Stomach Cancer

Stomach cancer is the 7th most frequent cancer in males and 9th most frequent cancer in females in Singapore according to Singapore’s cancer registry of 2015.

What is stomach cancer?

Stomach cancer is the cancer of the cells of the inner lining of the stomach. The medically scientific term is called gastric adenocarcinoma. It is quite an aggressive cancer. This is further worsened by the fact that stomach cancer often does not have any symptoms in the early stages. By the time the patient feels unwell, the cancer is usually quite advanced.

What are the risk factors of developing stomach cancer?

Infection with bacteria called Helicobactor pylori

Smoking

Family history of stomach cancer

Chronic inflammation of the stomach

Salty and smoked food

Lack of intake of fruits and vegetables

Lack of intake of Vitamin C

Pernicious Anaemia – this is an auto-immune disease where the body develops antibodies which attack parts of the stomach.

What are the symptoms?

Gastric cancer may not present with any symptoms in the early stages. Most patients experience non-specific symptoms such as indigestion, acid reflux or heartburn lasting more than 2 weeks, loss of appetite or weight and difficulty in swallowing. Other symptoms include:

 

Feeling bloated or full after eating small amounts of food

Persistent stomach pain

Persistent vomiting

Weakness or feeling easily tired

Anaemia (a drop in your haemoglobin level)

Passing of black-colored stools

Vomiting of blood

What will the doctor do to diagnose the cancer?

The ideal test is to perform a gastroscopy (a type of endoscopy). This allows the doctor to visualize the cancer, accurately locate the part of the stomach where the cancer is, and obtain tissue biopsy to confirm the diagnosis.

 

Following the diagnosis of the cancer, the doctor may organize scans like CT scan to check if the cancer has spread. If the tumour is large, the doctor may sometimes recommend a diagnostic laparoscopy, a minor surgery where he inserts a telescope-like instrument (called a laparoscope) into your abdomen to visualize the tumour, and to determine if a course of chemotherapy is needed before the surgery to shrink the tumour.

What is the treatment of stomach cancer?

Treatment depends on the location and stage of the disease as well as the patient’s general condition. Surgical treatment ranges from endoscopic resection, laparoscopic radical resection to open radical resection (subtotal or total gastrectomy). Chemotherapy and radiotherapy may be necessary as additional treatment.

 

Gastrectomy is an operation to remove part (partial gastrectomy) or all (total gastrectomy) of the stomach. The decision on which operation to perform depends on the location of the cancer and the size of the tumour also. This surgery can be performed by the traditional open technique or the laparoscopic or keyhole technique.

Open Gastrectomy
  • A vertical incision is made in the upper abdomen.
  • In a distal partial gastrectomy, the lower portion of the stomach is removed and the upper portion of the stomach is joined to the small intestine.

 

In a total gastrectomy, the entire stomach is removed and the oesophagus is attached to the small intestine. The surrounding lymph nodes are removed as well in cancer surgery.

 

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Laparoscopic Gastrectomy

In selected cases, the operation can be performed with small “keyhole” incisions in the abdomen. The advantages of a laparoscopic approach are:

 

  • less postoperative pain
  • early recovery of bowel function
  • early hospital discharge
  • early return to work
  • better cosmetic results
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Both the laparoscopic operation and the open operation are performed under General Anaesthesia. A thin tube may be inserted through the nose into the stomach during the operation. This nasogastric tube will usually be kept in place for a few days after the operation. The patient will also have a urinary catheter.

 

Initially, the patient will not be allowed to eat or drink. When bowel sounds return, the diet will gradually be advanced from liquids to soft foods.

How to prevent stomach cancer?

  • If you are found to have the bacteria Helicobactor pylori in your stomach, it is advisable to take the appropriate antibiotics to get rid of the bacteria
  • If you complain of frequent gastric pain, see a doctor rather than keep on self-medicating with gastric pills
  • If you have a history of stomach polyps, or family history of stomach cancer, consider going for a gastroscopy

 

A healthy lifestyle also helps to reduce the risk of getting stomach cancer:

 

  • Stop smoking
  • Exercise regularly
  • Eat a well-balanced diet, rich in vegetables and fresh fruits
  • Avoid eating too much salty and smoked food

Are there any other types of stomach tumours?

The answer is yes. Some of these tumours are:

 

  • Lymphoma. This is a cancer of the lymphatic cells located in the stomach
  • Gastrointestinal Stromal Tumour, or GIST for short. This is a cancer arising from the special cell located in the wall of the stomach

 

Both of the tumours listed above are less aggressive than stomach cancer.

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