National Cancer Institute


Posted Date: Aug 19, 2002

TABLE OF CONTENTS


Description

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What is cancer of the stomach?

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Cancer of the stomach, also called gastric cancer, is a disease in which cancer(malignant) cells are found in the tissues of the stomach. The stomach is aJ-shaped organ in the upper abdomen where the food is broken down (digested). Food reaches the stomach through a tube called the esophagus that connects themouth to the stomach. After leaving the stomach, partially digested foodpasses into the small intestine and then into the large intestine called thecolon.

Sometimes cancer can be in the stomach for a long time and can grow very largebefore it causes symptoms. In the early stages of cancer of the stomach, apatient may have:

  • Indigestion and stomach discomfort
  • A bloated feeling aftereating
  • Mild nausea
  • Loss of appetite
  • Heartburn

In more advanced stagesof cancer of the stomach, the patient may have:

  • Blood in the stool
  • Vomiting
  • Weight loss
  • Pain in the stomach

The chance of getting stomach cancer ishigher if the patient has had an infection of the stomach caused byHelicobacter pylori, or if the patient is older, is a man, smokes cigarettes,or frequently eats a diet that includes lots of dry, salted foods. Otherfactors that increase the chances of getting stomach cancer are a stomachdisorder called atrophic gastritis or Menetrier's disease, a disorder of theblood called pernicious anemia, or a hereditary condition of growths (calledpolyps) in the large intestine.

If there are symptoms, a doctor will usually order an upper gastrointestinalx-ray (also called an upper GI series). For this examination, the patientdrinks a liquid containing barium, which makes the stomach easier to see in thex-ray. This test is usually performed in a doctor's office or in a hospitalradiology department.

The doctor may also look inside the stomach with a thin, lighted tube called agastroscope. This is called a gastroscopy, and it finds most cancers of thestomach. For this test, the gastroscope is inserted through the mouth andguided into the stomach. The doctor may spray a local anesthetic (a drug thatcauses loss of feeling for a short period of time) into the throat or give thepatient other medicine before the test so that no pain is felt.

If the doctor sees tissue that is not normal, he or she may cut out a smallpiece so it can be looked at under a microscope to see if there are any cancercells. This is called a biopsy. Biopsies are usually done during thegastroscopy.

The chance of recovery (prognosis) and choice of treatment depend on the stageof the cancer (whether it is just in the stomach or if it has spread to otherplaces) and the patient's general state of health.


Stage Explanation

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Stages of cancer of the stomach

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Once cancer of the stomach is found, more tests will be done to find out ifcancer cells have spread to other parts of the body. This is called staging. The doctor needs to know the stage of the disease to plan treatment. Thefollowing stages are used for cancer of the stomach:


Stage 0

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Stage 0 cancer of the stomach is very early cancer. Cancer is found only inthe innermost layer of the stomach wall.


Stage I

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Cancer is in the second or third layers of the stomach wall and has not spreadto lymph nodes near the cancer or is in the second layer of the stomach walland has spread to lymph nodes very close to the tumor. (Lymph nodes are smallbean-shaped structures that are found throughout the body. They produce andstore infection-fighting cells.)


Stage II

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Any of the following may be true:

  1. Cancer is in the second layer of the stomach wall and has spread to lymph nodes further away from the tumor.
  2. Cancer is only in the muscle layer (the third layer) of the stomach andhas spread to lymph nodes very close to the tumor.
  3. Cancer is in all four layers of the stomach wall but has not spread tolymph nodes or other organs.


Stage III

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Any of the following may be true:

  1. Cancer is in the third layer of the stomach wall and has spread to lymphnodes further away from the tumor.
  2. Cancer is in all four layers of the stomach wall and has spread to lymphnodes either very close to the tumor or further away from the tumor.
  3. Cancer is in all four layers of the stomach wall and has spread to nearbytissues. The cancer may or may not have spread to lymph nodes very closeto the tumor.


Stage IV

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Cancer has spread to nearby tissues and to lymph nodes further away from thetumor or has spread to other parts of the body.


Recurrent

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Recurrent disease means that the cancer has come back (recurred) after it hasbeen treated. It may come back in the stomach or in another part of the bodysuch as the liver or lymph nodes.


Treatment Option Overview

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How cancer of the stomach is treated

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There are treatments for most patients with cancer of the stomach. Two kindsof treatment are used:

  • Surgery (taking out the cancer in an operation)
  • Chemotherapy (using drugs to kill cancer cells)

Radiation therapy and biological therapy are being tested in clinical trials.

Surgery is a common treatment of all stages of cancer of the stomach. Thedoctor may remove the cancer using one of the following operations:

  1. Subtotal gastrectomy removes the part of the stomach that contains cancerand parts of other tissues and organs near the tumor. Nearby lymph nodesare also removed (lymph node dissection). The spleen (an organ in the upperabdomen that filters the blood and removes old blood cells) may be removedif necessary.
  2. Total gastrectomy removes the entire stomach and parts of the esophagus, thesmall intestine, and other tissue near the tumor. The spleen is removed insome cases. Nearby lymph nodes are also removed (lymph node dissection).The esophagus is connected to the small intestine so a patient can continueto eat and swallow.

If only part of the stomach is removed, a patient should still be able to eatfairly normally. Frequent, small meals may need to be eaten, as well as foodslow in sugar and high in fat and protein, if the entire stomach is removed. Most patients can adjust to this new way of eating.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken bypill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters thebloodstream, travels through the body, and can kill cancer cells outside thestomach.

Treatment given after surgery when no cancer cells can be seen is calledadjuvant therapy. Adjuvant therapy for cancer of the stomach is being testedin clinical trials.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrinktumors. Radiation may come from a machine outside the body (external radiationtherapy) or from putting materials that produce radiation (radioisotopes)through thin plastic tubes in the area where the cancer cells are found(internal radiation therapy).

Biological therapy tries to get the body to fight cancer. It uses materialsmade by the body or made in a laboratory to boost, direct, or restore thebody's natural defenses against disease. Biological therapy is sometimescalled biological response modifier (BRM) therapy or immunotherapy.


Treatment by stage

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Treatment of cancer of the stomach depends on the stage of the disease, thepart of the stomach where the cancer is, and the patient's general health.

Standard treatment may be considered because of its effectiveness in patientsin past studies, or participation in a clinical trial may be considered. Manypatients with cancer of the stomach are not cured with standard therapy andsome standard treatments may have more side effects than are desired. Forthese reasons, clinical trials are designed to find better ways to treat cancerpatients and are based on the most up-to-date information. Clinical trials areongoing in most parts of the country for most stages of cancer of the stomach. To learn more about clinical trials, call the Cancer Information Service at1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


Stage 0 Gastric Cancer

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Treatment may be one of the following:

  1. Surgery to remove part of the stomach (subtotal gastrectomy) with removalof associated lymph nodes (lymphadenectomy).
  2. Surgery to remove the entire stomach and some of the tissue around it(total gastrectomy) with removal of associated lymph nodes (lymphadenectomy).


Stage I Gastric Cancer

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Treatment may be one of the following:

  1. Surgery to remove part of the stomach (subtotal gastrectomy) with removalof associated lymph nodes (lymphadenectomy).
  2. Surgery to remove the entire stomach and some of the tissue around it(total gastrectomy) with removal of associated lymph nodes(lymphadenectomy).
  3. Surgery followed by chemotherapy plus radiation therapy.
  4. A clinical trial evaluating chemotherapy plus radiation therapy givenbefore surgery.


Stage II Gastric Cancer

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Treatment may be one of the following:

  1. Surgery to remove part of the stomach (subtotal gastrectomy) with removalof associated lymph nodes (lymphadenectomy).
  2. Surgery to remove the entire stomach and some of the tissue around it(total gastrectomy) with removal of associated lymph nodes(lymphadenectomy).
  3. Surgery followed by chemotherapy plus radiation therapy.
  4. A clinical trial evaluating chemotherapy plus radiation therapy givenbefore surgery.


Stage III Gastric Cancer

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Treatment may be one of the following:

  1. Surgery to remove the entire stomach and some of the tissue around it(total gastrectomy) with removal of associated lymph nodes (lymphadenectomy).
  2. Surgery followed by chemotherapy plus radiation therapy.
  3. A clinical trial evaluating chemotherapy plus radiation therapy givenbefore surgery.


Stage IV Gastric Cancer

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Treatment may be one of the following:

  1. Surgery to remove the entire stomach and some of the tissue around it(total gastrectomy) with removal of associated lymph nodes(lymphadenectomy) followed by chemotherapy plus radiation therapy.
  2. A clinical trial evaluating chemotherapy plus radiation therapy givenbefore surgery.
  3. Chemotherapy to relieve symptoms.
  4. Surgery to relieve symptoms, reduce bleeding, or remove a tumorthat is blocking the stomach.
  5. Radiation therapy to relieve symptoms, reduce bleeding, or shrink a tumorthat is blocking the stomach.
  6. Additional surgery to relieve symptoms, reduce bleeding, orremove a tumor that is blocking the stomach.


Recurrent Gastric Cancer

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Treatment may be one of the following:

  1. Chemotherapy to relieve symptoms.
  2. Surgery to relieve symptoms, reduce bleeding, or remove a tumor that is blocking the stomach.
  3. Radiation therapy to relieve symptoms, reduce bleeding, or shrink a tumorthat is blocking the stomach.


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ

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PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


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