that predispose to the development of cancer.
Diagnostic tests for gastric cancer
Diagnosis of gastric cancer requires a comprehensive approach that combines several tests to confirm the presence of the disease, determine its extent and plan the most appropriate treatment. The main diagnostic tools are:
- Upper endoscopy: this procedure is essential to visualize the inside of the stomach and take biopsies. A thin, flexible tube with a camera (endoscope) is introduced through the mouth into the stomach. It allows the physician to see abnormal areas and take tissue samples for further analysis.
- Helicobacter pylori testing— Diagnosing and treating pylori infection is important because this bacteria increases the risk of gastric cancer. Tests may include blood tests, breath tests, stool tests and biopsies taken during endoscopy.
- Gastric biopsy: Biopsy is the definitive method of diagnosing gastric cancer. During an endoscopy, tissue samples are taken from the stomach and then examined under a microscope for cancer cells.
- Computed tomography (CT), magnetic resonance imaging (MRI) and PET-CT: These imaging tests are used to evaluate the extent of the cancer. CT uses X-rays to create detailed images of the inside of the body, while MRI uses magnetic fields and radio waves. Both help determine if the cancer has spread to other parts of the body.
Treatment options for stomach cancer
Treatment of gastric cancer is tailored according to the stage of the disease and the individual characteristics of the patient, combining different approaches to achieve the best possible results. Let’s take a look at the main therapeutic options, organized according to the stage of the disease and its main target:
Initial Stage
- Endoscopic resection: for premalignant lesions or patients at high surgical risk.
- Laparoscopic staging surgery: minimally invasive procedure to assess the extent of cancer in the abdomen.
- Subtotal gastrectomy: partial removal of the stomach, sometimes along with part of the esophagus or duodenum, and reconnection of the remaining stomach to the small intestine.
- Total gastrectomy: complete removal of the stomach, recommended if the cancer is close to the esophagus or a subtotal gastrectomy is not possible.
- Adjuvant chemotherapy after surgery: is a treatment given after surgery to kill any cancer cells that may be left in the body.
Advanced Stage
- Cytoreduction surgery and HIPEC: treatment for peritoneal metastases with PCI ≤ 7, combining surgery and intraperitoneal chemotherapy. The patient will also receive systemic treatment.
- PIPAC: minimally invasive intraperitoneal treatment in which aerosol chemotherapy is administered for peritoneal metastases with PCI > 7, combining with chemotherapy and systemic immunotherapy.
- ePIPAC: minimally invasive intraperitoneal treatment in which aerosol chemotherapy with electrostatic precipitation is administered for peritoneal metastases with PCI > 7, combined with systemic chemotherapy and immunotherapy.
- NIPEC: normothermic intraperitoneal chemotherapy through a subcutaneous reservoir in the abdomen, for peritoneal metastases with PCI > 7, combined with chemotherapy and systemic immunotherapy.
- Systemic chemotherapy:
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- Neoadjuvant: before surgery to shrink the tumor.
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- Adjuvant: after surgery to eliminate residual cells.
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- Primary: for advanced or metastatic cancer, combined with other techniques.
- Targeted therapies: some molecular markers such as HER-2 are evaluated to assess whether the patient will benefit from treatment with Trastuzumab.
- Molecular panels: genetic analysis of the tumor to determine effective therapies.
- Immunotherapy: combined with chemotherapy in advanced stages.
- Palliative care: relief of symptoms and treatment of side effects to improve quality of life.
Prevention and regular check-ups
Prevention of gastric cancer is based on adopting healthy lifestyle habits and regular medical check-ups to detect possible risks in early stages.
Preventive measures
- Healthy diet: consume fresh and natural foods, reducing the intake of salt and processed foods.
- Avoid smoking and alcohol: limit or eliminate tobacco and alcohol consumption to reduce risks.
- Infection control: especially helicobacter pylori infection, which can increase the risk of gastric problems.
- Physical exercise: exercise regularly.
Regular check-ups
- Endoscopic surveillance: recommended for people with a family history of gastric problems or chronic helicobacter pylori infections.
The treatment of stomach cancer requires a multidisciplinary approach, involving several specialists to ensure comprehensive and personalized care.
IVOQA offers oncological surgeons specialized in subtotal and total gastrectomy by minimally invasive routes, such as laparoscopy or robotic surgery, and in open surgery. We also have advanced molecular panels and treatments such as PIPAC, ePIPAC and NIPEC for patients with peritoneal carcinomatosis.
