Gastric cancer (or stomach cancer) is the ninth most common cancer in Malaysia, affecting 3.5% of all cancer incidences in 2007(National Cancer Registry 2007). Fairly uncommon compared to breast or lung cancer, gastric cancer still poses a significant health problem as it contributed to 0.68% of total deaths in our country in 2014 (WHO 2014).
The stomach is located in the upper abdomen and is part of the digestive system. Food is channelled through the oesophagus to the stomach where it gets partially digested before reaching the intestine. Cancer develops in cells of the stomach wall and subsequently invade through the wall, onto the adjacent organs, such as the liver, pancreas or the oesophagus. Some malignant cells may enter blood or lymphatic vessels to spread (metastasis) to lymph nodes or distant organs such as the bones or lungs.
There is no single cause for stomach cancer but there are certain risk factors that may increase the chance of getting it:
Older age, over the age of 55
Male sex is twice
High consumption of salted, cured or smoked food rich in nitrate and carbohydrate contents, contaminated food from poor preservation and storage process
Lower intake of vegetables and fruits
Infection with the H.pylori bacteria
Chronic gastro-oesophageal reflux disease ( GORD)
Certain inherited cancer syndromes and a family history of cancer
Environmental or industrial exposure to chemical, pollution or radiation
Early stomach cancer may produce no symptoms while symptoms of stomach cancer maybe confused with symptoms of some benign conditions;
Upper abdominal discomfort especially after eating
Feeling full or bloated
Unrelenting Nausea and/or persistent Vomiting
Passing blackened faeces
Loss of appetite
Following a complete physical examination and initial blood tests, an endoscopic procedure will be performed to diagnose stomach cancer whereby a thin tube containing a camera is passed into the stomach to view its inner aspect and biopsy is taken from any suspicious areas for confirmation of cancer in the laboratory. CT scan of the chest abdomen pelvis or a PET scan will then be arranged to stage the cancer and decide on the appropriate treatment.
When diagnosed at an early stage, there is high chance for cure but the majority of cases are at advanced stage at diagnosis thus affecting the outcome greatly. Its treatment depends on the tumour location, type and stage as well as the general health and personal wish of the patient. Treatment is often multidisciplinary involving a team of specialists namely surgeon, oncologists, pathologist, radiologist and other specialized health staff such as dietitian, psychologist and specialized nurses who discuss the best treatment and care for each individual patient. Early stage 1-3 may be treated with surgery or the combination of surgery, radiotherapy and chemotherapy with reasonable chance of cure. Advanced stage 4 cancers may be treated with chemotherapy, targeted therapy and/or some palliative procedures such as stenting or radiotherapy to alleviate cancer related symptoms and improve on patients’ quality of life.