Q. What is stomach cancer?

A. There are two main types of stomach cancer: called the intestinal and diffuse types. Intestinal stomach cancer is more common amongst older patients and patients from 'high-risk' groups (e.g. the Japanese and Koreans). Diffuse stomach cancer is found more frequently in women and people with blood group A. This variety of stomach cancer is more difficult to treat.

 

Q. How common is stomach cancer?

A. Stomach cancer is more common than most people realise. Each year there are 59,300 cases in the USA, 2,800 in Canada, 2,000 in Australia and 9,100 in the UK. However, it used to be much more common in the west. Fifty years ago it was the most common type of cancer. Now it is number five or six in most western countries. Currently, the incidence is much higher in places like Korea, Japan, Russia and some South American countries. Worldwide, there are nearly 800,000 cases each year.

 

Q. Who is most likely to get stomach cancer?

A. Like many cancers, this type is most common in older people. Few cases occur below 50 years of age and the highest rates are in men and women over 70. Men are twice as likely to get stomach cancer as women. The risk of stomach cancer also depends a lot on where you live (see above). Korea and Japan have the highest rates, ten times the rate in the USA. The function of the stomach and the wide differences in stomach cancer rates between different countries make it almost certain that the food we eat is - or was - a major factor in the cause. The likely reason that the number of cases has dropped over the last fifty years is that refrigeration of food became common and people ate less pickled, salted, smoked and cured foods.

 

Q. Who is at risk of stomach cancer?

· Diet - eating a diet high in preserved foods has been linked with higher rates of stomach cancer (see above).

· Gender - stomach cancer is almost twice as common in men as in women.

· Other diseases - people with pernicious anaemia or achlorhydria are more likely to get stomach cancer.

· Infections- stomach infections by a bacterium called Helicobacter pylori, which is a major cause of stomach ulcers, is also associated with a much higher risk of stomach cancer.

· Smoking - this is also known to increase the risk of getting stomach cancer.

 

Q. Does stomach cancer run in families?

A. A few cases of stomach cancer (about one in ten) appear to run in the family. We do not yet understand which genes are involved, so genetic testing is not yet possible.

 

Q. What are the symptoms of stomach cancer?

A. Early stomach cancer often has no symptoms or merely causes a stomach ache. As it becomes more advanced, it can cause loss of appetite, nausea, vomiting, severe stomach pain and weight loss. Since many of these symptoms are also caused by food poisoning, stomach ulcers and several other conditions, all too often stomach cancers are not diagnosed until they are quite advanced.

 

Q. How is stomach cancer diagnosed?

A. Normally, a procedure called endoscopy is used to see the inside of the stomach. Under sedation, a thin fibre-optic tube is passed down the throat. The inside of the stomach is lit up and photographed. Any growths can be spotted relatively easily by this method. Sometimes, more sophisticated endoscopes are used which can take a small sample of the stomach lining or even take an ultrasound scan from the inside of the stomach.In some cases, a barium meal is used instead of endoscopy. The patient is given a white liquid to drink, containing the element barium. Then the stomach is observed through an X-ray screen. The way that the barium flows through the stomach will reveal any growths.

 

Q. How is stomach cancer treated?

A. The main form of treatment is surgery. Sometimes only part of the stomach is removed, but in the more severe cases, it is necessary to remove the whole stomach. This is a major operation which will affect the amount and types of food of that can be eaten. Quite often, patients are given a course of drug treatment (chemotherapy) after the operation, to attack any remaining cancer cells. Sometimes, the chemotherapy is given first, because it will cause the tumour to shrink and make it easier to remove by surgery.

 

Q. How effective are the treatments?

A. In many countries, most cases of stomach cancer are not diagnosed until they are advanced, so the success rate of treatment is not high. Where there is a national screening programme and these cancers are usually diagnosed early, the success rate is much higher.In the USA, Canada, Australia and most of Europe, the treatments work for about one in four to one in five patients, by which we mean that they live for at least five years after the cancer is diagnosed. The UK, the success rate is noticeably lower, with only one in seven UK patients cured. In Japan, where there is a screening programme for stomach cancer, most cases are diagnosed early and over 50% of patients are treated successfully.