Gastric Cancer: Symptoms, Causes, Types & Stages, Diagnosis, Treatment & Prevention

Last Updated on May 5, 2023 by Shabnam Sengupta

Gastric cancer also known as stomach cancer refers to the development of abnormal growth of cancerous cells anywhere in the stomach.

The stomach is a muscular bag-like structure located in the upper abdomen after the oesophagus and has the function of digesting food by producing various digestive enzymes.

Since the stomach serves as the initial site which comes in contact with every harmful substance consumed, it can develop various diseases including cancer over a very long period of time.

Symptoms

The stomach is a small muscular organ with limited space for food storage and digestion, so whenever there is an abnormal growth of cells it starts causing obstruction and the following signs and symptoms:

• Pain in the abdomen 
• Difficulty in eating (dysphagia)
• Heartburn 
• Acid reflux 
• Indigestion and burping 
• Constipation or diarrhoea 
• Nausea 
• Vomiting (occasional presence of blood in the vomit)
• Digested blood in stools 
• Loss of appetite 
• Unintentional weight loss 
• Fatigue 
• Feeling of fullness after eating a small amount of food 
• Palpable mass over the abdomen 

If the tumour metastasises to a distant organ, then various other signs and symptoms will also be present depending on the organ.

Causes

There isn’t any particular cause which leads to gastric cancer but various risk factors that cause chronic irritation of the lining of the stomach. These irritations have the potential to bring about permanent mutations in the cells leading to cancer development.

Some of the common risk factors are:

• Excessive smoking 
• Obesity 
• High salt and low fruit and vegetable intake 
• Chronic stomach ulcers 
• H. Pylori infection
• Chronic consumption of spicy and hot food that irritates the stomach lining 
• Type A blood group
• History of stomach cancer in the family 
• Genetic mutations like Familial adenomatous polyposis, lynch syndrome 
• Diseases like pernicious anaemia and gastritis 
• Weak immune system 
• Occupational exposure to asbestos, coal, rubber etc.

Types

There are many types of gastric cancers depending upon the type of cell showing the malignancy like:

• Adenocarcinoma: This is the most common type of stomach cancer accounting for more than 95% of the total cases. The malignancy develops in the mucus-secreting cells in the lining of the stomach.
• Gastrointestinal Stromal tumours (GIST): This is a relatively rare type of cancer where the malignancy occurs in the interstitial cells of Cajal within the stomach.
• Neuroendocrine tumours (NETs): Also called carcinoid tumours, it is the malignancy of special cells, the neuroendocrine cells.
• Lymphomas are the cancerous growth of immune cells present in the stomach lining called lymphocytes.
• Other types: Other rare types of cancer include small cell cancer, squamous cell cancer, etc.
• Secondary cancers can also be observed from the metastasised cells of other cancers like breast, lung cancer, etc.

Stages

The staging is on the basis of TNM stages: 

T (Tumour stages) – There are a total of 5 stages depending on the size and extent of spread of the tumour:

• T0- No tumour or cancer in-situ where the malignant cells are present only in the topmost layer of cells. 
• T1- Along with the inner lining of the stomach the tumour has spread to the underlying layers and submucosa and may have involved a few lymph nodes.
• T2- Tumour has extended to the muscular layer of the stomach and may and may not have spread to lymph nodes 
• T3- Cancer cells have infiltrated all the layers of the stomach except the outer layer of serosa with the involvement of lymph nodes.
• T4- The cancer cells have involved all four layers and may have metastasised to distant organs like the brain, kidneys, etc.

N (Lymph node involvement):

• N0- No lymph node involvement 
• N1- only one- two lymph nodes involved 
• N2- 3-6 regional lymph nodes affected 
• N3- more than 7 lymph nodes are affected 

M (Metastasis): 

• M0- No metastasis present 
• M1- Metastasis to a distant organ is present 

Diagnosis

The signs and symptoms of gastric cancer can be often confused with gastro-oesophageal reflux disease or indigestion and can remain ignored till a very late stage of cancer which worsens the prognosis for the person.

Thus, early diagnosis and proper treatment are of utmost importance.

• Gastroscopy: In this, a small tube-like structure fitted with a camera at the end is passed through the mouth into the stomach of the person. The entire lining is visualised for any abnormal growth.

A small tissue sample is collected if any abnormality is present and sent for biopsy. It is usually done under general anaesthesia.

• Barium swallow test: The patient is asked to consume a liquid with barium which passes through the entire digestive tract. On X-ray, the path traversed by barium illuminates and any abnormal obstruction or growth can be found.
• Biopsy: Sample cells from the tumour taken during the endoscopic examination are observed under the microscope. This confirms malignancy if cancerous cells are found. 

This also helps us in typing and grading stomach cancer.

• CT scan and MRI: They help us visualise the tumour and the extent of stomach tissue involved.
• PET CT Scan- It helps us to locate the area of metastasis if present. 

Treatment

The exact treatment protocol varies with respect to the type of cancer, age and health of the patient, and extent of tumour of spread. The following treatments are usually opted for:

• Surgery: Depending upon the amount of stomach affected with cancer, the surgery can remove part of the stomach (partial gastrectomy) or completely remove the stomach. This procedure is called gastrectomy. 
• Chemotherapy: Strong anti-cancer medications are given in the bloodstream to kill the cancer cells.
• Radiotherapy: The high energy of these waves kills the fast-dividing cancer cells and spares the normal cells in the body.
• Targeted therapy

Prevention

The general preventative measures will include a healthy lifestyle with regular checkups:

• Maintain a healthy weight 
• Consumption of fresh fruits and vegetables 
• Avoiding smoking and alcohol 
• Reduce the amount of smoked and salty food intake 
• Regular screening and endoscopic examination in case of family history or genetic predispositions

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