Stomach Cancer

Adenocarcinoma of the stomach
More than 95 out of 100 stomach cancers are adenocarcinomas. This means that the cancer started in the stomach lining's gland cells.

Squamous cell cancers
Squamous cells make up your stomach lining. This type of cancer is treated the same as adenocarcinomas.

Lymphoma of the stomach
This very rare form develops in the lymphatic tissue that drains away fluid and helps to fight infections.

Gastrointestinal stromal tumour (GIST)
These rare tumours develop in the muscle or connective tissue of the stomach wall.

Neuroendocrine tumours
These tumours grow in the tissues that produce hormones in your digestive system.

Stomach cancer is caused when cells in your stomach change. What causes these cells to change isn't understood, but there are certain risk factors that are linked to an increased chance of developing stomach cancer. Risk factors include:

• growing older - stomach cancer is most often diagnosed around 70
• gender - men are twice as likely as women to develop stomach cancer
• smoking - smokers are twice as likely as non-smokers to develop stomach cancer
• helicobacter pylori infection
• a diet rich in pickles, salted fish, salt and smoked meats
• family history.

Some medical conditions can also increase your risk of getting stomach cancer these include:

• pernicious anaemia and atrophic gastritis
• stomach surgery for another reason.

Symptoms of stomach cancer include:

• persistent indigestion, acidity and burping
• feeling full up more quickly than normal
• unintentionally losing weight
• vomiting, which may contain blood
• blood clots, which can cause pain or swelling in a leg, sudden chest pain or breathlessness
• difficulty swallowing
• blood in your faeces (poo)
• feeling tired and breathless.

Lots of these symptoms can be signs of other health conditions. But it's important that you see your doctor as soon as you notice them. The sooner a problem is identified, the easier it is to treat.

Your doctor may refer you to a consultant gastroenterologist (a doctor who specialises in the digestive system) for further tests. At BMI Healthcare, we have a team of expert consultants who can help to diagnose and treat your condition.

Diagnosing stomach cancer

Your doctor will want to examine your tummy to feel for any tenderness or a lump. They'll also ask you about your general health and symptoms. You may also need further tests, in which case you'll need to see a consultant gastroenterologist.

At BMI Healthcare, your consultant gastroenterologist may run tests including:

• Blood tests and X-rays to check your general health
• An endoscopy. This is the main test to diagnose stomach cancer. This means your consultant will look at your stomach using a long, thin tube with a camera on the end called an endoscope
• An ultrasound endoscopy. Sometimes, the endoscope will have an ultrasound probe on the end so your consultant can take ultrasound scans
• A barium meal so that your stomach shows up on an X-ray. You'll need to swallow a chalky liquid that contains barium. This test is quite uncommon though
• Laparoscopy. A consultant will make a small cut in the lower part of your tummy so they can use a very thin camera called a laparoscope to see inside your stomach
• CT scans or PET scans to take a series of X-rays that build up a detailed picture of the inside of your body
• A liver ultrasound scan might be needed if there's a chance your stomach cancer has spread to your liver.

TNM staging system for stomach cancer4
After your tests, your consultant will tell you what stage your cancer is at by looking at a sample of your cancer cells under a microscope. This describes the spread of your cancer and will influence the type of treatment you're offered.

The most commonly used system for stomach cancer is the TNM system.

• T is the size and spread of your tumour. You'll be given a number between 0 and 4
• N measures the number of nearby lymph nodes that have cancer cells in them. You'll be given a number between 0 and 3
• M tells you whether or not the cancer has spread to other parts of your body. 0 means it hasn't spread. 1 means that it has spread.

Number stages of stomach cancer5
Sometimes, the number system will be used to describe the stage of your stomach cancer.

Stage 1

• The cancer is confined to your stomach's inner lining and may have spread to one or two lymph nodes
• Or the cancer has spread to the stomach's muscle layer, but there's no cancer in the lymph nodes.

Stage 2

• The cancer has spread to the stomach's lining and to three or more lymph nodes
• Or the cancer has started growing in the stomach's muscle layer and one to six lymph nodes
• Or the cancer has reached the stomach's outer layer, but no nearby tissues or lymph nodes are affected.

Stage 3 (locally advanced stomach cancer)

• The cancer has spread to the stomach's muscle layer and at least seven lymph nodes
• Or the cancer has reached the stomach's outer layer and three or more lymph nodes
• Or the cancer has grown through the stomach wall, into lymph nodes or nearby tissues.

Stage 4 (advanced or metastatic stomach cancer)

• The cancer has spread beyond the stomach to other parts of your body, like your lungs or bones.

For more information about each stage, please read Cancer Research's article about the stages of stomach cancer.

4 Macmillan, Staging and grading of stomach cancer: TNM staging system http://www.macmillan.org.uk/Cancerinformation/
Cancertypes/ Stomach/Symptomsdiagnosis/ Staginggrading.aspx#DynamicJumpMenuManager_3_Anchor_1
5 Macmillan, Staging and grading of stomach cancer: Number staging system http://www.macmillan.org.uk/Cancerinformation/
Cancertypes/ Stomach/Symptomsdiagnosis/ Staginggrading.aspx#DynamicJumpMenuManager_3_Anchor_1

The type of treatment you're offered depends on the type and stage of your stomach cancer, plus your overall health.

Surgery to remove the stomach cancer

f your stomach cancer has been diagnosed at an early stage, it may be possible to remove it with surgery.

Surgery to relieve symptoms

If you can't have surgery to remove the cancer, you might still need surgery to help to relieve your symptoms and improve your quality of life. This might involve using stents to help any blockages in your stomach. If your cancer has caused a blockage at either the entrance or exit to your stomach, you might need to have bypass surgery to get rid of the blockage so you can eat and drink.

Chemotherapy

You might need chemotherapy to treat your stomach cancer. This can be given before surgery to help shrink the tumour and make it more operable. Alternatively, you might need it after surgery to help prevent the cancer from returning. Depending on how advanced your cancer is, you might need chemotherapy to help shrink the cancer, slow its growth or relieve your symptoms.

If you have a stage 2 or 3 cancer, it's likely that you'll need chemotherapy before and after surgery to help prevent the cancer from coming back.

Radiotherapy

It's quite uncommon to use radiotherapy to treat stomach cancer, but it is sometimes used with advanced stomach cancer to help relieve symptoms like bleeding.

Biological therapy

Biological therapy is sometimes used to treat advanced stomach cancer. It's more commonly used to treat breast cancer, but it's effective against some stomach cancers. Some cells from your tumour will be tested to see if they produce the protein human epidermal growth factor receptor 2 (HER2). If they, do this might be an effective treatment for you.

After treatment

You'll have regular check-ups following your treatment. How often and for how long depends on the kind of treatment that you had.

At follow-up appointments, your consultant will ask how you're feeling and examine you. You might also need blood tests, a CT scan or ultrasound, or a combination of these tests.

If you're worried or spot any new symptoms between appointments, you should tell your consultant as soon as you can.

Paying for your treatment 

You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostics cost and treatment is covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the surgeon's fee, the consultant radiologist's fee and the hospital charge for your procedure.

Want to know more?

If you'd like to read more about stomach cancer, treatment or living with stomach cancer, please visit cancerresearchuk.org.uk.