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Two main varieties of stomach cancer are now recognised to exist in western populations; those of the oesophago-gastric junction (where the gullet joins the stomach) and those elsewhere in the stomach beyond. The incidence of the former is increasing whereas the later appears to be becoming less common.
It is clear that the cause of each type is multi-factorial and much remains to be fully understood about why such tumours develop. It is more common in men than women and the peak age of incidence is between 50 and 60 years of age.
Causes of stomach cancer
Gastro-oesophageal reflux disease and the presence of Barrett’s oesophagus (changes to the mucosa lining of the lower end of the gullet as a result of acid injury) have been shown clearly to influence the development of oesophago-gastric (junctional) cancers.
Obesity, the presence (or absence) of Helicobacter Pylori Infection, smoking, alcohol consumption, diet and certain occupations have been implicated in the development of all types of stomach cancer although in many cases causation is not completely clear-cut.
Symptoms are an unreliable predictor of the presence of stomach cancer since the common upper gastrointestinal symptoms of gastro-oesophageal reflux and indigestion are associated most commonly with completely benign conditions. Other complaints may be:
- Anaemia usually showing Iron deficiency
- Weight loss
- Difficulty swallowing
Stomach cancer may be diagnosed by a variety of means but the most accurate and useful is an OGD (Oesophago-Gastro-Duodenoscopy). A flexible endoscope is inserted via the mouth into the oesophagus, stomach and duodenum. The tumour is usually easily diagnosed and is routinely biopsied.
CT scanning of the chest and abdomen is performed to determine whether or not the disease has spread to other sites in the abdomen and chest. If there is no evidence of disease spread an endoscopic ultrasound scan is performed to determine the possible need for (neo-adjuvant) chemotherapy treatment before surgery. Other assessments of lung and heart function may also be required.
Ultimately only 30-40% of patients diagnosed with a stomach cancer will be suitable for an attempt at cure by surgical removal of the tumour. The majority of patients have disease that is already widespread or not surgically removable at the time of diagnosis. For these patients only palliative treatments with chemotherapy, radiotherapy and endoscopic procedures will be appropriate.
Surgical treatment usually offers a formidable challenge for both patient and surgeon. The surgery is complex, lengthy and often involves entering both the abdomen and chest to safely remove the affected part of the stomach and reconstruct the gut. A variety of operations are performed depending upon the nature of the disease and the patient many of these are routinely performed laparoscopically.