Gastric cancer, often referred to as stomach cancer, is a disease where abnormal cells grow uncontrollably in the stomach. It ranks as the fifth most frequently diagnosed cancer and is the fourth leading cause of cancer-related deaths worldwide. Awareness of this condition is important, as it often requires comprehensive medical attention and timely intervention.
Recognizing the Signs
The manifestations of gastric cancer can be subtle, especially in its early phases, making detection difficult. Early symptoms often include persistent indigestion, heartburn, or a feeling of being very full or bloated after consuming only small amounts of food. Individuals might also experience persistent stomach pain, nausea, or a reduced appetite. These indicators can easily be mistaken for less serious digestive issues, which sometimes delays diagnosis.
As gastric cancer progresses, more pronounced symptoms tend to appear. These can include unexplained weight loss, difficulty swallowing, and persistent vomiting, which may occasionally contain blood. Some individuals might notice changes in their bowel movements, such as black or tarry stools, due to blood in the digestive tract. Fatigue or weakness, often a result of anemia from internal bleeding, can also develop. When the cancer spreads, additional symptoms specific to the affected body parts, like yellowing of the skin if the liver is involved, may emerge.
Understanding Gastric Cancer Staging
Cancer staging determines the extent of cancer within the body, providing a standardized way to describe how far the disease has progressed. This classification helps predict the disease’s course and tailor appropriate treatment strategies. For gastric cancer, the most widely used system is the TNM (Tumor, Node, Metastasis) system. This system evaluates three main components: the size and local spread of the primary tumor (T), whether the cancer has spread to nearby lymph nodes (N), and if it has spread to distant parts of the body (M).
The TNM values are combined to categorize gastric cancer into stages, ranging from Stage 0 to Stage IV. Stage 0, also known as carcinoma in situ, indicates that abnormal cells are confined to the innermost lining of the stomach and have not spread. Stage I cancers are small and localized to the stomach wall, with minimal or no lymph node involvement. As the stage numbers increase through Stage II and Stage III, it indicates that the cancer has grown deeper into the stomach wall or has spread to more nearby lymph nodes. Stage IV signifies that the cancer has metastasized to distant organs or tissues beyond the stomach and regional lymph nodes.
Approaches to Treatment
Treating gastric cancer often involves a combination of methods, designed to address the specific characteristics and stage of the disease. A multidisciplinary team of healthcare professionals collaborates to develop a personalized treatment plan. The primary treatment modalities include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.
Surgery is a common treatment for gastric cancer, especially in earlier stages, aiming to remove the tumor and surrounding affected tissue. A gastrectomy, which involves removing part or all of the stomach, is a common surgical procedure. The extent of the resection, whether partial or total, depends on the tumor’s size and location. This procedure often includes the removal of nearby lymph nodes to check for cancer spread, which also helps refine the cancer’s stage.
Chemotherapy uses drugs to kill cancer cells or slow their growth throughout the body. It can be administered before surgery, known as neoadjuvant chemotherapy, to shrink tumors and make them easier to remove. Chemotherapy can also be used after surgery, called adjuvant therapy, to eliminate any remaining cancer cells and reduce the risk of recurrence. In advanced cases where surgery is not an option, chemotherapy may be used as a standalone treatment to manage the disease and alleviate symptoms.
Radiation therapy uses high-energy rays to destroy cancer cells, often delivered by an external machine that precisely targets the cancerous area. This treatment is often combined with chemotherapy, particularly for locally advanced gastric cancer. Radiation can be used before surgery to reduce tumor size or after surgery to eliminate any residual cancer cells. For patients with advanced disease, radiation therapy can also help relieve symptoms such as pain or difficulty swallowing.
Targeted therapy involves drugs that specifically attack cancer cells by interfering with particular molecules involved in their growth and spread. These drugs are designed to be more precise than traditional chemotherapy, often resulting in fewer side effects on healthy cells. For instance, some targeted therapies for gastric cancer focus on the HER2 pathway or the VEGF/VEGFR2 pathway.
Immunotherapy harnesses the body’s own immune system to recognize and destroy cancer cells. These treatments work by boosting the immune response against the tumor or by removing “brakes” that prevent the immune system from attacking cancer. Immune checkpoint inhibitors are examples of immunotherapies used in gastric cancer, sometimes in combination with chemotherapy.
Post-Treatment Monitoring and Support
After completing primary treatment for gastric cancer, ongoing monitoring and supportive care become important aspects of the patient’s long-term health plan. Regular follow-up appointments are scheduled to monitor for any signs of cancer recurrence or the development of new health issues. These appointments involve physical examinations, blood tests, and imaging scans.
Surveillance aims to detect local recurrence, either at the surgical site or in regional lymph nodes, as well as distant metastases. It serves to identify potential problems early. Detecting recurrence at an asymptomatic stage may improve survival outcomes, emphasizing the value of consistent follow-up.
Supportive care addresses the physical and psychological challenges that can arise after gastric cancer treatment. Many patients experience long-term side effects from surgery, including nutritional challenges. Managing these issues might involve dietary adjustments or vitamin supplements. Psychological support, including counseling or support groups, can help individuals process the emotional impact of their cancer journey. Lifestyle adjustments are also encouraged to promote overall well-being and enhance quality of life during recovery.