Description
Gastric cancer, also known as stomach cancer, is defined by the uncontrolled growth of cancer cells in the stomach. Anywhere in your stomach can develop cancer. The majority of stomach cancer instances in the United States involve abnormal cell growth at the junction of your esophagus and the stomach (gastroesophageal junction). The main portion of your stomach typically develops cancer in other countries where gastric cancer is more prevalent. Stomach cancer typically develops slowly and begins in the stomach lining around 95% of the time. If left untreated, it may expand deeper into your stomach walls and create a lump (cancer). Your pancreas and liver, two adjacent organs, could become infected by the tumor.
Summary Listen
- Gastric cancer typically originates from the inner lining (mucosa) of the stomach. However, other related conditions such as gastrointestinal stromal tumors (GIST) and neuroendocrine tumors exist, arising from different parts of the stomach. Factors like diet and pre-existing gastrointestinal illnesses, including GERD, increase the risk of developing gastric cancer. Common symptoms like indigestion, pain, discomfort, and bloating are often ignored due to unhealthy food habits, potentially delaying diagnosis.
- Early detection relies heavily on a thorough medical history, noting the frequency and recurrence of symptoms. This contrasts with the modern trend of rapid consultations that often bypass detailed history taking. Patient awareness and proactive engagement with healthcare providers are crucial for early diagnosis. Infectious agents like H. Pylori, chronic inflammation, pernicious anemia, intestinal metaplasia, familial syndromes, and viral infections like Epstein-Barr virus are also established risk factors.
- Diagnostic modalities include detailed history taking, blood tests (CBC), endoscopy, ultrasound-guided endoscopy, and barium swallow. CT scans and PET-CT scans help determine the extent of the cancer's spread, while MRI with gadolinium and laparoscopy are also utilized. Biopsies undergo pathological analysis, including H&E staining and immunohistochemistry (IHC) to check for specific markers. Comprehensive genomic profiling can identify molecular subtypes, which is not routinely performed, to inform targeted therapy decisions.
- Metastasis occurs through invasion of different stomach layers, progressing from the mucosa to the outer layers, and spreading through lymphatics and the bloodstream. Detecting metastasis early can significantly alter the treatment approach. Gastric cancer is staged from zero to four, with substages based on the extent of invasiveness and lymph node involvement. Treatment options range from surgery to chemotherapy, radiation therapy, targeted therapies, and immunotherapies.
- While surgery remains a common treatment, it is not always necessary, especially when early detection allows for medical management. Chemotherapy typically involves platinum-based treatments or irinotecan, with platinum preferred due to fewer adverse events. Targeted therapies include drugs like trastuzumab and ramucirumab, which target the VEGF pathway. Immunotherapies, such as checkpoint inhibitors, are becoming increasingly important due to their minimal toxicity and high efficacy.
- Immunotherapies block the communication between tumor cells and the immune system, enabling the immune system to attack the cancer. Drugs like pembrolizumab are widely used, representing a significant advancement in cancer treatment. Overall survival rates for gastric cancer have improved over the past decades due to the advent of targeted therapies and immunotherapies.
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About the Speakers
Dr. Shibichakravarthy Kannan
Precision Oncology, Founder & CEO in Oncophenomics Inc., Hyderabad
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