Stomach cancer starts in the inside lining of your stomach. It can grow into deeper layers or spread to nearby organs. Your doctor will decide what kind of treatment you need based on your stage of cancer and other factors.
Talk to your health care provider if you have symptoms of stomach cancer. You may be referred to a specialist, such as a gastroenterologist or a cancer doctor, for more tests.
The stomach is a muscular organ in the centre of your body that forms part of the digestive system. Food passes from the throat into the stomach where it is mixed with acid that helps to break down and digest food. Stomach cancer develops when cells in the lining of the stomach change and grow out of control. In its early stages, stomach cancer often has no symptoms so it is hard to diagnose. If you have persistent, unexplained symptoms, see your doctor.
It is not known what causes stomach cancer, but certain things increase your risk. These include infection with the bacteria H. pylori that can cause ulcers, long-lasting acid reflux, and a diet that is high in salty, pickled or smoked foods. A history of stomach polyps, stomach inflammation (gastritis) and taking certain medicines like aspirin or NSAIDs can also raise your risk. Smoking doubles your risk for stomach cancer.
Men are 2 times more likely to get stomach cancer than women and it is most common in people over 60. However, it can affect people of all ages.
Symptoms of stomach cancer can vary and include a feeling of fullness, weight loss, stomach pain, tiredness, breathlessness, coughing up blood or vomiting. If you have any of these symptoms, speak to your GP who can advise you on further tests and refer you to a specialist if necessary.
A diagnosis of stomach cancer can be shocking, upsetting and confusing. It is important to ask for as much information as you need and to discuss your treatment options with your doctors and family.
A test to check for stomach cancer may include an endoscopy where a thin tube with a camera at the end is passed down your throat and oesophagus, into your stomach and small bowel and then into your intestines. Another test is a computerised tomography (CT) scan which uses x-rays to take pictures of your insides. Your doctor may also want to do a Positron emission tomography – CT (PET-CT) scan which combines a CT scan with a type of nuclear medicine called a PET scan and this can help show if the tumour has spread.
Your doctor can diagnose stomach cancer by taking a tissue sample (biopsy) from the tumor or from the area where the cancer is most likely to be. The tissue is then tested in a laboratory to see if the cells are cancerous. Blood tests can also help your doctor look for certain changes in your cells that may be caused by cancer.
Your care team will also use imaging tests to check if the cancer has spread to nearby lymph nodes or other parts of your body. These include a CT scan and an MRI. These tests take pictures of your body from different angles and can show how the stomach cancer has spread. They can also help your doctors find out if the cancer has spread to other areas of your body, such as your lungs or liver.
Stomach cancer is most often caused by a change (mutation) in the DNA of your stomach cells. These mutations can make cells grow and divide faster than normal, causing a tumor to form. Other things that can cause mutations in the stomach cells are infection with a bacteria called Helicobacter pylori, and a diet that includes fatty, salty, or smoked foods.
Doctors don’t routinely screen people for stomach cancer. This is because the chance of getting it is very low for most people. If you have a risk factor for the disease, your doctor may recommend that you get more frequent screening.
If the cancer is stage 0 or 1, the surgery usually cures it. Your doctor will remove part or all of your stomach and the lymph nodes that surround it. You may also get chemo or a combination of chemo and radiation. If the cancer is in stage 2, 3, or 4, it’s harder to cure. But you can try to slow the growth of the cancer and ease your symptoms with treatment. Treatment options may include surgery, chemo, radiation, or a combination of these treatments. Your doctor can explain the treatment options and answer any questions you might have. The type of treatment you get depends on the stage of your stomach cancer, where it is in your body, and other factors, like your age and overall health.
Your doctor will order several tests to diagnose stomach cancer and find out how far it has spread. These include:
A specialized scan called a computed tomography (CT) scan that uses x-rays and a computer to make detailed pictures of your stomach and the lymph nodes near it. A procedure to check blood levels of certain chemicals that can help find out if cancer cells have spread. A procedure to remove a small piece of your stomach for testing. A flexible tube (endoscope) with an ultrasound probe on the end is inserted into your mouth, throat and oesophagus then down into your stomach and small bowel.
Stomach cancer may be in a stage that isn’t cancer or in the last stages of stomach cancer, when it has spread to other parts of your body. Your health care team will recommend treatment based on the type and stage of your cancer.
Surgery is the main treatment for stomach cancer, but you might also get chemo or radiation. These treatments kill cancer cells and lower your chance of the cancer coming back. They might be given before or after surgery to shrink large tumors or to reduce your chances of the cancer spreading. If your cancer is in the early stages, your health care team might recommend a special type of chemotherapy that goes directly into your belly. This is called hyperthermic intraperitoneal chemotherapy (HIPEC).
Other types of cancer that can start in the stomach include:
A rare blood cancer that starts in the immune system cells. This kind of cancer is usually found in older people. A kind of sarcoma that grows in the stomach’s connective tissue. It can be found in younger people. A neuroendocrine cancer, which starts in the lining of the gastrointestinal tract or in the endocrine system.
You can lower your risk of stomach cancer by not smoking, keeping a healthy weight, eating a balanced diet and avoiding smoked, pickled, preserved and salted foods. You can also try to avoid infections like the H. pylori infection that can cause ulcers and increase your risk of stomach cancer. Your provider might also recommend regular screening procedures, such as an upper endoscopy, if you have a condition that increases your risk for this cancer.
After your active treatment is completed, you will need to visit the doctor regularly for follow-up care. This is to ensure that the cancer has not recurred, and also to manage any side effects. Your care team may also recommend a diet and other lifestyle changes to help prevent the cancer from returning.
While there is no universal consensus on the utility, frequency and regimen of surveillance after curative gastrectomy for gastric cancer, most international societies and authors endorse its adoption.[1] The main reason for surveillance is to detect recurrence early and thus facilitate prompt diagnosis and treatment and to improve survival.
However, many patients with recurrence have no symptoms and are not detected with the available imaging techniques.[2] In addition, the ability of surveillance to increase survival has not been demonstrated.
Consequently, the decision to conduct surveillance should be based on individual patient risk assessment by means of tumor marker assays and imaging. A recent study by Marrelli et al[3] has demonstrated that a simple score can be used to identify the patients at high risk of recurrence after gastrectomy, allowing for tailoring of follow-up.
In this study, 1304 patients with stage III or IV resected stomach cancer were analyzed for recurrence patterns and timing in comparison to the site of first recurrence. Recurrence rates were compared among the groups: those recurrent within 3 months of surgery (the 3- to 6-mo group), those recurring in 6 to 12 months after surgery (the 3-6 to 12-mo group) and those whose first recurrence was observed in more than 24 months after the initial operation (the over-24-mo group).
In addition, the investigators surveyed potential risk factors for the different recurrence patterns. These included the recurrence site, recurrence duration and the time to the development of symptomatic disease. They found that the recurrence pattern influenced patient outcomes: asymptomatic recurrences were associated with improved survival, while symptomatic recurrences were not. The recurrence duration was significantly longer in the nonperitoneal recurrence group. They therefore concluded that the recurrence pattern was an important factor influencing outcome after gastrectomy for stomach cancer and that it warranted further investigations.
Stomach cancer develops when cancer cells grow out of control in the inner lining of your stomach. It’s less common than other types of cancer.
Symptoms include heartburn or pain in your upper abdomen. You might also have a bloated belly or trouble swallowing. Risk factors include a diet high in salted, pickled or smoked foods and certain genetic syndromes, like familial adenomatous polyposis.
Stomach cancer can sometimes cause heartburn or acid indigestion. This is because stomach cancer can affect the muscles and lining of the upper digestive tract, including the esophagus. If you have this symptom, you should talk to your doctor about it. It could be a sign of cancer or it could also mean that you have other conditions such as GERD (gastroesophageal reflux disease), hiatal hernia, or peptic ulcers.
Stomach Cancer symptoms may also include difficulty swallowing, a feeling that food is stuck in your throat, or a sour taste in the mouth. You may also feel bloated or experience a general feeling of discomfort in your stomach area. Some people also experience blood in their stools or vomit blood.
The first step in diagnosing stomach cancer is getting a physical exam from your doctor. Your doctor will feel your abdomen for any abnormalities and may order a blood test or fecal tests to check for signs of bleeding in your stomach. Blood tests can also help determine if the cancer has spread to other parts of your body, such as the lungs or liver.
Other tests your doctor may use include a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan of the chest and abdomen, or a positron emission tomography/CT scan combination (also called a PET-CT scan). These tests can help your doctor find out if the cancer is in other parts of your stomach or if it has spread beyond your stomach.
Your doctor may also use a thin, flexible tube with a camera on the end (an endoscope) to look inside your stomach and esophagus. A biopsy can be taken during this test if your doctor thinks the tissue is cancerous or pre-cancerous. A sample of the tissue can then be examined under a microscope. During the biopsy, you may also get a stent inserted into your stomach to keep the esophagus open. You may also get chemotherapy or radiation treatment at this stage of the cancer, depending on the type and stage of the cancer and how far it has spread.
A person with stomach cancer may experience bloating or abdominal distention, a feeling of fullness in the upper abdomen. This is caused by cancer cells that overtake the healthy ones, and this can cause a buildup of tissue or an abnormal lump. This is a common early symptom, but it can be difficult to diagnose. This is because stomach cancer symptoms are often similar to indigestion or a stomach virus, and can be misdiagnosed. It is important to talk to your doctor if you have these symptoms, especially if they are persistent or getting worse.
Stomach cancer can start anywhere in the stomach, but it is most likely to start near the gastroesophageal junction. This is where the long tube that carries food you swallow (the esophagus) joins the stomach. The cancer can also start in the wall of the stomach, or in other parts of the organ. Where the cancer starts can help health care providers decide on a treatment plan.
People who have stomach cancer may also have other symptoms, including pain in the lower belly, diarrhea, vomiting or loss of appetite. Cancer in the lining of the stomach can also lead to a condition called peritonitis. This is when the lining of the stomach gets inflamed and infected. Health care providers can treat peritonitis with antibiotics or by draining the fluid from around the organs.
If you have stomach cancer, your care team might do a blood test to look for signs of infection. They might also do an endoscopy to look at your stomach lining and take a sample of tissue for testing. They might also do a test to find out how far the cancer has spread.
Doctors don’t routinely screen for stomach cancer because it is so rare, but they might recommend it if you have risk factors. These include having a history of stomach ulcers or stomach polyps, having a diet that includes lots of fatty and salty foods, smoking or drinking alcohol regularly, or having type A blood. A person who has a family history of stomach cancer is also at higher risk.
Stomach cancer usually starts when something hurts cells in the inner lining of your stomach. The damaged cells develop changes in DNA. These changes allow the cells to grow quickly and overtake healthy cells. The extra cells can form a mass called a tumor. The tumor may also spread (metastasize) to other parts of your body.
Vomiting blood is a serious medical emergency. It is a sign of bleeding in your upper gastrointestinal tract, which includes the mouth, throat, esophagus, stomach and first part of the small intestine (duodenum). The vomit may look bright red or it might be darker, like used coffee grounds. The darker the color, the longer the blood has been in your stomach.
You might not feel sick if you throw up blood, but you should go to the hospital right away. The doctor will check your condition and might order a CT scan or other tests to find the source of the bleeding.
In advanced stomach cancer, there can be a lot of bleeding inside your stomach. Over time, this can reduce the number of red blood cells in your blood (anaemia). You might notice your poo is darker – almost black. You might also get tired easily, lose weight without trying and have pain in your abdomen.
Some people with stomach cancer don’t have any symptoms in the early stages. Other people might have indigestion or pain in the upper part of their stomach, which doesn’t go away. These symptoms might be mistaken for other conditions, such as peptic ulcers or severe inflammation of the stomach lining (gastritis).
The risk of stomach cancer increases with age. Other risk factors include a history of stomach ulcers or stomach polyps, a diet high in fatty or salty foods, and a family history of stomach cancer. People with type A blood have an increased risk of the disease. You might have an even higher risk if someone close to you has stomach cancer or you’ve had an infection with the bacteria H. pylori. This is because the bacteria can cause stomach ulcers and stomach cancer.
When cancer or its treatment causes a loss of appetite, it may be hard to keep up with the food you need. This is a common side effect of many types of chemotherapy, radiation and other cancer treatments.
If you are experiencing a loss of appetite, it is important to let your healthcare team know. They can help find the cause and make sure you are getting the nutrients you need. If the loss of appetite is severe, your doctor may prescribe medications to increase your appetite.
People who have stomach cancer often do not experience early symptoms that could alert them to the condition, such as indigestion or stomach pain. This is because the early stages of stomach cancer often mimic the symptoms of other conditions such as peptic ulcers or a stomach virus. As stomach cancer progresses, it can spread into deeper layers of the stomach wall or to lymph nodes around the body. Staging identifies how much the cancer has spread.
The most common type of stomach cancer is adenocarcinoma, which starts in the cells that line the stomach. Less common types include adenocarcinoma of the stomach gland, lymphoma of the stomach, carcinoid cancer that begins in hormone-producing cells and gastrointestinal stromal tumor (GIST).
Scientists don’t know exactly what causes stomach cancer to develop. But some things can raise your risk for the disease, such as a stomach infection with the bacteria H. pylori, long-lasting ulcers and a type of anemia called pernicious anemia.
Other risk factors for stomach cancer include being over 60, having a blood type A, a family history of stomach cancer and smoking. Having a weakened immune system and having chronic illness, such as heartburn or gastritis, can also increase your risk for stomach cancer.
Stomach cancer can be treated with surgery, chemotherapy and radiation. If the cancer is found in its earliest stage, when it has not spread to other parts of the body, it can usually be cured. If the cancer has progressed to a later stage, it is harder to cure. But if the cancer hasn’t spread, treatment can ease symptoms and help prolong life.
A diagnosis of stomach cancer can be frightening. But it’s important to remember that treatment can often cure the disease.
Your outlook depends on how much the cancer has spread by the time of diagnosis and other factors like your age and overall health. Your care team may recommend surgery, chemotherapy, radiation therapy, targeted drug therapies or immunotherapies.
Chemotherapy uses drugs to destroy cancer cells or stop them from growing. There are many types of chemotherapy, and your doctor will choose the one that is best for you.
The most common type of chemotherapy involves medicines that travel through your bloodstream to kill cancer cells throughout the body. This type of chemotherapy is called systemic chemotherapy. You might also receive targeted therapy, in which doctors use drugs that target specific proteins found on cancer cells.
In some cases, your doctor will recommend chemotherapy before surgery to shrink tumors or to reduce the risk that the cancer will return (recurrence). This is called neoadjuvant chemotherapy.
Some doctors will also give chemotherapy after surgery to prevent the cancer from coming back (adjuvant chemotherapy). The type of chemotherapy you receive depends on your stage and other factors.
Your doctor will use a needle or a soft, thin tube (catheter) to put chemotherapy drugs into a vein in your arm or chest area. The doctor will remove the catheter when your treatment is over. It’s important to watch for signs of infection around your catheter.
Sometimes, doctors will inject the chemotherapy directly into an artery that feeds a tumor. This is called intra-arterial (IA) chemotherapy. Sometimes, doctors will place the chemotherapy in your belly through a thin tube (catheter). This is called intraperitoneal (IP) chemotherapy.
Other treatments might include radiation therapy, which uses high-dose X-rays to kill cancer cells and shrink tumors. Your doctor may also recommend immunotherapy, which uses drugs that encourage your immune system to attack the cancer cells.
The goal of treatment for metastatic stomach cancer is to extend your life and control your symptoms, which may include bleeding in the gastrointestinal tract. Your doctor might recommend palliative chemotherapy, in which the medications are designed to make you comfortable and relieve your symptoms.
Your multidisciplinary care team at MD Anderson will develop a treatment plan that is right for you. We offer a variety of advanced therapies, including clinical trials, for all stages of stomach cancer. As the nation’s leading research center, we can provide access to cutting-edge therapies that aren’t yet available elsewhere.
Radiation therapy uses targeted energy beams like X-rays to kill cancer cells. It’s often used in combination with chemotherapy before and after surgery, and it can also help relieve symptoms. For early stage stomach cancer, radiation alone may not improve survival, but it can reduce the size of tumors and make it easier to remove with surgery.
Your care team will use imaging tests to find out if your cancer has spread to nearby lymph nodes or other parts of the body. These include CT and positron emission tomography (PET). If your cancer has already spread, your doctor may suggest surgery and/or radiation therapy.
For tumors in the middle or upper part of the stomach, your surgeon might recommend removing only that area. For advanced-stage disease, your surgeon might remove the entire stomach and connect the esophagus directly to the small intestine with a procedure called roux-en-Y. This can help protect your esophagus from stomach acid.
If your cancer has already spread, your doctor might prescribe radiation therapy to help control symptoms and prolong life. Your care team will discuss your options with you, including clinical trials that are researching new ways to treat recurrent stomach cancer.
Your treatment plan will depend on how far your cancer has spread, your health and your preferences. Your care team might also recommend palliative care to help ease pain and discomfort.
You’ll have different treatment sessions, depending on your schedule and the type of radiation you receive. During treatment, you’ll lie on a table while a machine called a linear accelerator rotates around you to reach your target from different angles. It makes a buzzing sound and might have molds to hold you in place. Your radiation team will stay in a room nearby, and you can talk to them through video or audio links.
Your care team might recommend follow-up visits to check your condition and see how well your treatment is working. They might repeat some of the tests that they used to diagnose your cancer, such as imaging and blood work. Your doctor might also ask about immunotherapy, which can help your immune system detect and destroy cancer cells.
Doctors can use several types of surgery to remove stomach cancer. It might also be part of a combination treatment, such as chemotherapy or radiation. During surgery, doctors can take out the cancer and some of the tissue around it. They might also take out any lymph nodes near the stomach that look abnormal. They might also remove the whole stomach. If the tumor is very small or in the early stages, surgery might not be needed.
Your health care team will talk with you about your symptoms and your options for treatment. They will also do tests to find out if the cancer has spread. These tests might include imaging tests, such as CT or positron emission tomography (PET).
If the cancer has spread, your surgeon may need to take out more of your stomach. They might do this using a procedure called a partial (wedge) gastrectomy. The surgeon might also need to remove parts of the stomach closest to the esophagus or the small intestine. This type of surgery is also called a subtotal gastrectomy.
The doctors at Winship can use minimally invasive techniques for these operations. For example, a thin tube (an endoscope) with surgical tools is inserted into the throat and stomach. This enables them to remove most early, non-invasive cancers.
You will not be able to have food or drink before surgery. This is because the people who work in the operating room (OR) need to keep it germ free. They wear special caps over their heads and masks over their mouths and noses.
If your cancer has spread to the lymph nodes near the stomach, doctors might give you an experimental treatment called hyperthermic intraperitoneal chemotherapy (HIPEC). With this treatment, doctors put heated chemotherapy drugs into your abdomen after they remove the cancer. They might also remove lymph nodes in the belly and send them to a lab to test for cancer cells.
Your doctor will talk with you about clinical trials (research studies). These can help you get the best treatment for your specific cancer and stage. Your doctor might also refer you to a specialist, such as a gastroenterologist or a cancer doctor (oncologist).
Scientists are always looking for better ways to treat cancer, and clinical trials (research studies that involve people) play an important role in finding these new treatments. All of the medicines that are now approved by the FDA were tested in clinical trials.
When doctors want to find out if a new treatment works, they first test it in volunteers who agree to take part in the study. These volunteers may be given the new treatment, or they may be given a standard treatment. Then doctors compare the outcomes of the two groups to see if the new treatment is better.
For stomach cancer, researchers are investigating several new treatments, including immunotherapy and combinations of drugs. Immunotherapy uses your body’s immune system to fight the tumor, and there are currently six approved immunotherapy options for stomach cancer.
Another new treatment being tested at MD Anderson is combination chemotherapy with radiation therapy. This approach is called neoadjuvant chemoradiation therapy, and it can help to shrink the tumor before surgery and to kill any remaining cancer cells.
Chemotherapy is also being studied in different doses, and whether or not it can be given with or without radiation. Some doctors are experimenting with the use of molecularly targeted therapies that attack tumors on a genetic level by blocking proteins that cancer cells need to grow and spread.
In a typical clinical trial, the first few participants get a very low dose of the drug being studied and are closely monitored for side effects. As the study continues, more and more people get higher doses of the drug until doctors decide on a safe and effective dosage. This phase is called a Phase II trial.
Phase III trials test the safety of high doses of the drug and whether it can be given with or without radiation. Phase IV trials test how well a drug works over time in large numbers of people.
Choosing to participate in a clinical trial is a very personal decision. Some people volunteer to be in a study because they know that their participation will help future patients by contributing to medical knowledge. Others choose to participate because they have already tried the standard treatment and feel that a clinical trial is their best option.
Stomach cancer starts in the cells that line the inner stomach lining. There are several types of this cancer. The most common type is adenocarcinoma. Other types of stomach cancer include squamous cell carcinoma, mucoesophageal junction carcinoma, and MALT lymphoma.
Stage 0: At this stage, the cancer is in the inner layer of your stomach and hasn’t spread to other parts of your body. You may need surgery to remove part or all of your stomach. You might also get chemotherapy or chemoradiation before surgery to shrink the tumor.
Adenocarcinoma is a type of cancer that starts in the cells that make up the lining of your stomach. It is the most common cancer of the digestive tract and is often linked to long periods of inflammation or irritation in the stomach lining, like from chronic stomach ulcers or gastroesophageal reflux disease. It also can be caused by eating a lot of foods that are high in salt, cured or smoked meats and fish. This cancer can spread to other parts of your body, too. It may occur in your esophagus (the tube that carries food from your mouth to your stomach) or to other parts of the stomach, intestines, liver or pancreas.
Adenocarcinomas start when there are changes, or mutations, in a cell’s DNA. A cell’s DNA holds the instructions that tell a cell when to grow and when to die. When a cell develops mutations, it grows and divides faster than healthy cells can, and these extra cells can overtake normal cells, forming a mass called a tumor. Cancer that begins in the stomach is more likely to spread to other organs than cancer that starts in other parts of your body, including your lungs and breasts.
Most stomach adenocarcinomas are well-differentiated, meaning that the cancer cells look similar to healthy cells under a microscope. However, a few types of adenocarcinoma are undifferentiated or diffuse, which means that the cancer cells look different under a microscope and grow and spread more quickly than normal cells do. This type of cancer can also be more difficult to treat than other types of adenocarcinoma.
If your doctor suspects that you have stomach adenocarcinoma, they will take a sample of tissue from the area of your body where they think the cancer is located. They will then examine this tissue under a microscope to see if there are any cancer cells. The sample can also show how far the cancer has moved and what stage it is in. Symptoms of stomach adenocarcinoma depend on what part of the stomach the cancer is in, but they may include indigestion and pain in the upper middle section of your belly.
In the United States, most stomach cancers start in the part of the stomach called the gastroesophageal junction. This is the place where the long tube that carries food from your mouth to your stomach meets the esophagus. But stomach cancer can also begin in other parts of the stomach. It might start in the top inch of the stomach, called the gastric cardia. Or it might start in other sections of the stomach, including the gastric antrum and the rest of the body of the stomach.
Adenosquamous carcinoma is a rare subtype of stomach cancer and represents less than 0.5% of all stomach malignancies. It is characterized by the combination of an adenocarcinoma and squamous cell carcinoma components. This cancer is invasive and has a poor prognosis. It usually progresses to an advanced stage at diagnosis and metastasizes to lymph nodes and liver. It is more likely to occur in Asians than in other races.
Gastric adenosquamous carcinoma can be identified by its characteristic CK7/CK20 coordinate staining pattern and immunohistochemical markers. The adenocarcinoma component of this disease is often CK7-/CK20+ and has a more pronounced cytoplasmic staining than the squamous cell carcinoma component. However, the squamous cell carcinoma may also stain with CK7-/CK20+ or be CK7-/CK20+ and CK20+.
Several reports of gastric adenosquamous cancer have been published, but comprehensive studies are limited. This case report describes two patients with adenosquamous carcinoma of the stomach. The adenocarcinoma element in both cases was granulocyte-colony stimulating factor–producing adenosquamous carcinoma, and the squamous cell carcinoma was signet ring cell carcinoma. The adenosquamous carcinoma demonstrates aggressive behavior and is associated with poor prognosis. It seems that the biologic behaviors of adenosquamous carcinoma are determined by its adenocarcinoma component, but further studies are needed to clarify the cellular origin of this tumor. The occurrence of adenosquamous cancer should be taken seriously and requires careful consideration in the planning of treatment. Currently, no effective chemotherapy has been developed for this tumor. A comprehensive multimodality treatment approach is necessary for the improvement of the prognosis of this disease. Patients with this tumor should be closely monitored for recurrence and be offered adjuvant chemotherapy.
In this type of cancer, the cells lining the esophagus and gastroesophageal junction (GEJ) are affected. GEJ cancer is more common in the developing world but is on the rise in the Western world because of increased incidence of reflux disease and obesity. The most common types of GEJ cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinomas are more common in the upper esophagus, while adenocarcinomas are more common in the lower esophagus. Both are linked to infection with Helicobacter pylori.
There are several different histologic types in this tumor including well-differentiated and poorly differentiated squamous cell carcinoma, glandular adenocarcinoma and verrucous carcinoma. Well-differentiated squamous cell carcinoma is more commonly seen in the upper 2/3 of the esophagus while poorly differentiated squamous cell and verrucous carcinoma are found more frequently in the distal GEJ. GEJ adenocarcinomas are more frequently associated with Barrett’s oesophagus and glandular metaplasia. Most adenocarcinomas have a papillary or tubular structure and are related to adenomatous hyperplasia.
Symptoms in this type of cancer include difficulty swallowing (dysphagia) and weight loss. If the cancer has spread to the esophageal mucosa, symptoms can also include regurgitation and aspiration.
Surgical treatment for this tumor can vary depending on where the tumour is located. If the cancer is in the stomach but extends up to the esophagus, Mark Duncan, head of surgical oncology at Johns Hopkins Bayview Medical Center, says he would remove the lower esophagus, most of the stomach and a large area of lymph nodes in the chest and abdomen. Similarly, if the tumour is mostly in the esophagus, he would remove most of the esophagus and a large area of lymph nodes around it. A right sided thoracotomy is generally preferred to avoid leaking from the stomach into the chest and to allow optimal lymphadenectomy. This includes removal of the lymph nodes in the aortopulmonary window, along both the splenic artery and the hepatic lobes, as well as a complete lymphadenectomy in the mediastinum including the para-esophageal, peritumoral and subcarinal nodes. Some centers use a more extensive lymphadenectomy, including the area around the brachio-cephalic trunc and left recurrent nerve in patients with a higher risk of recurrence.
MALT lymphoma is a type of low-grade non-Hodgkin lymphoma that starts in mucosa, the moist inner lining that lines some organs and cavities throughout the body. MALT lymphomas are usually found in the stomach, but can also form in other organs including the eyes, lungs, salivary glands and thyroid gland. They are also sometimes found in the skin. MALT lymphoma belongs to a group of cancers called marginal zone lymphomas, which are indolent (slow-growing) B-cell non-Hodgkin lymphomas.
Like other cancers, lymphoma is caused by changes in DNA, which leads to the growth of abnormal cells that form cancerous tumors. The most common cause of these changes is damage to DNA from a virus or infection. Other causes include exposure to certain chemicals, radiation and lifestyle factors. For example, smoking increases the risk of many types of lymphoma. Some cancers are also caused by inherited mutations that run in a person’s family, but most are caused by spontaneous (acquired) mutations that occur during a person’s lifetime.
Most MALT lymphomas develop in the stomach and are associated with a bacterial infection, usually one caused by Helicobacter pylori (H. pylori) bacteria. They tend to be slow-growing and may not cause symptoms, especially in the early stages. This is why they are often spotted only in routine medical exams.
The treatment of MALT lymphoma depends on how far the cancer has spread and which organ it is in. Most MALT lymphomas are in Stage I or II when diagnosed, which means they have not spread to other parts of the body. However, some are in advanced stages at diagnosis (Stage III or IV), which means they have spread to other organs such as the lungs, liver or bone marrow.
Doctors will usually start with antibiotics to treat a MALT lymphoma that’s only in the stomach. Antibiotics may be given by mouth or through a tube inserted into your stomach. They may also give you radiation therapy, which is used to destroy cancerous tissue by targeting the area with high-energy X-rays or particle beams. Targeted therapy is another option for MALT lymphoma, especially if it doesn’t respond to antibiotics or comes back after treatment. This type of therapy uses drugs that target specific molecules on the surface of cancerous cells and stop them from growing or dividing. The drug rituximab (Rituxan) is a type of targeted therapy and can be given alone or with chemotherapy.