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Stomach / Gastric Cancer

What is Stomach Cancer?
Stomach cancer, or gastric cancer, occurs when cells in the stomach grow abnormally and develop into tumours, which could become harmful if left untreated. It is particularly common in East Asia. It is the 6th most common cancer for Singaporean men, which means 1 in 50 men will develop stomach cancer in their lifetime. In Singaporean women, it is the 8th most common cancer. Stomach cancer claims about 300 lives yearly in Singapore¹.

¹Singapore Cancer Registry Interim Annual Report, Trends in Cancer Incidence in Singapore, 2010 – 2014, National Registry of Diseases Office (released 26 May 2015)

While the exact causes of stomach cancer are not clear, factors that may increase the risk of stomach cancer include:
- A diet high in salty and smoked foods
- A diet low in fruits and vegetables
- Family history of stomach cancer
- Infection with helicobacter pylori (H. pylori), which is a type of bacteria that lives in and affects the mucous lining of the stomach
- Chronic gastritis, a long-term inflammation of the stomach
- Pernicious anaemia, a decrease in red blood cells when the intestines cannot properly absorb vitamin B12
- Smoking
Signs & Symptoms

Stomach cancer has few or no symptoms in the early stages, making early detection difficult. When they are present, symptoms include a loss of appetite, unexplained weight loss, chronic abdominal or gastric pain, and dyspepsia (pain or discomfort in the upper abdomen). However, these are also symptoms of common conditions affecting the stomach like acid reflux or gastritis.

The main reason why stomach cancer is often discovered late is because many, even doctors, may not immediately suspect stomach cancer. Less common symptoms of stomach cancer, which tend to present in the more advanced stages, include black stools (a sign of bleeding in stomach).
Diagnosis & Assessment
Tests for the diagnosis of stomach cancer include:
Gastroscopy – This is the test most often done to diagnose stomach cancer. During this test, the doctor puts an endoscope (a long flexible tube with a camera and light) into the mouth and down into the stomach. This allows the doctor to look at the inside of the stomach.

Biopsy – This test is performed during a gastroscopy. In a biopsy, a small sample of tissue from an abnormal-looking area of the stomach is taken and later examined under a microscope.

Imaging tests of the stomach – Imaging tests such as computed tomography (CT) and ultrasound scans create pictures of the inside of the body to see if the cancer has spread.
Doctors will also check for H. pylori infection. This can be done in different ways, including breath tests, blood tests, and other laboratory tests.
Treatment & Care
Stomach cancer is usually treated with one or more of the following approaches:
Surgery

This can be an effective method to treat early stage stomach cancer. During surgery, the doctor may remove part or all of the stomach. In the advanced stages of stomach cancer, surgery may still be advised to reduce complications such as blockage of the stomach or bleeding from the cancer.

Radiation Therapy

After surgery, radiation therapy, also known as radiotherapy, may be given together with chemotherapy to destroy any remaining cancer not removed during surgery. In patients with advanced stomach cancer, radiotherapy may be useful for relieving stomach blockage. It may also be used to stop bleeding from cancers that cannot be operated on.

Chemotherapy

Chemotherapy is the use of drugs to help kill cancer cells and shrink the size of the tumour. It can be given by itself or combined with radiotherapy after surgery. It may also be used to reduce symptoms or lengthen the lifespan of patients with advanced stomach cancer that cannot be operated upon.

Targeted Therapy

Some stomach cancers have too much of a growth-promoting protein called HER2 on the surface of the cancer cells. Tumours with increased levels of HER2 are called HER2-positive. Trastuzumab (Herceptin®) is a man-made antibody which targets the HER2 protein. Using this drug with chemotherapy can help patients suffering from advanced, HER2-positive stomach cancer live longer than with just chemotherapy alone.

How to Prevent Stomach Cancer?

In many developed countries, where refrigeration allows a greater intake of fresh rather than salt-preserved foods, rates of stomach cancer have fallen over the years. Here are some steps that can be taken to reduce the risk of developing stomach cancer:

Consume more fresh fruits and vegetables

Reduce intake of salted and smoked foods

Stop smoking

Know your medical history (eg. past H. pylori infection) and go for regular gastroscopy screening

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