Stomach Cancer : Type, Symptom, Risk Factor, Diagnosis, Stage, Treatment, And Drug

Stomach Cancer (Gastric Cancer) is cancer that develops from the lining of the stomach.Stomach is a muscular organ located on the left side of the upper abdomen.Cardia, fundus, and corpus are called the proximal stomach.Antrum and pylorus are called the distal stomach.Stomach cancer tends to develop slowly.Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach.

Parts of Stomach :

• Cardia is the first portion (closest to the esophagus)
• Fundus is the upper part of stomach next to the cardia.
• Body (Corpus) is the main part of the stomach , between the upper and the lower parts.
• Antrum is the lower portion (near the intestine), where the food is mixed with gastric juice.
• Pylorus is the last part of the stomach, which acts as a valve to control emptying of the stomach contents into the small intestine.

The Types of Stomach Cancer :

• Adenocarcinoma develps from the cells that form the innermost lining of the stomach (mucosa).
• Lymphoma is found in the wall of the stomach.
• Gastrointestinal Stromal Tumor (GIST) starts in very early forms of cells in the wall of the stomach called interstitial cells of cajal.
• Carcinoid tumor starts in hormone-making cells of the stomach.

The Signs or Symptoms of Stomach Cancer

• Loss of appetite
• Fatigue
• Unexplained weight loss
• Nausea
• Vomiting with or without blood
• Abdominal (belly) pain 
• Yellow skin and white eyes
• Difficulty of swallowing
• Blood in the stools among others
• Heartburn or indigestion
• Swelling or fluid build-up in the abdomen
• Feeling of fullness
• Vague discomfort in the abdomen, usually above the navel
• Low red blood cell count (anemia)
• Weakness
• Diarrhea
• Constipation
• Bloating of the stomach after meals

The Risk Factors of Stomach Cancer

• Family history of stomach cancer
• Gender
• Age
• Ethnicity
• Helicobacter pylori infection
• Inherited cancer syndromes
• Geography
• Obesity
• Diet
• The use of tobacco smoking
• Type A blood
• Stomach lympoma
• Pernicious anemia
• Menetrier disease
• Previous stomach surgery
• Heriditary non-polyposis colorectal cancer
• Diabetes

Diagnosis

To find the cause of stomach cancer symptoms, the doctor will ask the medical history and physical exam.The tests are to diagnose the stomach cancer as follow :

• Upper Endoscopy (Esophagogastroduodenoscopy or EGD) is to find stomach cancer.
• Endoscopic Ultrasound uses sound waves to produce images of organs, such as the stomach.
• Biopsy is to check for stomach cancer.
• Testing Biopsy Samples is to check if samples contain cancer by looking at under a microscope.The biopsy samples may be tested in two different ways, such as Immunohistochemistry (IHC) is the test by special antibodies that stick to the HER2/ neu protein applied to the sample, which cause cells to change color if many copies are present and Fluorescent In Situ Hybridization (FISH) is the test that uses fluorescent pieces of DNA  specifically to stick the copies of the HER2/neu gene in cells, which can then be counted under special microscope.
• Imaging tests use x-rays, magnetic field, sound waves, or radioactive substances to create pictures of the inside of body.
• Upper Gastrointestina (GI) Series are an x-ray test to look at the inner lining of esophagus, stomach, and first part of the small intestine.
• Computed Tomagraphy (CT) scan is an x-ray test that produces detailed cross-sectional images of the body.
• CT-Guided Needle Biopsy is to guide a biopsy needle into a suspected area of cancer spread.
• Magnetic Resonance Imaging (MRI) scan uses radio waves and strong magnetic instead of x-rays.
• Positron Emission Tomography (PET) scan shows if the cancer has spread beyond the stomach to other parts of the body.
• Chest X-Ray is to find out if cancer has spread to the lungs.
• Laparoscopy is to confirm a stomach cancer that is still only in the stomach and can be removed completely with surgery.
• Lab Test uses blood test to look for anemia which could be caused by the cancer bleeding into the stomach.

The Stage of Stomach Cancer

• The Stage 0 (Carcinoma in situ) : The cancer has not spead to any lymph nodes or anywhere else.
• The Stage IA : The cancer has grown beneath the top layer of cells in the mucosa into tissue below, such as the connective tissue (lamina propria), the thin muscle layer (muscularis mucosa) or the submucosa.The cancer has not spead to any lymph nodes or anywhere else.

• The Stage IB : The cancer has grown into the layer of connective tissue (lamina propria), and may have grown into the thin muscle layer (muscularis mucosa) beneath it or deeper into the submucosa.Cancer has also spread to 1 or 2 lymph nodes near the stomach, but not to any distant tissues and organs.
• The Stage IIA : Cancer has grown beneath the top layer of cells in the mucosa into the layer of connective tissue (lamina propria), thin muscle layer (muscularis mucosa) or the submucosa.It has spread to 3 to 6 nearby lymph nodes.It has no spread to distant sites.

• The Stage IIB : Cancer has grown beneath the top layer of cells in the mucosa into the layer of connective tissue (lamina propria), thin muscle layer (muscularis mucosa) or the submucosa.It has spread to 7 or more nearby lymph nodes.It has no spread to distant tissues or organs.
• The Stage IIIA : The cancer has grown into the main muscle layer (muscularis mucosa).It has spread to 7 or more nearby lymph nodes.It has no spread to distant tissues or organs.

• The Stage IIIB : The cancer has grown into the subserosa layer but not through all the layers to the outside of the stomach.It has spread to 7 or more nearby lymph nodes, but it has no spread to distant sites.
• The Stage IIIC : The cancer has grown completely to all the layer of the stomach wall into the serosa, but it has not grown into nearby organs or tissues.It has spread to 7 or more nearby lymph nodes.It has no spread to distant tissues or organs.
• The Stage IV : The cancer has spread to distant organs, such as the liver, lungs, brain, or bones.

The Treatment of Stomach Cancer

I.The Treatments of Stage I  include

• Chemotherapy (5-Fluorouracil)
• Radiation therapy

II.The Treatments of Stage II include

• Chemotherapy (5-Fluorouracil)
• Radiation Therapy
• Neoadjuvant Chemotherapy

III. The Treatments of Stage III include

• Chemotherapy (5-Fluorouracil)
• Radiation Therapy
• Neoadjuvant Chemotherapy

IV. The Treatments of Stage IV include

• Laser treatment
• Surgery
• Chemotherapy by drugs, such as 5-Fluorouracil, cisplatin, epirubicin, docetaxel, etoposide, oxaliplatin, capecitabine, or irinotecan.

Drugs for Stomach Cancer

• 5-Fluorouracil
• Fluorouracil injection
• Docetaxel
• Cisplatin
• Cyramza (Ramucirumab)
• Irinotecan
• Etoposide
• Capecitabine
• Herceptin (Trastuzumab)
• Doxorubicin Hydrochloride
• Oxaliplatin
• Mitomycin C
• Mitozytrex (Mitomycin C)
• Mutamycin (Mitomycin C)
• Epirubicin
• Ramucirumab
• Taxotere (Docetaxel)
• Trastuzumab

Drugs combinations used in Stomach Cancer

• FU-LV
• TPF
• Xeliri