Stomach and Esophageal Cancer

Stomach and Esophageal Cancer

Stomach and esophageal cancer is the abnormal growth of cells anywhere in the stomach or esophagus. Cancer of the stomach usually affects the lining in the upper part of the stomach, and is more common in males than in females, with the risk being 1 in 63 for men and 1 in 151 for women. It is very rare for someone below the age of 50 to develop stomach cancer. Those diagnosed with stomach cancer have a five year survival rate of 30%.

Esophageal cancer usually affects the lower part of the esophagus, at the junction where it connects with the stomach. There are two main types of esophageal cancers in existence, including Adenocarcinoma (which arises in the glandular cells lining the esophagus) and Squamous cell carcinoma (which arises in the epithelial cells lining the esophagus and is the most common type to affect individuals in Asia).

Esophageal cancer is about 5 times more common in males than in females. There are about 17,290 new cases of esophageal cancer being diagnosed each year, with 13,480 being men and 3,810 being women. The fiver year survival rate for those diagnosed with esophageal cancer is 21%.

What Are the Symptoms of stomach and esophageal Cancer?

Both stomach and esophageal cancers do not grow very rapidly, therefore they do not cause any significant symptoms during the early stages of the disease. Some non-specific symptoms in the early stages include:

  • Heart burn
  • Abdominal pain especially following meals

Common symptoms in the late stage of esophageal cancer include:

  • Pain or difficulty when swallowing
  • Upper abdominal discomfort especially during meals
  • Blood stained vomitus
  • Easy fatigability and loss of weight
  • Loss of appetite

Common symptoms in the late stage of stomach cancer include:

  • Feeling of fullness in the abdomen even following small meals
  • Nausea and vomiting with blood stained vomitus on occasion
  • Abdominal distention
  • Passage of blackened stools
  • Easy fatigability
  • Loss of weight and loss of appetite

What causes stomach and esophageal cancer?

Although an exact cause for the development of stomach and esophageal cancer cannot be pointed out, there are certain factors associated with an increased risk of developing the disease. These include:

  • Tobacco smoking
  • Consumption of alcohol
  • Family history of any gastrointestinal disorders
  • Being older than 50 years of age
  • Males are at higher risk than females
  • Being overweight or obese
  • Consumption of meals high in pickles and salted foods
  • Having other gastrointestinal conditions such as GORD and Barrett’s Esophagus
  • Infection with Helicobacter Pylori

What tests are used to diagnose stomach and esophageal cancer?

Physical examination is highly unlikely to reveal anything significant to indicate the presence of stomach or esophageal cancer. Therefore it is the investigations which shed light into the presence of this condition. The investigations your doctor might perform on suspicion of stomach and esophageal cancer include:

  • Endoscopy – which is the gold standard investigation for the diagnosis of stomach and esophageal cancer. It is done by passing a thin, flexible tube fitted with a camera at one end, through your mouth into your esophagus and down into your stomach, so that your doctor can visualize the lining of the stomach and esophagus and determine if it looks abnormal. During the procedure, your doctor will also be able to take a biopsy/tissue sample from those areas of the lining which look abnormal.
  • Endoscopic Ultrasound – is again an endoscope fitted with an ultrasound probe, which causes the waves to bounce off anything which is solid, such as a tumor. But this investigation is used very rarely.

What is the treatment for stomach and esophageal cancer?

The type of treatment you will receive depends on the staging of the disease. For this your doctor will use the TNM system, which will be determined using the size of the tumor and the extent of spread of the tumor. You might have to undergo additional scans such as CT, MRI, PET and Bone scan in order to determine if the cancer has spread to other parts of the body.

Treatment of stomach or esophageal cancer has to be individualized according to each patient, depending on the stage of the disease. Therefore you need a specialized team of professionals to care for a patient diagnosed with stomach or esophageal cancer and this includes a GP, Gastroenterologist, Upper Gastrointestinal Surgeon, Endoscopist, Medical Oncologist, Radiation Oncologist, Cancer Nurses, as well as other healthcare workers such as dietician, speech and occupational therapists and social worker.

The treatment modalities available for stomach and esophageal cancer include:

  • Surgery – is the mainstay of treatment for stomach and esophageal cancer. The type of surgery which will be performed will depend on the exact location and size of the tumor.
  • Chemotherapy/Radiotherapy – is used in combination with surgery, sometimes before the surgery to shrink the tumor, or after surgery to prevent the recurrence of cancer.

Palliative care is aimed at symptom relief and slowing down the spread of the cancer, when nothing else can be done to completely cure the condition. Keeping the patient as comfortable as possible with pain relief is an important factor. Palliative care also makes use of chemotherapy, radiotherapy and various other drugs to achieve this.

What is the Prognosis of stomach and esophageal cancer?

The outcome of stomach and esophageal cancer is dependent on many factors such as the stage of the cancer and the exact location of it.The general health condition of the patient such as age, level of fitness and medical history also play a role in determining the outcome of the disease. But when detected in the early stages, both stomach and esophageal cancer have a good prognosis as surgical resection is almost always curative.

Screening for and prevention of stomach and esophageal cancer

There are currently no screening methods available for the early detection of stomach and esophageal cancer.

Alteration of lifestyle factors such as reducing alcohol consumption, weight reduction, consumption of a healthy diet and quitting tobacco smoking, have all shown to reduce the risk of developing stomach and esophageal cancer significantly, even though there is no specific method to prevent the development of these conditions.