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Gastric (stomach) cancer occurs when malignant cells form in the lining of the stomach. By far, it is known to be the second most common cause of cancer-related deaths not only in Asia but also worldwide. Though it can affect both male and female populace, it is seen more commonly in men and in people aged 50 years or older.
Type: Gastric cancers can present as one of the following types -
- Adenocarcinoma: Begins in the glandular cells lining the inside of the stomach. This forms a majority of the stomach cancers.
- Lymphoma: Begins in immune system cells present in the walls of the stomach. Occurrence of lymphoma, in the stomach, is rare.
- Carcinoid Tumor: Begins in hormone producing cells of the stomach. Occurrence of carcinoid cancer, in the stomach, is rare.
- Gastrointestinal Stromal Tumor (GIST): begins in nervous system cells of the stomach. Occurrence of GIST, in the stomach, is rare.
Gender: It affects both male and female populace.
Etiology: The factors that are associated with increased risk of gastric cancer include the following mostly –
- ‘Helicobacter Pylori’ bacterial infection in the stomach is a common cause of gastric cancer of both the intestinal (expanding) & diffuse (infiltrative) type. Furthermore, studies indicate that high salt intake is synergistic with H. Pylori infection in the manner that it is likely to increase the risk of gastric cancer that is induced by H. Pylori bacteria.
- Smoking, consuming alcohol, red meat, salty/ smoked/ processed foods, low intake of fruits and vegetables, diets rich in nitroso compounds, eating foods contaminated with aflatoxin fungus etc all.
- Atrophic gastritis characterized by chronic stomach inflammation is known to increase the risk multi-fold. Chronic gastric inflammation can lead to atrophy of the gastric mucosa, metaplasia, dysplasia and finally carcinoma.
- History of pernicious anaemia, gastric ulcers, adenomatous gastric polyp etc all.
- Family history of gastric cancer. Several familial syndromes that have been associated with a pre-disposition to gastric cancer include familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome and e-cadherin mutation (diffuse type)
- Blood group A, Obesity etc all are known to be associated with diffuse or cardia gastric cancer.
- Low socioeconomic status - persistent lifestyle issues/ irregularities including high stress coupled with an improper diet/ dietary pattern.
- Epidemiological evidence is indicative of a risk or pre-disposition to gastric/ stomach cancer for people suffering from diabetes mellitus (DM).
- Very high dose ionizing radiation exposure is an uncommon risk for gastric cancer.
Features: There are often no early stage symptoms. Early stage symptoms, if any, are non-specific and are likely to be ignored, thus delaying the diagnosis most often. Hence, gastric/ stomach cancer is often detected at an advanced stage where the disease is either locally advanced or metastatic. The various presentations (of signs & symptoms), by stage (early or advanced), of gastric cancer are as enumerated below:
Early Stage – can present with one or more of the following non-specific symptoms/ signs -
- Dyspepsia (Indigestion),
- Stomach/ Epigastric discomfort,
- Bloated feeling after eating,
- Mild Nausea/ Vomiting,
- Blood in Vomit (Haematemesis),
- weight loss (Cachexia)
- Occult blood in stool/ Melaena,
- Advanced Stage – presents with one or more of the following symptoms/ signs -
- GI Bleeding with black tarry stools (Melaena),
- Persistent Nausea/ Vomiting,
- Blood in Vomit (Haematemesis),
- Early Satiety,
- Loss of Appetite (Anorexia),
- Weight loss (Cachexia),
- Persistent pain in the abdomen,
- Fluid build-up in the peritoneal cavity (Ascites),
- Edema of the lower extremities,
- Liver Enlargement (Hepatomegaly)/ Jaundice,
- Difficulty swallowing food (Dysphagia)
- Screening: Is generally recommended for asymptomatic populations in high incidence areas or as surveillance for high risk individuals. The goal of screening, as usual, is to be able to detect & diagnose gastric cancer at an early stage which is potentially curable. It is mostly endoscopic/ radiologic.
Diagnosis: Following are the diagnostics employed in gastic cancer -
- Physical Examination: May be remarkable for palpable abdominal mass, weight loss (cachexia), abdominal distension, ascites, hepatomegaly, lower extremities edema and lymphadenopathy for gastric cancers in the advanced stage. For early gastric cancers, however, physical examination is largely uninformative.
- Blood: Hb- may be low, ESR – raised, tumor markers CEA & CA-19-9 could be raised sometimes in adenocarcinoma but are not frequently elevated. Abnormal blood test results may be indicative of malignancy, but a follow-up gastroscopy/ biopsy is always the gold standard for accurate diagnosis.
- Stool: Occult blood may be +ve
- Barium Meal X-Ray: Could show a filling defect at the site of the carcinoma/ cancer growth.
- Gastroscopy/ Biopsy: Clinches the diagnosis.
- Endoscopic Ultrasound: Maximizes tumor staging as it helps determine the depth of invasion of the tumor.
- CT Scan: Of chest, abdomen & pelvis helps detect metastatic disease, if any, and also helps stage the disease (TNM) appropriately.
- Bone Scan: Helps detect osseous metastasis (bone mets), if any.
- Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Surgery (i.e. gastrectomy either sub-total or total), with an adjuvant chemotherapy and/ or radiotherapy as contextually relevant, is the only treatment that is known to cure the disease in light of the prognostic indicators as briefly enumerated in the section below. Chemptherapy and/ or radiation alone cannot be curative. Mostly, it can improve symptoms, and may prolong survival. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as feasible contextually.
Prognosis: For gastric cancer is variable. Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage gastric cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Distal tumors are known to be cured more often than the proximal ones. Again, intestinal-type gastric cancers are known to have a better treatment outlook in comparison to the diffuse-type gastric cancers.
Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an adherence to a relative Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising, de-stressing and relaxation is highly recommended for reducing the risks of many cancers including gastric cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. The consumption of alcohol, if any, has to be strictly in moderation, and is best avoided in a high risk scenario. Smoking is to be avoided too. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly. Not only it is important to eat healthy, but also it is equally important to eat properly. Insufficient chewing, eating until full, eating meals within a short time etc all are best avoided so as to ease off digestive burden on the stomach/ other organs in the GI tract. Last but not the least, consumption of clean and filtered water, natural probiotics like freshly prepared yogurt/ butter milk, maintenance of cleanliness & hygiene including oral hygiene etc. all can help guard against H. Pylori infections. Breastfeeding is known to be protective against H. Pylori infections too.
Evey day around evening I use to have lots of gas passed compare to normal day and every day early morning I fell bit in comfortable because of gas . Through out day other time it's OK . I was but was bit worried. Is there any stomach urcel happen? How frequently we can go for upper endoscopy? I did it 6 month back.
I recently had fever accompanied with cold. Since then I have been getting regular head aches in the afternoon or evening and my fore head becomes war. It has been about a week and a half since this is happening. I am 21 years old and my weight is 45, I am not anemic. Please tell me if this is a serious problem and what can I do about it.
My wife and I used to be unable to have intercourse for almost 3 years. Whenever we tried, she would feel pain and her muscles would contract, preventing me from penetration. However, since the last two months, we tried with lox 2% gel and her pain reduced. Subsequently, we are able to have intercourse without any lubricant now, although it takes a really long time for her to open up completely. The problem now is that, she does not feel any pleasure whatsoever, even when I am completely inside of her. What could possibly be the problem here?
What is the good time for sex if she has menustration just over by one day then is it safe to have a sex with partner?
Since last 5 weeks I am having my left leg plastered for metatarsal fracture. I am using my right leg for walking. Now my left leg becomes very thin. I have to continue with my plaster for 4 more weeks. What care shall I have to take to prevent thinning of my leg?
I am stuff for URIC ACID. Last 3 years, Uric Acid label is 7.0. How can I control it. Sajest some medicine.
I have habit of masturbation from last 10 years due to that I have suffering lot of health problem like continues headache, muscle weakness, joint pain, hair fall .now I have stop that habit. But how can I restore my health problem. Any device.
My relatives son is suffering from severe diarrhoea for 3 days and they tried many medicines. But the disease is not getting curr. What should they do now ?
From last Friday (13.5. 16) after having lunch I have sensation of something stuck inside my lower throat, I've consulted ENT he checked and found nothing said OK but he said sometime if there inside throat small scratch would cause such type of stuck sensation so he gave me antibiotics for 5 days course I've consumed two days but no improvement please advise.
I could not able to sleep for long periods of time because of this I am getting severe headache. Please reply to my question.
My stomach is giving pain to me. My continent colour is dark chocolaty. I'm not feeling well. Please help.
Hello, I have gone through a hernia operation. What if I have still got some pain in the same region where the operation had done? Should I be concerned or should I have to consult the doctor again?
A healthy set of teeth is essential for good living. However, teeth problems are widespread and you are susceptible to it at any age, at any time. Though there are medications available for tooth problems, sometimes extraction of the tooth remains the only plausible solution.
You may have to undergo tooth extraction for multiple reasons. Some of them are:
- Unaligned teeth: In case you are suffering from unaligned teeth, chances are that you may suffer from what in technical terms is known as "crowded mouth." In such a situation you have difficulty in eating as there is not enough room for the teeth in the mouth. Extraction of tooth, in this case, is the only way to rectify it and align the teeth in a better fashion.
- Infection: Sometimes if you suffer from a tooth infection, it tends to quickly spread to the pulp, affecting and damaging the blood vessels and different nerves. Though medications are available, if the intensity of the infection increases, extraction of tooth remains the only option.
Procedure: There are different steps that are involved in the extraction of teeth. They are:
- Local anesthesia: Like all other surgeries, administering a local anesthesia is the first step. If you are undergoing a tooth extraction, the dentist or the surgeon will inject anesthesia that will create numbness and soothe you of the ensuing pain.
- Cutting away gum and bone tissues: After the anesthesia, the dentist will proceed to extract the infected tooth. In order to do this, the doctor cuts away the gum and the tissues covering the tooth. After the root of the infected tooth has been exposed, the dentist would then with the help of forceps, sever it from the jaw.
After the surgery, you must observe certain precautions to expedite the recovery process. Some of them are:
- Take painkillers: After the tooth extraction, the possibility of suffering from an ensuing pain is incredibly high. Therefore, in most cases the dentist prescribes certain painkillers and you must take them regularly.
- Change the dressing: The operated area will be covered with bandages to preclude any infection. However, the dressing must be changed from time to time. If the same dressing remains for a long time, chances of an infection increase.
- Complete rest: After the extraction, you must take complete rest and not engage in any form of physical activity.
- Avoid certain foods: Just after the surgery, the operated area remains tender. Therefore, you must eat food that requires less effort to chew like soup, pudding, ice cream etc. You must also abstain from smoking and drinking for some time.