What is stomach?

The stomach is part of the digestive system. It is a hollow organ in the upper abdomen, under the ribs.

The wall of the stomach has five layers:

• Inner layer or lining (mucosa): Juices made by glands in the inner layer help digest food. Most stomach cancers begin in this layer.

• Submucosa: This is the support tissue for the inner layer.

• Muscle layer: Muscles in this layer create a rippling motion that mixes and mashes food.

• Subserosa: This is the support tissue for the outer layer.

• Outer layer (serosa): The outer layer covers the stomach. It holds the stomach in place.

Food moves from the mouth through the esophagus to reach the stomach. In the stomach, the food becomes liquid. The liquid then moves into the small intestine, where it is digested even more.

What is cancer, and how does stomach cancer spread?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

• Benign tumors are not cancer:
  
  • Benign tumors are rarely life-threatening.
  • Most benign tumors can be removed. They usually do not grow back.
  • Cells from benign tumors do not invade the tissues around them.
  • Cells from benign tumors do not spread to other parts of the body.
  
  
• Malignant tumors are cancer:
  
  • Malignant tumors are generally more serious than benign tumors. They may be life- threatening.
  • Malignant tumors often can be removed. But sometimes they grow back.
  • Cells from malignant tumors can invade and damage nearby tissues and organs.
  • Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original tumor and entering the bloodstream or the lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

Stomach cancer can affect nearby organs and lymph nodes:

• • A stomach tumor can grow through the stomach's outer layer into nearby organs, such as the pancreas, esophagus, or intestine.
  • Stomach cancer cells can spread through the blood to the liver, lungs, and other organs.
  • Cancer cells also can spread through the lymphatic system to lymph nodes all over the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if stomach cancer spreads to the liver, the cancer cells in the liver are actually stomach cancer cells. The disease is metastatic stomach cancer, not liver cancer. For that reason, it is treated as stomach cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.

What are the risk factor and causes of stomach cancer?

No one knows the exact causes of stomach cancer. Doctors often cannot explain why one person develops this disease and another does not.

Research has shown that people with certain risk factors are more likely than others to develop stomach cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for stomach cancer:

• Age: Most people with this disease are 72 or older.

• Sex: Men are more likely than women to develop stomach cancer.

• Race: Stomach cancer is more common in Asian, Pacific Islander, Hispanic, and African Americans than in non-Hispanic white Americans.

• Diet: Studies suggest that people who eat a diet high in foods that are smoked, salted, or pickled may be at increased risk for stomach cancer. On the other hand, eating fresh fruits and vegetables may protect against this disease.

• Helicobacter pylori infection: H. pylori is a type of bacteria that commonly lives in the stomach. H. pylori infection increases the risk of stomach inflammation and stomach ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer. Although infection increases the risk, cancer is not contagious. You cannot catch stomach cancer from another person who has it.

• Smoking: People who smoke are more likely to develop stomach cancer than people who do not smoke.

• Certain health problems: Conditions that cause inflammation or other problems in the stomach may increase the risk of stomach cancer:
  
  • Stomach surgery
  • Chronic gastritis (long-term inflammation of the stomach lining)
  • Pernicious anemia (a blood disease that affects the stomach)
  
  
• Family history: A rare type of stomach cancer runs in some families.

Most people who have known risk factors do not develop stomach cancer. For example, many people have H. pylori in their stomach but never develop cancer. On the other hand, people who do develop the disease sometimes have no known risk factors.

If you think you may be at risk, you should talk with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

What are the symtomps of stomach cancer?

Early stomach cancer often does not cause clear symptoms. As the cancer grows, the most common symptoms are:

• Discomfort in the stomach area
• Feeling full or bloated after a small meal
• Nausea and vomiting
• Weight loss

Most often, these symptoms are not due to cancer. Other health problems, such as an ulcer or infection, can cause the same symptoms. Anyone with these symptoms should tell the doctor so that problems can be found and treated as early as possible.

How is stomach cancer diagnosed?

If you have a symptom that suggests stomach cancer, your doctor must find out whether it is really due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems.

The doctor asks about your personal and family health history. You may have blood or other lab tests. You also may have:

• Physical exam: The doctor checks your abdomen for fluid, swelling, or other changes. The doctor also feels for swollen lymph nodes. Your skin and eyes are checked to see if they seem yellow.
• Upper GI series: The doctor orders x-rays of your esophagus and stomach. The x-rays are taken after you drink a barium solution. The solution makes your stomach show up more clearly on the x-rays.
• Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into your stomach. The doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.
• Biopsy: The doctor uses an endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.
  

What is the treatment of stomach cancer?

Many people with stomach cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about the disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor—to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist who has experience treating stomach cancer, or you may ask for a referral. Specialists who treat stomach cancer include gastroenterologists, surgeons, medical oncologists, and radiation oncologists.

What are some of the nutritional concerns of stomach cancer patients?

Nutrition

It is important to eat well during and after cancer treatment. You need the right amount of calories, protein, vitamins, and minerals. Eating well may help you feel better and have more energy.

Eating well can be hard. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. You also may have side effects of treatment such as poor appetite, nausea, vomiting, or diarrhea.

A registered dietitian can suggest ways to deal with these problems. Some people with stomach cancer are helped by receiving nutrition by a feeding tube or by injection into a blood vessel. Some are helped by nutritional beverage products.

You may want to read the NCI booklet Eating Hints for Cancer Patients. It contains many useful ideas and recipes.

Nutrition after stomach surgery

Weight loss after surgery for stomach cancer is common. You may need to change the types of food you eat. A registered dietitian can help you plan a diet that will give you the nutrition you need.

Another common problem after stomach surgery is dumping syndrome. This problem occurs when food or liquid enters the small intestine too fast. It can cause cramps, nausea, bloating, diarrhea, and dizziness. Eating smaller meals can help prevent dumping syndrome. Also, you may wish to cut down on very sweet foods and drinks, such as cookies, candy, soda, and juices. A registered dietitian can suggest foods to try. Also, your health care team may suggest medicine to control the symptoms.

You may need to take daily supplements of vitamins and minerals, such as calcium. You also may need injections of vitamin B12.

What support is there for cancer patients?

Living with a serious disease such as stomach cancer is not easy. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy also can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

Information Specialists at 1-800-4-CANCER and at LiveHelp (http://www.cancer.gov/cis) can help you locate programs, services, and publications. For a list of organizations offering support, you may want to get the NCI fact sheet "National Organizations That Offer Services to People With Cancer and Their Families." For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer and the People Who Care About Them.

The promise of cancer research

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). For stomach cancer, they are studying surgery, chemotherapy, radiation therapy, and combinations of these types of treatment.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances, and researchers continue to search for more effective methods for dealing with stomach cancer.

People who join clinical trials may be among the first to benefit if a new approach is effective. And even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn more about stomach cancer and how to control it in other patients. Although clinical trials may have some risks, doctors do all they can to protect their patients.

If you are interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. NCI also offers an easy-to-read brochure called If You Have Cancer…What You Should Know About Clinical Trials. These NCI publications describe how clinical trials are carried out and explain their possible benefits and risks.

Stomach Cancer At A Glance

• Stomach cancer (gastric cancer) can develop in any part of the stomach and spread to other organs.
  
• The cause of stomach cancer is not known, but certain risk factors for stomach cancer have been identified.
  
• Stomach ulcers do not appear to increase a person's risk of developing stomach cancer.
  
• Symptoms of stomach cancer are often vague.
  
• Stomach cancer is diagnosed with a biopsy of stomach tissue during a procedure called an endoscopy.
  
• Treatment of stomach cancer depends on the size, location, and extent of the tumor, the stage of the disease, and the health of the patient.