Stomach Cancer Treatment Hospital in Hyderabad | Surgery, Types & Cost

The warning, that something is not right!

If we know the symptoms, we can be more cautious and report to our doctor for evaluation at the earliest. As the survival depends on the stage of the cancer, earlier it is detected, better the survival outcome! The following are the typical nonspecific gastric cancer / stomach cancer symptoms:

• Fatigue - an overall feeling of tiredness or lack of energy
• Feeling bloated after eating - due to excess intestinal gas and digestive contents
• Feeling full after eating small amount
• Severe and persistent heartburn
• Severe and unrelenting indigestion
• Chronic unexplained nausea and vomiting
• Unexplained Stomach pain
• Unexplained Weight loss
  

Types of stomach cancer

The evaluation, treatment and prognosis, all depend on the type of the gastric cancer, which is determined by the cells that make up the tumour:

• Adenocarcinoma (originates in the glandular cells) - accounts for the majority of stomach cancers. It is of various subtypes -intestinal, diffuse, indeterminate or mixed type
• Lymphoma (originates in the cells of the immune system) - a relatively rare form of stomach cancer
  
• Carcinoid cancer or cancer that begins in hormone-producing cells-rare cancer which originates in the hormone-producing cells
  
• Gastrointestinal stromal tumour (GIST, originates in nervous system tissues) – another relatively rarer form of gastric cancer.

As most of the types of stomach cancers, other than adenocarcinoma, are rare, when doctors use the term “stomach cancer” they mean adenocarcinoma.

If we know, what predisposes us to develop this cancer, we can take measures to protect us! The etiology of gastric cancer is multifactorial, more than 80% of cases have been attributed to H. pylori infection and in addition, diet, lifestyle, genetic, socioeconomic and other factors contribute to gastric carcinogenesis.

Helicobacter pylori

It is a gram-negative bacterium that lives and multiplies in stomach mucosa and triggers the progressive sequences of gastric lesions (from chronic gastritis, gastric atrophy, intestinal metaplasia, dysplasia, and finally gastric cancer). H. pylori infection is considered one of the most important risk factors for non-cardia gastric cancer. Many studies conducted in various parts of the world observed 2-3-fold increase in gastric cancer among individuals exposed compared to non-exposed to H. pylori infection. H. pylori infection is mainly acquired in childhood through oral ingestion, and infection may persist throughout the life The Cag A gene, which is the main virulence factor of H.pylori, has been identified to be responsible for the development of gastric adenocarcinoma. A point of concern is that the seroprevalence of H. pylori infection in adult population in India is 55%–92%, as compared to 44% and 55% in Chinese and Japanese population, respectively

Diet

Diet plays a major role in gastric carcinogenesis. Globally, literature suggests that populations at high risk for stomach cancer consume diets rich in starch and poor in protein quality, and are not inclined to eat fresh fruits and vegetables. Both high starch and low protein diet may favour acid-catalyzed nitrosation in the stomach and cause mechanical damage to the gastric lining and none or low-starch vegetable including green yellow vegetables, cruciferous and allium vegetables (garlic and onion) and fruits are considered to be probable protective factors. Limited evidence recommends that pulses (including soy) and selenium are also protective in nature. The recent decline in the incident of stomach cancer in many countries may be in part explained not only by higher consumption of fruit but also due to highly reduced intake of salt, preserved foods as well as the availability of refrigeration.

In Indian scenario, pickled food, high rice intake, spicy food, excess chilly consumption, consumption of very hot food, smoked dried salted meat, use of soda and consumption of dried salted fish have emerged as significant dietary risk factors. These practices are prevalent in southern and eastern states of India, a where a higher frequency of gastric cases are also observed. 

Studies strongly support the role of excessive salt intake in gastric carcinogenesis. Consumption of large amount of salted fish, soy sauce, pickled vegetables, cured meat and other salt-preserved foods enhances H. pylori colonization, and increases the risk of gastric cancer through direct damage to the gastric mucosa resulting in gastritis. Salt is also known to induce hypergastrinemia and endogenous mutations, promoting epithelial cell proliferation which eventually leads to parietal cell loss and gastric cancer progression. Salted tea (Nuun Chai), a drink of the poor farmers of Kashmir, has been very strongly implicated it carcinogenesis. A statistically significant interaction between H. pylori infection, smoked, salted meat and Sa-um (fermented pork fat, a locally made dish in Mizoram) has been documented. 

Dietary nitrates are found either naturally in foods such as cabbage, cauliflower, carrot, celery, radish, beets, and spinach or added during preservation. In addition, the nitrate content of fertilizers, soil, and water also contribute to dietary nitrate. Dietary nitrate is converted to carcinogenic N-nitroso compounds (NNC) by gastric acid thereby increasing gastric cancer risk. Small quantities of preformed NNC and nitrosamines may also be present in some foods including cured meats, dried milk, instant soups, and coffee dried on direct flame

Lifestyle

Alcohol, a gastric irritant, is an important risk factor for gastric cancer. Many studies have reported an increased risk of stomach cancer in men and women who regularly consume strong alcoholic beverages.

Globally, tobacco smoking has been indicated as an independent risk factor for gastric cancer. In India, not only tobacco smoking but also tobacco chewing is highly prevalent. Tobacco is used in various forms like, hukka, snuff, bidis, cigarettes, taibur, Meiziol, etc. This is one of the main reasons for male predominance of gastric cancer.

Weight

A meta-analysis of many studies indicated that overweight status and obesity are associated with an increased risk of gastric cancer. The strength of the association increases with an increase in the body mass index (BMI)

Genetic susceptibility 

The first documented report of familial predisposition to gastric cancer was described for Napoleon Bonaparte’s family, with Napoleon, his father, grandfather, brother, and three sisters, all dying of stomach cancer at a relatively early age. In addition to the genetic predisposition to develop cancer, family members usually share the same environment and have similar socioeconomic status. These risk factors act independently or in conjunction with genetic factors, thereby increasing the risk of stomach cancer

Globally literature suggest that polymorphism in genes involved in inflammation, that is interleukin, toll-like receptor 4, hyuman leukocyte antigen, metabolic phase I enzyme viz CYP1A1, metabolic phase II enzyme viz GSTM1, GSTT1 (Glutathione-S-transferase) [35] and NAT1, NAT2 (N-acetyltransferase), DNA repair Viz XRCC1, are involved in development of gastric cancer. Indian studies on this topic are however limited because of multiple factors (inadequate sample size, improper study designs and inability to controls for confounders). 

A family history of gastric cancer is observed in up to 10–15% of cases. A history of gastric cancer in siblings or parents is associated with an at least 2 times increased risk of gastric cancer. Gastric cancer can also be a part of inherited syndromes such as hereditary nonpolyposis colon cancer and hereditary diffuse gastric cancer and Li-Fraumeni syndrome.

Occupations

A positive correlation has been recognized between increased stomach cancer risk and a number of occupations including mining, farming, refining, and fishing as well as in workers processing rubber, timber, and asbestos. Occupational exposure to dusty and high temperature environments such as in cooks, wood processing plant operators, food and related products machine operators was associated with a significant increased risk of gastric cancer of the diffuse subtype.

How do you diagnose stomach cancer?

Once the patient report to the doctor, the doctor will then perform a series of investigations to confirm the diagnosis and evaluate to find the stage of the cancer. These are very important steps, as diagnosis and type and stage of cancer determine further treatment and survival of the patient. Commonly used procedures to diagnose stomach cancer include:

• Endoscopy – A thin tube with a tiny camera is passed down the throat and into the stomach to look for the tumour. 
• Biopsy of the Tumour - a piece of tissue sample is taken as biopsy during endoscopy for further evaluation, a very essential step as without tissue diagnosis, no therapy can be given.
• Endoscopic Ultrasound – done to assess the depth of tumour invasion, required for staging of the cancer.
• Imaging tests - Imaging tests to find the extent of disease, for staging, include computerized tomography (CT) scan, MRI, positron emission tomography (PET) and a barium swallow.
• Exploratory surgery - Once a decision is taken to operate, exploratory laparoscopy is undertaken to confirm operability.