Stomach cancer

Stomach cancer

Stomach cancer is a common cancer in Australia, however the number of people diagnosed has been falling. It is rare in people under 50 years of age and affects more men than women.

Incidence and mortality

In 2011, 2093 new cases of stomach cancer were diagnosed in Australia. Stomach cancer affects nearly twice as many men as women. The risk of being diagnosed with stomach cancer by age 85 is 1 in 60 for men compared to 1 in 138 for women.

In 2012, there were 1143 deaths due to stomach cancer in Australia.

Screening

There is no routine screening test for stomach cancer.

Symptoms and diagnosis

In the early stages, stomach cancers often do not cause any symptoms.

Signs of early stomach cancer include:

a painful or burning sensation in the abdomen

heartburn or indigestion (dyspepsia).

Other symptoms that can occur later include:

a sense of fullness, even after a small meal

nausea and/or vomiting

loss of appetite and/or weight loss

swelling of the abdomen

unexplained tiredness or weakness

blood in vomit

black-coloured faeces.

The most common tests to diagnose stomach cancer are an endoscopy or gastroscopy (possibly with biopsy). Other tests, used less often, are barium swallow/upper gastrointestinal x-ray or endoscopic ultrasound.

Staging

After stomach cancer is diagnosed, one or more of the following tests are used to determine the extent of the cancer (its stage):

CT scan

ultrasound scan

PET scan

laparoscopy

bone scan.

The staging system used for stomach cancer is the TNM system , which describes the stage of the cancer from stage I to stage IV.

Causes

The causes of stomach cancer are not known, but factors that put some people at higher risk are:

smoking

age over 50

being male - stomach cancers are more common in men than in women

infection with the bacteria Helicobacter pylori

a diet high in smoked, pickled and salted foods and low in fresh fruit and vegetables

a family history of stomach cancer

partial gastrectomy for ulcer disease (after about 20 years)

inheriting a genetic change that causes the bowel disorders familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer.

Prevention

Not smoking or quitting smoking. A diet that is high in fresh vegetables and fruit, and low in smoked, pickled and salted foods, may be protective. Treatment of Helicobacter pylori infection may also be protective.

Treatment

The main treatment for stomach cancer is surgery – a total or partial gastrectomy (removing all or part of the stomach). Chemotherapy may be given before and/or after surgery, usually:

1. Three cycles of pre-operative chemotherapy (epirubicin/cisplatin/fluorouracil) and three cycles of post-operative chemotherapy (the MAGIC  protocol).

or

2. Post-operative chemotherapy with fluorouracil, folinic acid and radiation (Intergroup protocol).