Key Facts
Cancers that start in the lower part of the stomach affect people over 55 and are twice as common in men. However, overall these cancers are becoming less common - the incidence rate has reduced by 50% over the last 30 years.
Cancers that develop in the upper part of the stomach are becoming more common. They can affect people in their 40s and are more common in men.
Stomach cancer is more common in Eastern Europe as well as in a number of areas outside Europe, notably Japan.
The cancers of the upper and lower part of the stomach are almost all adenocarcinomas.
GastroIntestinal Stromal Tumour (GIST), or sarcoma of the stomach, is rare.
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Key Figures
| Total number of cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new stomach cancer cases (2006) |
159,900 |
|
(96,100 men) |
|
(63,800 women) |
|
81,600 (EEA) |
|
(50,600 men) |
|
(31,000 women) |
|
80,100 (EU25) |
|
(49,600 men) |
|
(30,500 women) |
| Number of stomach cancer deaths (2006) |
118,200 |
|
(70,400 men) |
|
(47,800 women) |
|
68,300 (EEA) |
|
(34,600 men) |
|
(23,700 women) |
|
47,400 (EU25) |
|
(34,000 men) |
|
(23,400 women) |
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Cancer Types
Most stomach cancers are adenocarcinomas.
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Causes of Stomach Cancer
There are many risk factors associated with stomach cancer.
An infection with Helicobacter pylori (H. pylori) is associated with cancers in the lower part of the stomach (however, many people with H. pylori infection do not develop stomach cancer).
Age is another important factor for developing stomach cancer. It can be seen that:
- cancer in the lower part of the stomach mostly affects people over 55
- cancers of the upper part of the stomach are becoming more frequent and may affect people in their 40s
Diet also plays a part in the development of stomach cancer:
- eating large amounts of smoked foods, salted fish and meat increases the risk
- by contrast, eating fresh fruits and vegetables containing antioxidant vitamins (such as A and C) lowers the risk.
In addition, smoking and obesity both increase the risk of developing stomach cancer.
Those with pernicious anaemia (due to a failure to absorb vitamin B12) have a slightly increased risk of developing stomach cancer.
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Prevention of Stomach Cancer
There are various ways of reducing the risk of developing stomach cancer. These include:
- Possible treatment of the H. pylori infection
- Stopping smoking
- Reducing obesity
- Maintaining a healthy diet
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Common Symptoms
Symptoms of stomach cancer tend to be general and vague often resulting in late presentation of the cancer by a patient. However, the notable symptoms of the condition are:
- Indigestion - particularly if a new symptom
- Heartburn -particularly if a new symptom
- Loss of appetite - especially if combined with feeling bloated after eating
- Persistent vomiting
- Blood in the stool or black stools (a sign of bleeding into the bowel)
- Weight loss
- Tiredness
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Diagnostic Tests
The main diagnostic test for stomach cancer is a gastroscopy – looking inside the stomach with a flexible telescope - which allows doctors to:
- see the lining of the stomach
- assess the size of any tumour that is present
- take a biopsy of suspicious areas.
In addition, a gastroscopic ultrasound may be used. The gastroscopic ultrasound scans the stomach and surrounding structures to see if the cancer has spread to other tissues.
A barium meal is a special X-ray test where radio-opaque material is swallowed to show up the lining of the stomach. It used to be used very frequently in the assessment of stomach cancer but has recently become less popular in favour of other diagnostic tests such as endoscopy.
Positron Emission Tomography (a PET scan) uses small amounts of radioactive material to detect cancer and other diseases in the body. Different radioactive materials are given as an injection or a drink. Once in the body the material concentrates in certain tissues giving off focal radiation which can be detected by the scanner to produce visual images. Experts can then use these images to help make a diagnosis.
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Treatment
Surgery
Surgery is the main form of treatment for stomach cancer. It involves:
- Either removing part of the stomach and the lymph nodes near the stomach – a partial gastrectomy and lymph node dissection.
- Or removing all of the stomach – a total gastrectomy and lymph node dissection.
Surgery can also be used to prevent bleeding from the tumour and blocking food from entering the rest of the digestive system.
Surgery (particularly the removal of the entire stomach) is major surgery and is therefore not suitable for all patients.
External Beam Radiation
Radiotherapy combined with chemotherapy (chemoradiation) can be used as the main treatment for stomach cancer. Drugs, such as 5 Fluorouracil, sensitise the cancer cells to the radiotherapy making it more effective.
Alternatively, this treatment can be used before or after surgery. Recent studies have shown that this form of combined treatment gives better results than surgery alone.
Chemotherapy
Chemotherapy may be given as the main treatment for stomach cancer that has spread to other areas of the body and may also be given together with radiotherapy as the main treatment for stomach cancer (see above).
Biological Therapies – Monoclonal Antibodies
Monoclonal antibodies are used in the treatment of many forms of cancer. They target specific proteins necessary to the progression of the cancer, causing few side effects. In some patients with stomach cancer, proteins in the cancer cells can be targeted by specific monoclonal antibodies slowing cancer cell growth.
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Key Trends
- The decreasing numbers of cancers of the lower part of the stomach (which tend to affect people over 55).
- The increasing numbers of cancers of the upper part of the stomach (which affect a younger group of patients).
- Multidisciplinary approach to the treatment of stomach cancer to secure the best quality of care.
- The development of treatments tailored to each patient based upon the predicted response of their tumour to available treatments.
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Important Research Areas
- Further investigation of techniques to diagnose stomach cancer.
- Evaluation of adjuvant and neo-chemotherapy and/or radiation following surgery for stomach cancer.
- The use of monoclonal antibodies in the treatment of stomach cancer.
- The identification of receptors in individual patients to ensure benefit from monoclonal antibodies and other forms of therapy.
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Unresolved Questions
- Functional imaging and PET scanning in diagnosis and response prediction of stomach cancer.
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