Definition

A stomach or gastric tumor is characterized by the abnormal and excessive growth of cells within the stomach. The stomach is an organ located in the upper part of the abdomen, beneath the ribs. Its primary function is to receive food from the mouth and aid digestion. The stomach comprises several parts, including the fundus, body, and antrum. While gastric tumors can develop in any of these parts, they most commonly occur in the main body of the stomach. The location of the tumor can significantly impact the treatment plan.

According to GLOBOCAN 2018 data, gastric tumors rank as the fifth most common tumor worldwide and the third deadliest.

Causes

The exact cause of stomach tumors remains incompletely understood, although various risk factors have been identified. Stomach tumors arise from alterations in the DNA structure of cells within the stomach. These genetic changes prompt abnormal cell growth and inhibit their normal programmed cell death, known as apoptosis. Consequently, these proliferating cells accumulate, grow larger, and invade surrounding healthy tissue. Over time, these cells may metastasize, spreading to other organs within the body.

Risk factor

Risk factors that can increase the likelihood of developing stomach tumors include:

• Male gender
• Advanced age
• Gastroesophageal reflux disease (GERD)
• Anemia (low blood)
• Obesity
• Consumption of high-salt and spicy foods
• Low intake of fruits and vegetables
• Family history of stomach tumors
• Infection with Helicobacter pylori bacteria
• Chronic (prolonged) inflammation of the stomach (gastritis)
• Smoking
• Presence of stomach polyps

Symptoms

Symptoms of stomach cancer in the initial stages may include:

• Discomfort in the abdomen and frequent belching
• Feeling bloated after eating
• Mild nausea
• Loss of appetite
• Feeling full quickly even after eating a small amount of food
• Heartburn

In later stages, stomach tumors can lead to the following symptoms:

• Presence of blood in stool
• Vomiting
• Unexplained weight loss
• Abdominal pain
• Yellowing of the eyes and skin (jaundice)
• Abdominal swelling (ascites)
• Difficulty swallowing

Diagnosis

To establish a diagnosis of a stomach tumor, doctors typically rely on symptoms, physical examination, and results of diagnostic tests. These tests may include:

• Endoscopy: A procedure involving the insertion of a camera-shaped tube through the esophagus and into the stomach to visualize any abnormal structures. This examination is usually painless but may cause slight discomfort. Biopsy samples may be taken during endoscopy for further examination under a microscope.
• Radiological examinations: CT scans or barium swallow tests can be performed to check for abnormalities in the stomach structure. Barium swallow involves swallowing barium while X-rays are taken to enhance visualization.

If a tissue sample confirms the presence of a stomach tumor, further examinations may be performed to determine the stage of the tumor. These may include:

• Blood tests: These are used to assess the function of other organs, such as the liver, which may be affected by stomach tumors.
• Laparoscopic examination: A minimally invasive surgery to view the abdominal area.
• Additional radiological examinations such as CT scans or PET scans.
• Endoscopic ultrasound (EUS): Similar to endoscopy, this procedure involves inserting a camera through the mouth to view the stomach. Additionally, high-energy waves are used to determine the depth of tumor invasion and stage.

Management

The stages of stomach cancer are as follows:

• Stage 0: Unhealthy cells are present on the stomach's lining (mucosa), but they have not developed into a tumor. Treatment options may include surgery (gastrectomy) or mucosal resection to remove the abnormal cells.
• Stage I: The tumor has spread to deeper layers (submucosa) of the stomach and may involve 1-2 nearby lymph nodes. Treatment options may include surgery, mucosal resection, surgery followed by chemoradiation, or surgery combined with chemotherapy.
• Stage II: The tumor has spread to the muscle wall of the stomach and may involve 3-15 nearby lymph nodes. Treatment options may include surgery, surgery with chemotherapy, or surgery combined with chemoradiation or chemotherapy.
• Stage III: The tumor has reached all layers of the stomach and may involve nearby organs such as the spleen, large intestine, pancreas, kidneys, etc. Treatment options may include surgery, surgery with chemotherapy, or surgery combined with chemoradiation or chemotherapy.
• Stage IV: The tumor has spread to distant organs such as the lungs, liver, lymph nodes far from the stomach, and the posterior wall of the abdomen. Treatment options may include chemotherapy, targeted therapy, immunotherapy, radiation therapy, and laser therapy. Surgery is generally not an option at this stage and is only considered for palliative purposes, such as controlling bleeding.

The treatment choice depends on the tumor's stage, location, extent of spread, and the patient's overall health condition. Before deciding on a treatment plan, the doctor will thoroughly explain each treatment option's procedures, potential risks, and benefits and help the patient choose the most suitable approach.

Complications

Complications of stomach tumors may include:

• Gastrointestinal bleeding
• Gastric perforation (presence of a hole in the stomach)
• Intestinal obstruction
• Malnutrition and malabsorption
• Death

The recoverability of stomach cancer is influenced by several factors, including the cancer stage and the patient's general health condition. In general, if the tumor is detected early, the chance of recovery is higher. However, if the tumor is found at an advanced stage, the chance of recovery is smaller.

Prevention

To reduce the risk of stomach tumors, consider the following:

• Maintain optimal body weight: If overweight or obese, aim for gradual weight loss through healthy lifestyle changes.
• Consume fruits and vegetables: Incorporate a variety of fruits and vegetables into your diet to promote overall health and reduce the risk of stomach tumors.
• Reduce intake of salty and grilled foods: Limiting consumption of salty and grilled foods may help protect against stomach tumors.
• Quit smoking: Smoking increases the risk of stomach tumors and other cancers. If you smoke, seek support to quit, and if you don't smoke, avoid starting.
• Be cautious with medications: Use medications such as aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs) cautiously.
• Discuss risk factors with your doctor: If you have a family history of stomach tumors or other risk factors, consult your doctor about potential screening tests, such as endoscopy, to detect early signs of stomach tumors.

When to see a doctor?

If you experience disturbing persistent symptoms that have lasted for more than two days, it's important to consult the nearest health facility. A doctor will conduct further examinations to determine the cause of your symptoms.