What patients need to know about gastric cancerThis medical guide is designed to provide the backgroundand necessary information for gastric cancer management.Discussions with your healthcare provider will help you further understand symptoms, risks, and overall health.

GASTRIC CANCER

GASTRIC CANCER What patients need to know about gastric cancer

How does a healthy stomach work?

Fundus

Middle

Pylorus

Cardiac sphincter

Pyloric sphincter

Bowel

Esophagus

The stomach is a part of the digestive system. It is a muscular bag that digests your food by churning it with the acidic juices and pepsin produced in the walls of the stomach. The thick liquid mixture moves down to the bowel where the body absorbs it. To protect its lining from the acid and pepsin when it is empty, the stomach produces a thick mucus.1

Esophagus: The food pipe that carries the food from your mouth to your stomach. Cardiac sphincter: The valve at the top of the stomach that joins with the esophagus. Fundus: The upper part of the stomach. Pylorus: The end part of the stomach which marks the end of the stomach and the beginning of the small intestine. Pyloric sphincter: The valve at the bottom of the stomach that joins with the small intestine.

What patients need to know about gastric cancer

CONTENTS• How does a healthy stomach work?

• What is gastric cancer?

• What are the different types of gastric cancer?

• What causes gastric cancer?

• What are the symptoms of gastric cancer?

• How is gastric cancer diagnosed?

• How is gastric cancer treated?

• Living with gastric cancer

• Frequently asked questions

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GA

STRI

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CA

NC

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GASTRIC CANCER What patients need to know about gastric cancer

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NormalGastric Cancer

What is gastric cancer?

Stages of Gastric Cancer

Stage 0 Stage IVStage I Stage II Stage III

MucosaSubmucosa

Muscle

Outer layer (serosa)

Gastric cancer commonly begins in the inner lining of the upper part of the stomach. It can spread through the walls of the stomach and invade other organs or spread to the lymph vessels and nodes.2-4

Gastric cancer can be staged from 0 to IV. Stage 0 is when the tumour is found only in the inner layer of the stomach. As the stage number increases, the bigger the cancer has grown and the further the cancer has spread.5

Gastric cancer, also called stomach cancer, begins when stomach cells grow excessively and build up to form a tumour. These tumours are harmful if they are malignant or cancerous. 2-4

Tumour Healthy mucosa

Tumour

GASTRIC CANCER What patients need to know about gastric cancer

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Adenocarcinoma Gastroesophageal cancer

Gastroesophageal junction cancer

Esophagus

Gastroesophageal junction

Gastric cancer

What are the different types of gastric cancer? Stomach cancer may include other rare cancers that develop inside

the stomach. They include:7

A type of skin cancer that begins in the squamous cells (cells of the middle and outer layer of the skin)12

Squamous Cell Cancer

Cancer that starts in the lymph nodes of the lymphatic system8Lymphoma

A common type of soft tissue sarcoma that develop in smooth muscle cells11Leiomyoarcoma

Rare tumours that develop in nerve or gland cells of the neuroendocrine system10

Neuroendocrine Tumours

A rare type of sarcoma found in the wall of the stomach9

Gastrointestinal Stromal Tumour

(GIST)

The most common type of cancer is adenocarcinoma. This type of cancer forms in the gland cells that line the stomach.6

Recently, the rates of cancer in the stomach body have been decreasing while the number of cancer in the gastroesophageal junction (where the lower end of the esophagus and the top part of the stomach meet) has been increasing.6

This type of cancer is called gastroesophageal cancer.6

GASTRIC CANCER What patients need to know about gastric cancer

Gender

Gastric cancer occurs more often in males than in females.

Family History

Those who have a family history of stomach cancer have a higher risk of getting the disease.

Infection with Helicobacter pylori Bacteria

Long term infection with Helicobacter pylori, a type of bacteria that lives in the mucus of the stomach’s lining, increases the risk of gastric cancer.

Lifestyle Factors

Smoking and a poor diet that is high in pickled, smoked, processed, and salted foods and low in fresh fruits and vegetables are highly linked with gastric cancer.

Age

The risk of gastric cancer increases with age like many other types of cancer. Most men who are diagnosed with gastric cancer are above 50 years old and around half of gastric cancers develop in people aged 75 or over.

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What causes gastric cancer? Although the exact cause of how cells in the stomach lining become cancerous is still unknown, there are several risk factors that are associated with gastric cancer including:13-15

GASTRIC CANCER What patients need to know about gastric cancer

What are the symptoms of gastric cancer?Many symptoms of gastric cancer can be easily mistaken for symptoms of other health problems, such as ulcer.

However, it is very important for you not to leave them unnoticed. If you have any of these symptoms, it is highly recommended that you consult with your doctor.16

Nausea and vomiting Stomach pain Unintended

weight lossHaving blood

in vomit or stool

Difficulty in swallowing or

digesting

Feeling full or bloated after eating a small

amount of food

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Symptoms of Gastric Cancer

GASTRIC CANCER What patients need to know about gastric cancer

Endoscopy Ultrasound

x-rayBiopsy

Endoscopy Ultrasound

x-rayBiopsy

Endoscopy Ultrasound

x-rayBiopsy

MRI PET

MRI PET

MRI PET

MRI PET

Endoscopy Ultrasound

x-rayBiopsy

How is gastric cancer diagnosed?

Diag nosis of gastri c cancer

Upper endoscopyThe main test used to find stomach cancer

Endoscopic ultrasoundAn ultrasound procedure that uses a small transducer placed on the tip of the endoscope

BiopsyThe removal of a sample of stomach cells through endoscopy for analysis

Upper gastrointestinal (GI) seriesAn x-ray that is used to look at the inner lining of the esophagus, stomach, and first part of the small intestine

If gastric cancer is suspected, the doctor will review your medical history and examine you to confirm the diagnosis.

Endoscopy: A procedure that uses a thin, flexible tube with a small video camera on the end (endoscope) and passes it down the throat to see the linings of the esophagus and the stomach. Endoscopic ultrasound: Ultrasound procedure that has the transducer rest directly on the wall of the stomach where the cancer is located. Upper gastrointestinal (GI) series: An x-ray procedure that requires the patient to drink a substance called barium that coats the lining of the esophagus, stomach, and small intestine prior to imaging.

CT (computerized tomography) scan: a type of scan that uses series of X-rays that build up a 3D picture of inside the body. MRI (magnetic resonance imaging) scan: a type of scan that uses strong magnetic fields and radio waves to produce detailed images of inside the body. PET (positron emission tomography) scan: a type of scan that creates a picture using a radioactive substance that is injected into the vein.

Tests and procedures used to diagnose both adenocarcinoma and gastroesophageal cancer include:17

CT/CAT scanTo check the spread of cancer through detailed cross–sectional images of the body

MRI scanA scan that uses radio waves and strong magnetic fields instead of x-rays

PET scanTo find out whether the cancer has spread to other areas of the body

Chest X-rayTo find out if the cancer has spread to the lungs

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Diagnosis of Gastric Cancer

GASTRIC CANCER What patients need to know about gastric cancer

Hormone theraphy

Radiation theraphy Surgery

chemotheraphy

Targeted theraphy

How is gastric cancer treated? Depending on the location, size, type, and stage of your gastric cancer, there are various ways to treat the disease. The main treatments include:18, 19

Hormone theraphy

Radiation theraphy Surgery

chemotheraphy

Targeted theraphy

Obesity Alcohol Radiation therapy

Hormone Therapy Birth control

Hormone theraphy

Radiation theraphy Surgery

chemotheraphy

Targeted theraphy

Targeted Therapy

Targeted therapy is a drug-treatment that attacks specific cell irregularities or directs the immune system to kill cancer cells. Some targeted drugs used to treat stomach cancer include trastuzumab, ramucirumab, imatinib, sunitinib, and regorafenib.

Chemotherapy

Chemotherapy is a cancer-killing drug treatment given by injection or by mouth. It is often combined with radiation therapy. Chemotherapy regimens that are useful in treating gastric cancer include capecitabine, docetaxel, epirubicin, etc.

Surgery

Surgery is done to remove all of the stomach cancer, typically along with nearby lymph nodes. This may also mean removing a margin of healthy tissue around the stomach cancer.

Radiation Therapy

Radiation therapy uses high-energy beams such as X-rays and protons to kill cancer cells.

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GASTRIC CANCER What patients need to know about gastric cancer

Living with gastric cancer

Stay active. Do not let your diagnosis prevent you from enjoying the things you normally do.20

Do not be afraid to join a support group. Connecting with other cancer survivors will help you cope with your physical and emotional changes.20

Make sure you are well-informed about the details of your cancer and the benefits and risks of each treatment option. Frequent communication with your doctor is very important.20

A diagnosis of any form of cancer can be overwhelming. It is very normal to feel frightened at first, but once you begin to adjust after the initial shock from your diagnosis, self-management will help you cope with the disease.

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GASTRIC CANCER What patients need to know about gastric cancer

3. What can reduce my risk of gastric cancer?20

You can reduce your risk of gastric cancer by making small changesin your everyday life. These include regular exercise, a well-balanceddiet, reduction of the amount of salty and smoked foods you eat,and nonsmoking.

4. Does gastric cancer cause problems with eating?21

Yes, gastric cancer and its treatment can cause problems witheating. These include indigestion, diarrhea, steatorrhea, morningsickness, weight loss, and dizziness. It is important to consumeenough protein and maintain healthy eating habits in order to keepyour weight and strength in balance.

5. What is HER2-positive gastric cancer?22,23

About 20% of stomach cancer patients exhibit overexpression of agrowth-promoting protein called HER2 in a number of solid tumours.Tumours with increased levels of HER2 are called HER2-positive.There is increasing evidence that HER2 is an important biomarker ingastric and gastro–esophageal junction tumours.

1. How does endoscopy work? Does it hurt?17

During endoscopy, a thin, flexible tube is inserted down your throat.This tube has a small video camera on the end, which allows thedoctor to see the lining of your esophagus, stomach, and thefirst part of your small intestine. If any abnormalities are noticed,tissue samples can be taken using the instruments through theendoscope. Prior to the test, you will be given medication to makeyou sleep. This process is called sedation.

2. How is targeted therapy different from chemotherapy?18

The drugs in chemotherapy travel throughout your body andkill cancer cells that have possibly spread outside of the stomach.On the other hand, drugs in targeted therapy directly attack specificabnormalities within cancer cells. For instance, immunotherapyis a type of targeted therapy where the drug directs the immunesystem to kill the cancer cells.

Frequently asked questions

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References1. Cancer Research UK. About Stomach Cancer. Available at: http://www.cancerresearchuk.org/about-cancer/stomach-cancer/about-stomach-cancer. Accessed December 2017. 2. American Cancer Society. What is Stomach Cancer? Available at: https://www.cancer.org/cancer/stomach-cancer/about/what-is-stomach-cancer.html. Accessed December 2017. 3. Gastric Cancer Foundation. Cancer Cells. Available at: http://www.gastriccancer.org/about-gastric-cancer/what-is-gastric-cancer/cancer-cells/. Accessed December 2017. 4. Cancer Council Australia. What isstomach cancer?. Available at: http://www.cancer.org.au/about-cancer/types-of-cancer/stomach-cancer.html#jump_1. Accessed December2017. 5. Gastric Cancer Foundation. Stomach Cancer Stages. Available at: http://www.gastriccancer.org/about-gastric-cancer/symptoms/stages/ Accessed December 2017. 6. Mayo Foundation for Medical Education and Research. Overview. Available at: http://www.mayoclinic.org/diseases-conditions/stomach-cancer/home/ovc-20202327. Accessed December 2017. 7.Cancer Research UK. Types and grades. Available at:http://about-cancer.cancerresearchuk.org/about-cancer/stomach-cancer/getting-diagnosed/types-and-grades. Accessed December 2017. 8. Cancer Research UK. About non Hodgkin Lymphoma. Available at: http://www.cancerresearchuk.org/about-cancer/non-hodgkin-lymphoma/about. Accessed December 2017. 9. Cancer Research UK. Gastrointestinal stroma tumour (GIST). Available at: http://www.cancerresearchuk.org/about-cancer/soft-tissue-sarcoma/types/gastrointestinal-stromal-tumour-gist?_ga=2.223488728.23076236.1510540289-1372855996.1510540289. Accessed December 2017. 10. Cancer Research UK. About neuroendocrine tumours (NETs). Available at: http://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/about. Accessed December 2017. 11. Cancer Research UK. Types of soft tissuesarcoma. Available at: http://www.cancerresearchuk.org/about-cancer/soft-tissue-sarcoma/types?_ga=2.170536291.23076236.1510540289-1372855996.1510540289. Accessed December 2017. 12. Mayo Foundation for Medical Education and Research. Squamous cell carcinoma ofthe skin. Available at: https://www.mayoclinic.org/diseases-conditions/squamous-cell-carcinoma/symptoms-causes/syc-20352480. Accessed December 2017. 13. American Cancer Society. Do We Know What Causes Stomach Cancer? Available at: https://www.cancer.org/cancer/stomach-cancer/causes-risks-prevention/what-causes.html. Accessed December 2017. 14. Cancer Council Australia. Causes of stomach cancer.Available at: http://www.cancer.org.au/about-cancer/types-of-cancer/stomach-cancer.html#jump_3. Accessed December 2017. 15. CancerResearch UK. Causes and risks of stomach cancer. Available at: http://www.cancerresearchuk.org/about-cancer/stomach-cancer/causes-risks. Accessed December 2017. 16. Gastric Cancer Foundation. Stomach Cancer Symptoms. Available at: http://www.gastriccancer.org/about-gastric-cancer/symptoms/. Accessed December 2017. 17. American Cancer Society. How Is Stomach Cancer Diagnosed? Available at: https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed December 2017. 18. Mayo Foundationfor the Medical Education and Research. Treatment. Available at: http://www.mayoclinic.org/diseases-conditions/stomach-cancer/diagnosis-treatment/treatment/txc-20202344. Accessed December 2017. 19. American Cancer Society. Chemotherapy for Stomach Cancer. Availableat: https://www.cancer.org/cancer/stomach-cancer/treating/chemotherapy.html Accessed December 2017. 20. Mayo Foundation for theMedical Education and Research. Self-management. Available at: http://www.mayoclinic.org/diseases-conditions/stomach-cancer/manage/ptc-20202330. Accessed December 2017. 21. Cancer Research UK. Eating problems. Available at: http://about-cancer.cancerresearchuk.org/about-cancer/stomach-cancer/living-with/eating-problems. Accessed December 2017. 22. American Cancer Society. Targeted Therapies forStomach Cancer. Available at: https://www.cancer.org/cancer/stomach-cancer/treating/targeted-therapies.html Accessed December 2017. 23. Josef Ruschoff, Wedad Hanna, Michael Bilous, et al. Modern Pathology. 2012;25:637–650.

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