November is Stomach Cancer Awareness Month. Did you know that stomach cancer is the fifth most commonly diagnosed cancer in the world? It is also the 3rd leading cause of cancer deaths worldwide. In 2020 alone, there were an estimated 1.1 million new diagnoses of stomach cancer and 800,000 deaths attributable to stomach cancer. It is a devastating disease, and fortunately, incidence has been on the decrease in the United States over the last few decades. Stomach cancer is most commonly seen in developing countries, particularly in Asian countries. It is twice as common in men as in women and is more frequently diagnosed in black men than in white men and more common in Hispanic women than in white women. Stomach cancer is more common in older patients, typically presenting after age 45. Most stomach cancer cases are sporadic (random), but about 5-10% can be seen in patients with a family history of stomach cancer.

Stomach Cancer Risk Factors

While the exact way that stomach cancer develops has not been identified, several risk factors have been linked to increased risk of developing this disease. These include:

• Consumption of high-salt/salt-preserved foods
• Consumption of N-nitroso compound foods (ex., processed or cured meats)
• Smoking
• A diet low in Vitamin A and Vitamin C
• Consuming large amounts of smoked or cured foods
• Contaminated drinking water
• High BMI (body mass index)
• Increased calorie consumption
• GERD/acid reflux
• Occupational exposure to rubber manufacturing, tin mining, metal processing, and coal
• H. pylori infection (an infection that affects the stomach)
• Epstein Barr Virus (the virus that causes mononucleosis)
• Pernicious anemia
• Gastric ulcers
• Gastric polyps
• Possible risk factors: radiation exposure and gastric surgery

Please note that long-term use of antacids such as H2 blockers (famotidine/Pepcid) and PPIs/proton pump inhibitors (omeprazole/Prilosec, esomeprazole/Nexium, lansoprazole/Prevacid, deslansoprazole/Dexilant, pantoprazole/Protonix) has not been linked to an increased risk of stomach cancer.

There are also some protective factors against stomach cancer. These include:

• High consumption of fiber
• High consumption of fruits and vegetables
• Aspirin and NSAID products (ex., ibuprofen/Advil, naproxen/Aleve) – but please keep in mind that regular use of NSAID products does come with its risks.

Symptoms for Stomach Cancer

Unfortunately, most cases of stomach cancer are caught at an advanced stage. Symptoms that can be concerning for stomach cancer include unintended weight loss, persistent abdominal pain, difficulty swallowing, throwing up blood, loss of appetite, nausea, filling up after only eating 1-2 bites of a meal, and discomfort in your upper abdomen after eating. Patients with symptoms concerning stomach cancer should undergo an upper endoscopy, also known as an esophagogastroduodenoscopy (or ‘EGD’ for short). This is a brief procedure where the patient is put to sleep, and a light and camera are inserted into the mouth and run down the esophagus into the stomach and the first part of the small interesting to take a look around and look for any concerns, potentially taking biopsies for more information. This procedure typically takes 5-10 minutes, and biopsy results return in about 7-10 days.

Treatment Options for Stomach Cancer

If a patient is diagnosed with stomach cancer, other tests may be performed before starting treatment to “stage” the cancer – that is, to determine how aggressive the cancer is. These can include CT scans of the chest and abdomen to look for metastases (invasion of cancer into other organs or tissues) and determine whether surgery is a viable option; endoscopic ultrasound (‘EUS’), which is an ultrasound that is performed during an EGD to look directly at a stomach tumor and determine how deep it extends and whether there are lymph nodes affected; PET-CT which is a special CT scan that can also help determine if surgery is a viable treatment option. The most common sites of metastatic invasion are the lungs, liver, and bones. An interdisciplinary team will work closely to determine the extent of the disease and the best treatment plan for an individual.

Treatment can consist of surgery, chemotherapy, and sometimes radiation. If the cancer is caught very early and has not invaded other organs, surgical removal of the stomach can result in 5-year survival rates of up to 98%. Sometimes partial resections are performed endoscopically, with 5-year survival rates of 84-96%. Most surgeons prefer to perform a complete resection of the stomach, as well as a biopsy of and potential resection of multiple surrounding lymph nodes.

Some patients undergo pre-operative or post-operative therapies such as chemotherapy. Pre-operative chemotherapy can help down-stage primary tumors and regional lymph nodes with the hope of increasing post-operative survival. For patients in whom the cancer is diagnosed at a point where it has already spread and is not amenable to surgical resection, palliative chemotherapy may be offered with the goal of reducing symptoms, improving quality of life, and possibly moderately prolonging life by several weeks or months. Unfortunately, only about 10-20% of patients present with early, localized disease that is curable with surgery alone. The remainder of patients present with metastatic disease, with survival rates ranging from 0-50%.

Although stomach cancer is far less common in the United States than in other countries, if you have signs or symptoms that concern you, please reach out to your gastroenterology provider today!

– Published November 1, 2023

By Caroline Shropshire, PA-C

Physician Assistant at Digestive Health Specialists. She works at our Thomasville and Winston-Salem locations.
Learn more about her on her profile at the link: https://digestivehealth.ws/provider/caroline-shropshire-pa-c/