PITTSBURGH -- Stomach (gastric) cancer is about one-fourth as common today in the United States as it was just 70 years ago. Changes in diet and advances in food refrigeration may be factors in its lower incidence. However, it's still a significant problem because it's difficult to detect in its early stages when successful treatment is possible.

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If caught early, stomach cancer is treatable. When the cancer has spread, the outlook isn't as good. The 5-year survival rate for stomach cancer is 90 percent when the cancer is detected in its earliest stages. However, most people in the United States don't receive a diagnosis until stomach cancer is more advanced. For the most advanced stage of stomach cancer, the 5-year survival rate is only 3 percent.

The cancer is difficult to detect in its early stages, when it usually doesn't cause any symptoms and the only evidence may be microscopic internal bleeding. By the time symptoms, similar to those caused by ulcers, do occur the disease is often at a more advanced stage and no longer treatable.

Doctors diagnose about 22,000 cases of stomach cancer in the United States annually, and nearly 13,000 Americans with stomach cancer die annually.

Signs and Symptoms

Signs and symptoms of stomach cancer may include:

• Discomfort in the upper or middle region of your abdomen that's not relieved by food or antacids
• Abdominal discomfort aggravated by eating
• Black, tarry stools
• Vomiting of blood
• Vomiting after meals
• Weakness, fatigue and weight loss
• Persistent low-grade fever
• Bloated feeling after meals

For both malignant and benign stomach tumors, the most common early sign is microscopic bleeding. Your doctor can detect this only by examining the stool for blood. You may feel weak and tired because of anemia, a potential result of the bleeding. Anemia can be confirmed by a blood test.

People with a peptic ulcer often have the same symptoms as does someone with a malignant stomach tumor.

Risk Factors

It's difficult to say why some people get stomach cancer while others don't. But the follwing factors increase your risk of stomach cancer:

• Helicobacter pylori infection: Presence in your stomach of corkscrew-shaped bacteria called Helicobacter pylori (H. pylori) may damage the lining of your stomach, thereby increasing your risk of stomach cancer. H. pylori is a common cause of ulcers and infects over half the world's population. According to the World Health Organization, at least 335,000 out of 800,000 annual new cases of gastric cancer can be attributed to H. pylori infection. Most people with H. pylori in their stomachs never develop stomach cancer. However, people with H. pylori infection have three to eight times greater risk of developing gastric cancer than those not infected.
• Diet: People who consume a diet high in foods that are smoked, dried, salted or pickled ingest greater amounts of nitrates and nitrites. These substances can be converted inside your stomach into compounds that increase your risk of stomach cancer. On the other hand, the risk is lower for people whose diet contains plenty of fresh fruits and vegetables, whole grains and properly refrigerated foods.
• Smoking and alcohol abuse: The irritation caused by these habits particularly increase your risk of cancer of the upper part of the stomach, the portion closest to the esophagus.
• Previous stomach surgery: Having had this surgery may result in higher levels of nitrite-producing bacteria and bile in your stomach, which increases your risk of stomach cancer.
• Genetics: Stomach cancers are two to four times more common for immediate family members of people who have had the disease. However, more than 90 percent of people with stomach cancer have no family members with stomach cancer.
• Country of origin: Stomach cancer is much more common in some countries, such as Japan, Korea, parts of Eastern Europe and Latin America. However, people of Japanese ancestry who live in the United States have a much lower incidence of stomach cancer, suggesting environmental influences such as diet.
• Gender: About two-thirds of cases are in men.
• Age: Stomach cancer usually occurs between age 50 and 70. It's rare before age 40.

When To Seek Medical Advice

See your doctor if you have a persistent feeling of discomfort in the upper or middle region of your abdomen and if eating aggravates that feeling, you have black and tarry stools, you're fatigued and you've lost weight. Your doctor can help determine what underlying condition may be causing your signs and symptoms.

Screening And Diagnosis

Diagnosis involves you undergoing a general physical examination and a discussion with your doctor of your medical history. This may include your description of your symptoms and when they first occurred and information about your family's medical history. In addition, you may undergo one or more of the following diagnostic procedures:

• Upper endoscopy. In this procedure, your doctor inserts a thin, flexible tube (endoscope) equipped with a light through your mouth and into your esophagus, stomach and small intestine. Your doctor will be able to see the upper part of your digestive tract. This procedure also allows your doctor to remove a small sample (biopsy) of any tissue that appears abnormal for further assessment.
• Stomach X-ray. After fasting overnight, you'll drink a barium mixture, a chalky liquid that will coat your upper gastrointestinal tract and small bowel to enhance viewing on an X-ray.
• Blood test. A test called a complete blood count (cbc) can indicate anemia.
• Stool test for occult blood. This can detect microscopic amounts of blood in your stool.

Once a diagnosis of gastric cancer is made, your doctor may recommend additional tests to determine the extent of the disease and the best course of treatment. These tests may include:

• Endoscopic ultrasound. Using a small flexible tube with a light (endoscope), your doctor can thread a small ultrasound device into your stomach to generate a close-up image of your stomach on a computer screen. This procedure may help your doctor determine the extent of the cancer.
• Computerized tomography (CT) scan. To see if the cancer has spread to nearby organs, such as the lymph nodes, pancreas and liver, your doctor may have you undergo a CT scan. A CT scan allows your doctor to see your internal organs.

Treatment

Stomach cancer can develop in any part of your stomach. In its earliest stage, stomach cancer is confined to the stomach's lining. The treatment and outlook will vary depending on several factors. They include which section of your stomach the cancer affects, the size of the tumor, whether the cancer is confined to the lining or has spread deeper into the stomach muscle, whether the cancer has spread beyond the stomach to nearby organs or lymph nodes and what the cancer looks like under a microscope.

Depending on the stage of the cancer, your doctor may recommend one form of treatment or a combination of treatments. The treatment options include:

• Surgery. Surgical removal of the stomach tumor (gastrectomy) is the only chance for successful treatment for most types of stomach cancer. For cancer in an early stage, and if surgery can remove all of the affected areas of your stomach, then a full recovery is possible. Depending on the extent of the cancer, your doctor may remove part (subtotal or partial gastrectomy) or all (total gastrectomy) of your stomach. After a total gastrectomy, your doctor attaches the esophagus directly to the small intestine. If the cancer is more advanced, your doctor still may recommend surgery to alleviate pain, bleeding or obstruction.
• Chemotherapy. In chemotherapy, your doctor gives you cancer-fighting drugs, usually either orally or intravenously. These drugs will work against cancer cells wherever they're located in your body, not just in your stomach. Sometimes, doctors try chemotherapy before surgery in order to reduce the size of the tumor. Or your doctor may choose chemotherapy as an additional treatment after an operation to destroy cancer cells that remain after surgery.
• Radiation therapy. This treatment uses X-rays to kill cancer cells in a specific area. Radiation therapy may be used after surgery to destroy remaining cancer cells. Sometimes, this treatment is used in combination with chemotherapy.

At times, stomach cancer isn't found until a very advanced stage. In these cases, chemotherapy, radiation treatments or surgery may not be helpful. The focus of the treatment then becomes comfort, rather than trying to shrink or treat the cancer. Your doctor can prescribe treatments and medicines to help relieve pain or other symptoms. You may decide to participate in a clinical trial as part of your treatment. Clinical trials are designed to allow doctors to see if new forms of treatment are effective. In the case of stomach cancer, clinical trials are proceeding to see which chemotherapy approaches are best.

Prevention

There's no sure way of preventing stomach cancer, but you can reduce some of the risk factors. The rate of stomach cancer in the United States has decreased greatly in the past 70 years as greater use of refrigeration and freezing for food preservation occurred rather than smoking, pickling and salting.

You can reduce your risk of stomach cancer by avoiding foods preserved with nitrates and nitrites and consuming a diet high in fresh fruits and vegetables and whole grains.

In addition, don't smoke and if you drink alcohol, do so in moderation. Smoking and excessive alcohol consumption increase your risk of cancer of the upper portion of the stomach.

Self Care

Changes in diet are common following surgery to remove stomach cancer. You're likely to feel full after eating a smaller amount of food, and the taste of food may change. Your doctor may recommend smaller, more frequent meals. Taking care of yourself after stomach cancer surgery means making sure you eat well in order to avoid weight loss and to regain your strength. Your doctor or a dietitian can advise you on healthy nutrition following surgery.

Loss of all or part of your stomach also affects your body's ability to absorb vitamins. Taking prescription vitamins may help you maintain your body's proper level of vitamins. Some of these vitamins can be taken only by injection.

Coping Skills

A diagnosis of cancer can be extremely challenging. Remember that no matter what your concerns or prognosis, you're not alone. These strategies and resources may make dealing with cancer easier:

• Know what to expect. Find out everything you can about your cancer — the type, stage, your treatment options and their side effects. The more you know, the more active you can be in your own care. In addition to talking with your doctor, look for information in your local library and on the Internet. The National Cancer Institute will answer questions from the public. You can reach them at 800-4-cancer (800-422-6237). Or contact the American Cancer Society at 800-227-2345.
• Be proactive. Although you may feel tired and discouraged, don't let others — including your family or your doctor — make important decisions for you. It's vital that you take an active role in your treatment.
• Maintain a strong support system. Having a support system can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful. Although support groups aren't for everyone, they can be a good source for practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are.
• Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able work a 40-hour week, for example, but you may be able to work part time. In fact, many people find that continuing to work can be helpful.
• Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the down times when you may need to rest more or limit what you do.
• Stay active. Being diagnosed with cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It's important to stay involved as much as you can.
• Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself seems to be a key factor in successfully coping with cancer.

Additional Resources

• National Cancer Institute
• American Cancer Society
• National Institutes of Health

Source: Mayo Foundation for Medical Education and Research