While the exact cause of gastric cancer is still unclear, there are several risk factors that have been identified, which can contribute to the development of this disease. These risk factors include lifestyle, environmental influences, medical conditions, and genetic factors. Understanding these factors is essential for prevention and early detection.

1. Helicobacter pylori Infection

One of the most significant risk factors for gastric cancer is infection with Helicobacter pylori (H. pylori), a type of bacteria that can infect the stomach lining. This bacterium causes chronic inflammation and is associated with ulcers, gastric atrophy, and precancerous changes in the stomach lining. Over time, the persistent inflammation caused by H. pylori can lead to the development of gastric cancer. H. pylori infection is estimated to be present in more than half of the world’s population, but not all individuals infected with this bacterium will develop gastric cancer.

2. Diet and Nutrition

Diet plays a pivotal role in the development of gastric cancer. A diet high in processed meats, salt, and low in fruits and vegetables can increase the risk of gastric cancer. The following dietary habits have been linked to an elevated risk:

1. High Salt Intake: High consumption of salt, particularly from preserved foods such as pickled vegetables, salted meats, and fermented foods, can damage the stomach lining and increase cancer risk.

2. Low Intake of Fresh Fruits and Vegetables: A lack of essential vitamins and antioxidants from fruits and vegetables can weaken the stomach lining, making it more susceptible to cancer-causing substances.

3. Consumption of Smoked or Charred Foods: Foods cooked at high temperatures, such as grilled or barbecued meats, may produce carcinogens that contribute to stomach cancer risk.

3. Smoking and Alcohol Consumption

Both smoking and excessive alcohol consumption are well-established risk factors for gastric cancer. Smoking introduces harmful chemicals into the body that directly damage the stomach lining and increase the likelihood of mutations in stomach cells. Smoking is particularly associated with an increased risk of adenocarcinoma and gastric lymphoma.

Alcohol, when consumed heavily over time, can irritate the stomach lining and contribute to the development of cancer, particularly when combined with smoking. The carcinogenic effects of alcohol and tobacco can be synergistic, meaning their combined impact is greater than the individual effects of each.

4. Genetic and Family History

A family history of gastric cancer significantly increases an individual's risk of developing the disease. Certain inherited genetic conditions, such as Lynch syndrome, hereditary diffuse gastric cancer (HDGC), and familial adenomatous polyposis (FAP), predispose individuals to higher risks of stomach cancer.

Lynch syndrome, for example, is associated with a mutation in mismatch repair genes, leading to an increased risk of gastric, colorectal, and other cancers. Hereditary diffuse gastric cancer is an inherited condition linked to mutations in the CDH1 gene, which greatly raises the risk of developing diffuse-type gastric cancer at an earlier age.

5. Age and Gender

The risk of developing gastric cancer increases with age, particularly after the age of 50. Men are at higher risk than women, with the male-to-female ratio being approximately 2:1. This gender disparity may be related to differences in risk factors such as smoking, alcohol use, and diet.

6. Previous Stomach Surgery and Medical Conditions

People who have undergone stomach surgery, particularly for other conditions such as peptic ulcer disease or gastric bypass, may have an increased risk of developing gastric cancer later in life. Additionally, certain medical conditions can also elevate risk, such as gastric ulcers, chronic gastritis, Barrett’s esophagus, and gastroesophageal reflux disease (GERD). Individuals with long-standing acid reflux or those who have a history of intestinal metaplasia are more likely to develop stomach cancer.

7. Occupational Exposures

Certain occupations expose individuals to chemicals and substances that may increase the risk of gastric cancer. For example, workers in the rubber, metal, and coal industries may be exposed to harmful chemicals such as benzene and other carcinogens, which can increase the likelihood of developing gastric cancer.

Early-stage gastric cancer often does not present any specific symptoms, which makes it difficult to diagnose. When symptoms do appear, they are typically vague and can be mistaken for less serious digestive conditions, such as indigestion or gastritis. Common symptoms include:

Early Symptoms

1. Indigestion: Feeling of discomfort or burning in the upper abdomen after eating.

2. Heartburn: A persistent burning sensation in the chest or throat.

3. Loss of Appetite: A lack of interest in food or early satiety (feeling full after eating only a small amount).

4. Unexplained Weight Loss: Losing weight without dieting or intentional lifestyle changes.

5. Bloating: Feeling of fullness or pressure in the abdomen, particularly after eating.

Advanced Symptoms

As gastric cancer progresses, symptoms become more severe and may include:

1. Abdominal Pain: Persistent pain or discomfort in the stomach area, often worsening after meals.

2. Nausea and Vomiting: Severe nausea, sometimes accompanied by vomiting, may indicate an obstruction in the stomach.

3. Difficulty Swallowing: Difficulty swallowing food or liquids, particularly as the tumor affects the upper part of the stomach.

4. Blood in the Stool or Vomit: Dark, tarry stools or vomiting blood (hematemesis) are signs of internal bleeding.

5. Fatigue and Weakness: A general feeling of tiredness or weakness, often caused by anemia or the body’s response to cancer.

When to Seek Medical Advice

If any of the symptoms listed above persist for more than a few weeks or worsen over time, it is important to seek medical advice. Early diagnosis and intervention can significantly improve treatment outcomes.

Diagnosing gastric cancer involves a combination of physical examination, imaging studies, and biopsies. Early diagnosis is crucial for improving treatment outcomes and increasing survival rates.

1. Physical Examination

A healthcare provider will start by conducting a thorough physical examination. This includes palpating the abdomen to check for any abnormal masses or tenderness.

2. Endoscopy

The primary diagnostic tool for gastric cancer is upper endoscopy (gastroscopy). A flexible tube with a camera is inserted through the mouth to examine the stomach lining directly. This procedure allows doctors to visualize the cancerous growth and take biopsies of suspicious areas for histological analysis.

3. Imaging Tests

1. CT Scan: A CT scan provides detailed images of the stomach and surrounding organs to assess the spread of cancer.

2. Endoscopic Ultrasound (EUS): This procedure combines endoscopy and ultrasound to assess the depth of the tumor’s invasion into the stomach wall and check for nearby lymph node involvement.

3. Barium Swallow: A barium contrast material is swallowed to help highlight any abnormalities in the stomach lining on X-rays.

4. Biopsy

During an endoscopy, the doctor will take tissue samples (biopsies) from suspicious areas of the stomach. These samples are examined under a microscope to confirm the presence of cancer cells.

5. Blood Tests

Blood tests, such as complete blood count (CBC), can detect signs of anemia, which may be caused by bleeding. Tumor markers such as carcinoembryonic antigen (CEA) or CA 19-9 may also be elevated in some patients with gastric cancer.

Treatment for gastric cancer depends on the stage of the cancer, its location, and the patient’s overall health. The main treatment modalities include surgery, chemotherapy, radiation therapy, and targeted therapy.

1. Surgery

1. Subtotal Gastrectomy: Removal of part of the stomach where the tumor is located. The remaining part of the stomach is then reconnected to the small intestine.

2. Total Gastrectomy: In cases where the tumor has spread throughout the stomach, the entire stomach may need to be removed. This is followed by reconstructive surgery to reconnect the esophagus to the small intestine.

3. Lymph Node Dissection: Lymph nodes near the tumor may be removed to check for cancer spread.

2. Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells or stop them from growing. Chemotherapy may be used in the following scenarios:

1. Neoadjuvant Chemotherapy: Before surgery to shrink the tumor.

2. Adjuvant Chemotherapy: After surgery to kill any remaining cancer cells and reduce the risk of recurrence.

3. Palliative Chemotherapy: For advanced cancer, chemotherapy can help alleviate symptoms and improve quality of life.

3. Radiation Therapy

Radiation therapy uses high-energy rays to target and destroy cancer cells. It is typically used in combination with chemotherapy for localized gastric cancer or to treat metastatic cancer in areas like the liver or lymph nodes.

4. Targeted Therapy

Targeted therapies focus on specific molecules involved in cancer cell growth. Drugs like trastuzumab (Herceptin) are used to target cancers that overexpress the HER2 protein.

5. Immunotherapy

Immunotherapy is used to help the body’s immune system recognize and attack cancer cells. Drugs such as nivolumab (Opdivo) and pembrolizumab (Keytruda) are increasingly used to treat advanced gastric cancer, especially those with specific genetic markers.

While not all cases of gastric cancer are preventable, certain lifestyle changes and early interventions can reduce the risk:

1. Healthy Diet: A diet high in fruits, vegetables, and whole grains and low in processed meats and salt may lower the risk.

2. Quit Smoking: Smoking cessation is one of the most important factors in reducing gastric cancer risk.

3. Limit Alcohol Consumption: Reducing alcohol intake can also decrease the risk of gastric cancer.

4. Treat H. pylori Infection: Eradicating H. pylori infection can prevent the development of gastric cancer, particularly in individuals with precancerous changes.

5. Regular Screenings: For those with a family history of gastric cancer or other genetic risks, regular screenings can help detect the disease early, when it is most treatable.

Without proper treatment, gastric cancer can lead to a range of complications, including:

1. Perforation: A hole in the stomach wall that leads to infection.

2. Metastasis: The spread of cancer to other organs, such as the liver, lungs, and lymph nodes.

3. Obstruction: A blockage in the stomach or intestines, making it difficult for food to pass through.

4. Nutritional Deficiencies: Due to difficulty eating, weight loss, or surgery that affects digestion.

Living with gastric cancer can be physically and emotionally challenging. It is important for individuals with gastric cancer to receive comprehensive care that includes physical, psychological, and nutritional support.

Physical Rehabilitation

1. Nutritional Support: Dietitians can help manage nutritional issues, particularly if the patient has difficulty eating after surgery.

2. Pain Management: Managing pain is essential, especially for those undergoing chemotherapy or radiation therapy.

Emotional Support

1. Psychological Counseling: Coping with the emotional toll of cancer is vital. Support groups and therapy can provide assistance.

2. Survivorship Care: Regular follow-ups and monitoring for recurrence are critical to managing life after treatment.

1. What is Gastric (Stomach) Cancer?