1 AnswerPatrick Maguire, MD, Oncology, answeredAn esophagogastroduodenoscopy (EGD) provides both diagnosis and staging information. Patients should then have computerized tomography (CT) of the chest and abdomen, as well as consideration for bone scan if the cancer appears to be more advanced. Positron emission tomography (PET) and CT can be substituted for those two tests and may also be used for restaging postoperatively, in order to guide further treatment recommendations. Endoscopic ultrasound (EUS) is often performed at major cancer centers. This procedure provides additional information, including depth of tumor penetration into the gastroesophageal (GE) junction (the junction between the stomach and esophagus) or stomach wall, as well as potential enlarged lymph nodes that may be biopsied. Early stage disease is limited to stomach lining and muscle. Advanced stage disease includes deep tumor penetration through the stomach wall and/or involving nearby lymph nodes. Patients who present with metastatic stomach cancer to the liver or other organs are considered to have stage IV disease, generally incurable.
1 AnswerPatrick Maguire, MD, Oncology, answeredThe lifetime risk of developing cancer of the stomach is about 0.9%, or one in 110 people. According to the most recent National Cancer Institute's Surveillance, Epidemiology and End Results (NCI's SEER) Cancer Statistics Review, the five-year survival for stomach cancer, relative to the general population, for all stages combined is 26%. If the disease is localized, then the five-year survival is 63%. Patients with regional spread to lymph nodes have a five-year survival rate of 27%. Those with metastatic stomach cancer have a 3% survival rate at five years following diagnosis.
3 AnswersMehmet Oz, MD, Cardiology, answered
Average folks can be at higher risk for colorectal cancer, especially if they partake in some unhealthy lifestyle behaviors.
Lifestyle risk factors for colorectal cancer:
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- diets high in fat or low in fiber, calcium, or both
- physical inactivity
- tobacco smoking
- high alcohol intake
5 AnswersMehmet Oz, MD, Cardiology, answered
To put it simply, all adults are at risk for colorectal cancer, even those that live healthily.
Some people are at very high risk. They have a particular gene mutation that predisposes them to developing multiple polyps. These are hereditary syndromes such as familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer syndrome and MutY homolog (MUTYH) polyposis.
The risk is also high, almost doubled, in people with a diagnosed first-degree relative (mother, father, sister, brother, child), especially if the relative was diagnosed before the age of 50. Ulcerative colitis and Crohn's disease, types of inflammatory bowel diseases, also up the risk.
Yes, there are a few different types of stomach cancer, but the vast majority—90 percent—are adenocarcinomas. These tumors develop from the cells that form the innermost layer of the stomach, called the mucosa. In some cases, it can spread (metastasize) throughout the stomach, penetrate the wall and progress to the adjacent lymph nodes and other organs. One form of adenocarcinoma is linitus plastica or diffuse gastric cancer often involving most of the stomach
The other, less common tumors that can be found in the stomach are:
- Lymphomas - cancers of immune system tissue
- Gastrointestinal stromal tumors (GIST) - can be benign or cancerous
- Carcinoid tumors - come from hormone-producing cells in the stomach
- Leimyosarcoma - cancer of the soft tissue
These types of stomach cancer are very rare and their treatment and prognosis differ from adenocarcinomas.
The first step in reducing your chances of getting stomach cancer is knowing the risks associated with the disease. There are, obviously, risks that are out of your control like your family history. Additionally, there are other non-controllable risks like:
- Sex (men have a much higher incidence of stomach cancer than women)
- Age (the majority of patients are over 65)
- Race (more common in Asians, Pacific Islanders, Hispanics and African Americans)
- Helicobacter pylori (H. pylori) infection (bacteria that commonly lives in the stomach and can cause peptic ulcers and gastritis)
- History of health problems such as chronic gastritis and peptic ulcers (both of which can be caused by the Helicobacter pylori (H. pylori) infection), pemicious anemia or a history of stomach surgery
Even if you have have several of these risk factors, it doesn’t mean stomach cancer is inevitable. There are many things you can do to reduce your risk:
- Diet - avoid foods that are smoked, pickled or high in salt. Fortunately, the incidence of stomach cancer from this risk has been reduced over the years because of refrigeration, rather than other methods of preserving freshness. Also, eating food with plenty of fiber and vitamin A & C may lower your risk, as well.
- Smoking - quitting is always the right decision for your overall health, including reducing your chances of getting stomach cancer.
- Alcohol - moderation is key. Limit the amount you drink.
- Maintain a healthy weight
So, even if your uncontrolled factors are high, there’s a lot you can do reduce your overall risk. Should you still be concerned that you may have stomach cancer in the absence of symptoms, talk to your doctor. He may suggest an endoscopic screening (a flexible fiberoptic light tube is introduced through the mouth, esophagus, stomach and first part of the small intestines to view and biopsy any suspicious areas for examination) to rule out or confirm the diagnosis.
2 Answers"Staging" refers to the extent of the disease, which is a critical factor in determining what course of treatment would be most effective. It is based on the size and extent of the tumor, the number of lymph nodes involved, and how far the cancer has spread. That information is obtained from biopsies (sampling of tumor tissue which can be collected during diagnosis or after surgery), examination of removed lymph nodes, imaging tests like CT scans and other diagnostic exams.
Stage grouping is used to determine the overall disease stage and is expressed from 0 (the least advanced) to IV (the most advanced stage). The following stage groupings are used for stomach cancer:
- Stage 0 - Also known as carcinoma in situ, the cancer is found only in the innermost layer of the stomach wall and has not spread anywhere else.
- Stage I - The cancer is either in the first and second layer of the stomach wall and has spread to up to two lymph nodes close to the tumor; or the cancer is in the first or second layer of the stomach wall and has permeated the muscle layer. It has not spread to other organs.
- Stage II - The cancer is only in the second layer of the stomach and has spread to three to 15 lymph nodes very close to the tumor; or It’s in the third and, possibly, the fourth layer of the stomach wall and has spread to one to six nearby lymph nodes; or the cancer has gone through the outermost layer of the stomach wall, but has not spread to lymph nodes or other organs.
- Stage III - The cancer is in the third or fourth layer of the stomach wall and has spread to three to 15 lymph nodes; or it has invaded nearby organs, such as the liver or spleen, but not distant organs with or without spread to lymph nodes very close to the tumor.
- Stage IV - The cancer has spread to distant parts of the body.
- Recurrent disease - Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the stomach or in another part of the body, such as the liver or lymph nodes.
Surgery is the primary treatment for a stomach cancer diagnosis. However, depending on the size of the tumor and the stage (extent of the disease), additional therapies including radiation and/or chemotherapy may be warranted. If your oncologist recommends one or both of these therapies, it is dependent upon your specific disease factors whether you would have them before or after surgery.
The most common surgical treatments for stomach cancer are:
• Partial gastrectomy - part of the stomach is removed together with adjacent lymph nodes.
• Total gastrectomy - the stomach is completely removed together with adjacent lymph nodes.
• Palliative surgery - partial tumor removal to prevent bleeding or a blockage in the stomach, which eases or prevents symptoms but will not cure the cancer
In cases where the entire stomach is removed, the esophagus is connected directly to the intestines, which can cause “dumping syndrome.” Dumping syndrome occurs when the intestines fill too quickly with undigested food. Symptoms include shortness of breath, nausea, vomiting, diarrhea and bloating. Often, these symptoms can be controlled by diet.
Other treatments include:
• Radiation therapy is administered according to the type and stage of the cancer. It may be recommended prior to surgery, after surgery or in combination with chemotherapy.
• Chemotherapy may be recommended as a single agent or in combination with other drugs. The way chemotherapy is administered depends on the type and stage of cancer.
Although appetite loss and stomach pain are considered two symptoms of stomach cancer, there are also many other common ailments that could be causing them. Don’t panic and assume the worst, but if you’ve had those symptoms for awhile, a visit to your doctor would be logical. Should symptoms persist -- especially after you’ve been treated by a physician -- further investigation should be made.
The majority of stomach cancer patients do have non-specific complaints, such as:
• Indigestion or heartburn
• Abdominal discomfort (bloating, belching, gas pains, etc.)
• Loss of appetite
• Occasional vomiting
• Diarrhea or constipation
• Unexplained weight loss
• Decreased ability to eat a large meal
Other less common, yet serious, symptoms are:
• Difficulty swallowing
• Vomiting blood or blood in the stool
Should you experience these symptoms, don’t delay medical attention