How does stomach cancer develop?
Most stomach tumors are adenocarcinomas. Their development usually goes through a sequence of changes in the mucosa, stretched over years and decades. This makes it possible to detect precancerous conditions early and prevent cancer. Other tumors are less common: lymphomas, gastrointestinal stromal tumors, neuroendocrine tumors.
- Chronic gastritis associated with H. pylori
- Atrophic gastritis
- Intestinal metaplasia
- Dysplasia (low and high grade)
- Early cancer limited to the mucous and submucosal layer
- Advanced cancer with wall invasion and metastases
Risk factors
The main factor that can be influenced is H. pylori infection. Diet, smoking and heredity also play a role. The risk increases with age and is higher in men.
- Helicobacter pylori infection
- Atrophic gastritis, intestinal metaplasia, adenomatous polyps of the stomach
- Smoking and alcohol
- Excess salt, salted, smoked and pickled foods, lack of vegetables and fruits
- Stomach cancer in close relatives
- Had gastric surgery many years ago
- Pernicious anemia
Symptoms
Early stomach cancer is most often asymptomatic or manifests itself as nonspecific discomfort, which can easily be mistaken for gastritis. Therefore, it is impossible to treat “gastritis” for years without gastroscopy, especially in adulthood. As the tumor grows, more severe symptoms appear.
- Discomfort or pain in the upper abdomen
- Heaviness and quick satiety after a small portion
- Decreased appetite, aversion to meat
- Weight loss, weakness, anemia
- Nausea, vomiting
- Difficulty swallowing with a tumor in the upper part
- Black stool due to bleeding from a tumor
Diagnostics
The main method is gastroscopy with biopsy of suspicious areas. Modern endoscopes with magnification and narrow-spectrum mode make it possible to examine the smallest changes in the mucous membrane. After confirming the diagnosis, the stage is determined: depth of germination and prevalence. The choice of treatment depends on the stage, so the examination must be complete.
- Gastroscopy with multiple biopsy and histological examination
- Endoscopic ultrasound to assess the depth of germination
- CT scan of the chest, abdomen and pelvis
- General blood test, biochemistry, tumor markers as an auxiliary method
- Molecular studies of the tumor (HER2, etc.) to select therapy
- Diagnostic laparoscopy according to indications
Treatment and prevention
The tactics are determined by a council of oncologists, surgeons and chemotherapists. Early cancer limited to the mucosa can be removed endoscopically while sparing the stomach. For deeper germination, partial or complete removal of the stomach and lymph nodes is performed, often in combination with chemotherapy before and after surgery. In the case of a common process, chemotherapy, targeted and immune drugs are used to prolong life and improve its quality. Prevention is aimed at eliminating risk factors and early detection of precancerous changes.
- Test and, if necessary, treat H. pylori, especially in cases of stomach cancer in relatives
- Perform a gastroscopy if there are alarming signs and if complaints arise after 45 years
- Observe by a gastroenterologist for atrophic gastritis and metaplasia
- Stop smoking, limit alcohol and salt
- Eat more fresh vegetables and fruits
