Stomach cancer

There are two main types of cancer of the stomach, also named gastric cancer: adenocarcinoma of the intestinal type and cancer of the diffuse type (with isolated cells). There are also other less common types of stomach cancer.

Risk factors include infection by the bacterium Helicobacter pylori , auto-immune atrophic gastritis, alcohol, tobacco, nitrite-rich diet (additives added to food) and hereditary reasons.

The main symptoms of stomach cancer

Manifestations of stomach cancer include unexplained weight loss, abdominal pain, and/or dysphagia . 

Diagnosis and determination of the type of stomach cancer requires gastroscopy with biopsies, upper endoscopy , CT scan of the abdomen and the chest, blood test and, in some cases, surgical exploration of the abdominal cavity (exploratory laparoscopy). Sometimes, a PET scan may be recommended.

Surgery, the treatment of choice for stomach cancer

Treatment strategy for stomach cancer is discussed during a multidisciplinary meeting named tumor board  . When removal of the tumor is possible, surgery is the treatment of choice for stomach cancer. Perioperative chemotherapy before and after resection is indicated in locoregional advanced disease. 

Depending on the type of cancer and its location, a subtotal or total gastrectomy with D2 lymph node dissection is indicated. The surgical procedure is performed under general anesthesia by laparoscopy with robotic assistance or by laparotomy depending on the tumor stage. The digestive tract is surgically reconnected by a Roux-en-Y reconstruction to avoid biliary reflux. Thereafter, in case of locoregional advanced disease a chemotherapy is generally proposed.

In some cases of early stage cancer of small size without lymph node involvement, i.e. limited to the superficial layers of the stomach wall, endoscopic submucosal dissection of the tumor may be proposed.

If the tumor is non-resectable, palliative chemotherapy and/or immunotherapy with or without radiation therapy may be given.

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