Gastric cancer

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Gastric cancer
Antigenics Inc.


What is gastric cancer?
Most cancers of the stomach are adenocarcinomas, a type of cancer that develops in the mucosal cells that form the innermost lining of the stomach. Other types of stomach cancers include lymphomas and sarcomas. Stomach cancer can be hard to detect early. Often there are no symptoms in the early stages and, in many cases, the cancer has spread before it is found. As the disease progresses, the cancer may invade the stomach wall and/or metastasize (spread to other parts of the body).

How many people get gastric cancer?
The American Cancer Society estimates that in 2007, about 21,260 new cases of gastric cancer will be diagnosed in the United States, and that about 11,210 people will die of the disease. Most people diagnosed with stomach cancer are in their 60s and 70s. The majority of people diagnosed with gastric cancer are over the age of 65.

What causes gastric cancer?
Gastric cancer is a major cause of cancer death worldwide, especially in developing countries. Although infection with Helicobacter pylori bacteria may be a risk factor, the exact cause of stomach cancer is unknown. Certain populations appear to be at higher risk, with the incidence of gastric cancer highest in Central Europe, South America, and Asia, especially Japan. Yet over the past several decades, the frequency and mortality associated with gastric cancer have decreased significantly in the United States. For example, since 1930, the incidence has declined about fourfold to about seven cases for every 100,000 people. The reasons for this decline are unknown, but it has been proposed that it may be related to changes in diet and improved food storage.

How is gastric cancer diagnosed?
People who have stomach cancer rarely have symptoms in the early stages of the disease, which is one of the reasons why stomach cancer is so hard to find early. The signs and symptoms of gastric cancer may include:

Unintended weight loss and lack of appetite
Abdominal pain
Vague discomfort in the abdomen, often above the navel
A sense of fullness just below the chest bone after eating a small meal
Heartburn, indigestion or ulcer-type symptoms
Nausea
Vomiting, with or without blood
Swelling of the abdomen
It is important to note that many of these symptoms can be caused by conditions other than cancer. However, in people who are over 50 years old or have stomach cancer risk factors, a doctor should be consulted if any of these problems persist for a long time.

How is gastric cancer staged?
Staging is the process of finding out how far the cancer has spread. It is very important because, to a large extent, treatment and outlook for recovery depend on the stage of the cancer. In general, the lower the number, the less the cancer has spread.

Stage 0 The cancer is located in the inner layer of the stomach (epithelium) but has not yet spread to the second layer (lamina propia).
Stage I The cancer has started to penetrate toward the outer layer of the stomach (lamina propia, submucosa, muscularis propia or subserosa), and nearby lymph nodes may be involved.
Stage II The cancer has penetrated the lining of the abdominal cavity but has not invaded adjacent organs, or more distant lymph nodes may be involved.
Stage III The cancer has spread to nearby organs such as the liver or kidney, or more distant lymph nodes may be involved.
Stage IV The cancer has spread to nearby organs or metastasized to more distant places in the body.

Is gastric cancer fatal?
The overall five-year survival rate of people with stomach cancer in the United States is about 21 percent. The five-year survival rate for early stage cancers of the upper part of the stomach is about 10 percent to 15 percent. For early stage cancer of the lower portion of the stomach, the five-year survival rate is 50 percent.

How is gastric cancer treated?
Overall, stomach cancers are difficult to detect and treat effectively. The three main treatments for gastric cancer are surgery, chemotherapy and radiation therapy. Surgery to remove the cancer (gastrectomy) is common for all stages of cancer and may be curative for early, localized disease. However, in cases of advanced disease, long remissions are uncommon and the cancer returns (or recurs) in about 80 percent of patients after surgery. Chemotherapy and radiation therapy can also be used to treat and relieve symptoms of the disease. New approaches to the treatment of gastric cancer include the use of antibodies to deliver targeted radiation or chemotherapeutic agents directly to cancer cells, and vaccine therapy to boost the ability of the immune system to recognize and attack cancer cells.



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