Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about or that we otherwise haven’t been able to report on very often.

Eyes front and ears open. Class is now in session.

The disease that we will be learning about today is:

Stomach Cancer

Sometimes called gastric cancer.

What is Stomach Cancer?

• Stomach cancer is a form of cancer that originates in the lining of the stomach
  • Most stomach cancers are categorized as gastric carcinomas or adenocarcinomas
• Mesenchymal tumors and even lymphoma can also develop in the stomach
• The cancer usually develops slowly over a period of years
  • Survival rates are rather poor because the cancer is often not diagnosed until it reaches an advanced stage
• Around a century ago, stomach cancer was the most common cause of cancer-related death throughout the world
  • Rates of stomach cancer death have since decreased; this may be the result of increased use of refrigeration and less consumption of pickled and salt-cured foods

How Do You Get It?

• Males are twice as likely to develop stomach cancer as females
  • Estrogen may have a protective effect against stomach cancer
• Over half of cases are related to infection with Helicobacter pylori, a type of bacterium.
• Around 10% of cases have a hereditary basis, meaning that they run in families; up to three percent of cases are the result of rare inherited syndromes, including hereditary diffuse gastric cancer
• A wide range of risk factors have been identified that can contribute to the development of stomach cancer. These can include:
  • H. plyori infection is the most important risk factor in the majority of cases. However, only about two percent of people infected with the bacterium ultimately develop stomach cancer. The mechanism appears to involve chronic inflammation
    • AIDs and the Epstein-Barr virus have also been linked to stomach cancer
  • Smoking
  • Alcohol
  • Dietary choices can increase risk as well, but the connection is relatively week. A diet high in red meat, salty foods, smoked foods, pickled foods, processed meat, and bracken can contribute to stomach cancer risk
    • Meanwhile, a diet including fresh fruit, citrus, antioxidants, or a Mediterranean diet reduces risk
  • Obesity
  • Pernicious anemia
  • Diabetes
  • Intestinal metaplasia
  • Menetrier’s disease
  • Chronic atrophic gastritis

What Are the Symptoms?

• In the early stages, stomach cancer doesn’t cause symptoms, or may only cause nonspecific symptoms
• Often, when symptoms are recognized, the cancer has reached an advanced stage or has even metastasized to other parts of the body
• Symptoms can include:
  • Heartburn
  • Indigestion
  • Abdominal pain
  • Loss of appetite, specifically for meat
  • Fatigue
  • Stomach bloating
  • Nausea
  • Vomiting, often with blood
  • Weakness
  • Bloody stools
  • Difficulty swallowing

How Is It Treated?

• Unless detected early, stomach cancer is difficult to cure and treat effectively
• The disease is usually advanced at diagnosis
• Surgery is the only potential cure for stomach cancer.
  • Endoscopic mucosal resection, a procedure developed in Japan, can be effective in early-stage stomach cancer
  • Full gastrectomy, in which the stomach is removed, can also be used, but carries a significant risk of complications
  • Surgery even after metastasis appears to improve survival rates
• Chemotherapy can be used for stomach cancer, but there is no established standard of care and cannot cure the cancer on its own. However, an effective chemo regimen can improve survival.
• Radiation therapy is another option for stomach cancer and is typically used to augment surgery or chemotherapy
• Targeted therapies, such as the HER2 inhibitor trastuzumab, have been demonstrated to improve survival.
• Despite the array of therapies, survival times for stomach cancer are generally poor. Late diagnosis and more frequent diagnosis in the elderly are contributing factors
  • Five-year survival rate is under 10%

Where Can I Learn More???

• Check out our cornerstone on this disease here.
• Learn more from No Stomach for Cancer.