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What Is Stomach Neoplasm?
A neoplasm, or tumor, can be benign/non-cancerous, or it can be malignant/cancer. Since benign stomach tumors are mostly harmless polyps that often go unnoticed, the term stomach neoplasm usually refers to stomach cancer . Because stomach cancer usually goes undetected until an advanced stage, it tends to be a very serious condition which is difficult to treat and often fatal [2,3,5].
Symptoms include unintentional weight loss, nausea and vomiting, a loss of appetite, feeling full or bloated, belly pain, and trouble swallowing.
Treatments include surgery, chemotherapy, and radiation, or a combination of the three. Palliative care may also be helpful in some cases.
You schedule a visit with your primary care physician (PCP). It is likely imaging will be performed as well as blood tests to inform next steps.
Stomach Neoplasm Symptoms
Stomach cancer rarely causes symptoms in the early stages [3-5]. Sometimes, the first symptoms are remote, like bone pain, that result from cancer spreading to other parts of the body. When symptoms of the original (primary) tumor do appear, they often include the following [2,4,5].
- Unintentional weight loss: While many cancers can cause weight loss due to the increased demands of the growing tumor, weight loss is particularly common in stomach cancer. This is because people with stomach cancer tend to avoid food for a variety of reasons (described below).
- Nausea and vomiting
- Loss of appetite
- Feeling full or bloated: This can result from the direct influence of the original tumor, or from spread to other organs.
- Belly pain: This is typically in the upper abdomen, initially vague and mild but occasionally severe as the disease progresses.
- Trouble swallowing: While not seen in every case of stomach cancer, this is often reported by people whose cancer arises in the upper stomach where food enters from the esophagus.
Stomach Neoplasm Causes
Like all forms of neoplasm, stomach cancer results from uncontrolled growth of specific groups of cells. Normally an elaborate system of molecular checkpoints and protections prevents any cell line from growing too fast or too much. Tumors occur when certain cells find a way to bypass those safety mechanisms, usually as a result of random mutation. Cancer, or malignancy, occurs when those rogue cell lines have the ability to spread and invade other tissues.
Like most cancers, stomach cancer results from a diverse and complicated series of mutations. We rarely know what causes a specific mutation, but most cancers are associated with certain risk factors which make those mutations more likely. Often these risk factors are things that damage the stomach lining such as smoking or excessive alcohol consumption. Tissue damage kills off healthy cells which then need to be replaced by new cells. This replication process is the most common time for mutations and other genetic mistakes to occur, making tissue damage and cell turnover a common feature predisposing to many cancers.
Specific risk factors
In the case of stomach cancer, predisposing damage includes stomach inflammation (known as gastritis) and stomach ulcers, which are seen in around one in four people with stomach cancer. Other specific risk factors for the development of stomach cancer include the following [2-5].
- Older age: Most cases of stomach cancer occur in people over 65 years old.
- Male sex: For unclear reasons, men are at higher risk of stomach cancer.
- Smoking cigarettes
- Diet of heavily processed foods: In particular, foods that are salted, pickled or smoked have been associated with an increased risk of stomach cancer while intake of fruits and vegetables may be protective.
- Infection with H. pylori: This bacteria is responsible for many cases of gastritis, ulcers and several kinds of stomach cancer.
- History of major stomach surgery
- Rare stomach disorders: Obscure diseases such as pernicious anemia, chronic atrophic gastritis and hypertrophic gastropathy (Menetrier's disease) can damage the stomach and increase the risk of cancer.
- Rare genetic syndromes: Risk of stomach cancer is increased by a variety of inherited genetic syndromes such as Li-Fraumeni syndrome, Peutz-Jeghers syndrome and familial adenomatous polyposis. These syndromes are quite rare and often carry a family history of many cancers at young ages.
Stomach Neoplasm Symptom Checker
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Treatment Options and Prevention for Stomach Neoplasm
Treatment options for stomach cancer depend mainly on the stage of disease, which defines how advanced the cancer is and how far it has spread . Therefore the first step in management is usually extensive imaging and other workup such as endoscopies and biopsies. Once staging is complete, treatment can consist of surgery, chemotherapy and radiation, or most often some combination of the three. More recently, several "targeted therapies" have been used to block specific molecular pathways, usually for advanced cancer that hasn't responded to other treatments .
Surgery is the mainstay treatment for early gastric cancer. When the cancer is limited to the stomach itself or nearby tissues, surgery may offer a chance of removing all of the cancer and providing a complete cure. Unfortunately, very few cases of stomach cancer are caught early enough for a full cure to be realistic [3-4]. Nevertheless, surgery to remove all or part of the stomach (total or subtotal gastrectomy) may still play an important role in relieving symptoms or slowing spread.
Chemotherapy uses medications that kill cells or stop them from replicating and treats cancers that have spread, or metastasized, to many parts of the body. However, most chemotherapy often carry difficult side effects. Chemotherapy is often used in conjunction with surgery (known as adjuvant or neoadjuvant chemotherapy) or radiation therapy (collectively known as chemoradiation) .
Radiation uses high-energy beams or particles to kill cancer cells or interrupt their growth . Radiotherapy is particularly useful for targeting particularly symptomatic areas of cancer that are causing problems like pain or bleeding . Like chemotherapy, radiotherapy is often used in conjunction with other treatments and carries its own significant side effects.
Targeted therapy describes treatments which block specific molecular pathways. They carry fewer side effects than chemotherapy and radiation which tend to damage healthy cells and cancer cells alike. Targeted therapies only work for cancers that depend on the specific pathways they target. While several of these targeted treatments have recently started being used for stomach cancer, they are used mainly as part of clinical trials for advanced cancer that has failed other treatments [2,3].
Palliative care describes the treatment of severe illness like cancer that is focused on alleviating symptoms and reducing suffering rather than curing the disease itself. This can include surgeries, chemotherapy, radiation or many other forms of treatment. Because most cases of stomach cancer cannot be cured, palliative treatments become particularly important [3-5].
Prevention: Risk reduction
Given how difficult it is to treat most instances of stomach cancer, prevention becomes particularly important. While there is no sure way to prevent stomach cancer, certain things can be done to decrease the risk including the following [2-4].
- Treating stomach conditions such as H. pylori or stomach ulcers: The details of H. pylori infection are beyond the scope of this article, but suffice it to say these things can be stubborn and hard to eradicate. Those with a history of H. pylori infection or stomach ulcers from any cause should follow closely with their physician to make sure these conditions have been fully treated.
- Maintaining a healthy weight
- Consuming a healthy diet: In particular, avoiding heavily processed foods and consuming plenty of fruits and vegetables have both been associated with a decreased chance of developing stomach cancer.
- Not smoking
- Avoiding excess alcohol consumption
Screening is looking for a disease in people with no symptoms. Since there's no external evidence of early stomach cancer, screening usually involves performing endoscopies. This can allow for earlier detection of stomach cancer, but achieving that goal requires performing a somewhat invasive test on large numbers of people, most of whom will never have stomach cancer [3-5]. Non-invasive techniques have been attempted but their sensitivity is relatively low, meaning that many cancers get missed.
Stomach cancer screening varies by country. In places like Japan where stomach cancer is more common, screening with endoscopies is considered an overall beneficial public health endeavor . In the U.S. stomach cancer is relatively less common, leading to the conclusion that widespread screening with endoscopies would do more harm than good.
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When to Seek Further Consultation for Stomach Neoplasm
Unfortunately, the symptoms seen in stomach cancer are often vague and more likely to be caused by a less dangerous condition. However, early detection offers the best chance to successfully treat stomach cancer. Therefore, anyone concerned they may have symptoms of stomach cancer would be well advised to seek medical care sooner rather than later [4,5].
For those who have been diagnosed with stomach cancer, close follow-up with your medical providers is very important, particularly whenever there are significant changes in your symptoms. Given the severity of gastric cancer, it is usually helpful to have a palliative care team involved . Their involvement has been repeatedly shown to improve quality of life for people with cancer, and even prolong survival in some cases .
Questions Your Doctor May Ask to Determine Stomach Neoplasm
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you lost your appetite recently?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Any fever today or during the last week?
- Do you currently smoke?
- Where is your abdominal pain?
If you've answered yes to one or more of these questions
Stomach Neoplasm Symptom Checker
Take a quiz to find out if you have Stomach Neoplasm
- Non-cancerous tumours of the stomach. Canadian Cancer Society. Canadian Cancer Society Link
- Stomach cancer. U.S. National Library of Medicine: MedlinePlus. Updated August 23, 2018. MedlinePlus Link
- Stomach (gastric) cancer - patient version. National Cancer Institute. National Cancer Institute Link
- Stomach cancer. American Cancer Society. American Cancer Society Link
- Layke JC, Lopez PP. Gastric cancer: Diagnosis and treatment options. American Family Physician. 2004;69(5):1133-1141. AAFP Link
- Prescott AT, Hull JG, Dionne-Odom JN, et al. The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer. Health Psychology. 2017;36(12):1140-6. APA PsycNET Link
- Sitarz R, Skierucha M, Mielko J, Offerhaus GJA, Maciejewski R, Polkowski WP. Gastric cancer: Epidemiology, prevention, classification, and treatment. Cancer Manag Res. 2018;10:239-248. NCBI Link
- Stomach (gastric) cancer screening (PDQ) - patient version. National Cancer Institute. National Cancer Institute Link
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