By Brijesh Ghelani

Stomach cancer, often also referred to as gastric cancer, can start in any part of the stomach and then spread to other parts of the body such as the esophagus, liver, lungs and lymph nodes before it is discovered. This can often be attributed to the fact that it has no noticeable early symptoms or perhaps it can be better said that the early symptoms are easily and often attributed to other causes, such as heartburn, indigestion or loss of appetite. It has been noted that people in the early stages of this cancer often find that they no longer like to eat meat.

The symptoms that show up later tend to be much more attention getting, being such things as abdominal pain, nausea and vomiting, often accompanied by vomiting up blood, diarrhea or constipation, often with blood in the stools and difficulty in swallowing.

While these things don't always mean this cancer, many times they do and it is important to be checked by a doctor for the possibility as soon as possible.

The leading cause of stomach cancer is helicobacter pylori, which is simply a fancy term for a bacteria which invades the stomach and quietly takes over. Doctors and other medical professionals are investigating the very real possibility that there is a genetic connection involved in the attacks of this bacteria.

Diet may also have a great influence on whether or not an individual gets stomach cancer. Studies seem to indicate that those persons whose diets are high in smoked foods, salted fish and meat, and pickled vegetables are more apt to be stricken with this cancer than those persons whose diets consist highly of fresh fruits and vegetables which are high in such vitamins as A and C and who seem less apt to be stricken with this cancer.

Studies have also shown that smoking tobacco increases the very real possibility of contracting stomach cancer as does the consumption of alcohol.

Stomach cancer progresses in different stages and therefore can often be treated in different ways. Stage 0, which is when this cancer is in a very early development, can be easily treated by what is called endoscopic mucosal resectin, requiring no chemotherapy or radiation. Stages 1, 1A and 1B are further progressed and require chemotherapy and radiation therapy. Stage 2 is treated similarly to stage 1, only with an additional form of chemotherapy. Stage 3 is treated in the same way as stage 2 and sometimes can be beaten. Stage 4 is when the cancer has spread through the body and in this case treatments are given, perhaps to prolong life or to improve what one might term the quality of the life.

Periodic routine checkups may reveal the presence of stomach cancer in its early stages. It is much recommended that these checkups be made before this so called silent killer begins to speak loudly.

By Brijesh Ghelani

Stomach or gastric cancer starts when cancerous cells form in the lining of the stomach. According to records, stomach cancer cases in the United States are continuously declining; however, cases in Asian countries are rapidly increasing. This may be attributed to race - certain races are more susceptible to certain types of cancers - or to lifestyle trends.

The stomach expands when eating; thus it can also house growing tumors without being noticed. Furthermore, symptoms of stomach cancer are vague and very similar to other ailments. Bloody stools, for instance, is common to many types of cancers and other diseases. Blood in stools are not always visible and may also occur recurrently but not always. This is why some people think that having bloody stools once doesn't signify any health problems. However, not being able to see the blood doesn't mean it is no longer there. Examinations like Fecal Occult Blood Test are conducted to identify the presence of blood in the stools.

Other symptoms of stomach cancer include abdominal pain. Frequent and severe abdominal pains can already be a sign of advanced cancer. Other noticeable signs of stomach cancer are abdominal bloating and reflux.

Vomiting and nausea are also vague indications of stomach cancer. Constant vomiting can damage the esophagus and can also lead to irregular metabolism. Dysphagia or difficult swallowing also occurs once the esophagus is damaged. The esophagus is a tube connected to the stomach and one of the first body parts to be infected once the cancer spreads outside the stomach.

Loss of appetite for two days is still considered normal or simply a sign of non-fatal infections such as fever. However, if the condition lasts longer, then it can already be a symptom of more serious illnesses such as stomach cancer. Losing about 5% of your weight in less than six months without any aim of dieting can also be considered serious. This may be due to irregular bowel movement and heightened loss of appetite due to stomach cancer. Irregular bowel movement may be characterized by constipation and diarrhea or alternation of both. Constant burping also signifies changes in the digestive function.

Heartburn and fatigue can be natural. However, experiencing these two even without engaging in strenuous activities is already a red flag. Heartburn can be caused by the irregular metabolism and clogging of acids in the lower esophagus. Prolonged fatigue, on the other hand, can be a side effect of anemia. People with stomach cancer experience anemia due to blood loss through vomiting or through stools. There are also some cases of blood clots within the lungs and the legs. These cause swelling of the legs and constant breathlessness accompanied by chest pains. Blood clotting usually occurs after hemorrhage anemia or profuse bleeding. Internal bleeding, especially in areas apart from the digestive tract, is already an indication of critical stomach cancer.

If you have any of these symptoms, it is best to seek medical assistance. Though these indications are vague, immediate diagnosis and treatment are necessary to prevent further complications of the sickness.

By Michael Zadeh, M.D.

The stomach is a sac-like organ located in the upper abdomen between the esophagus and small intestine. It is part of the digestive system, functioning in the storage and digestion of food through the secretion of gastric juices. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.

The development of stomach cancer, also referred to as gastric cancer, usually occurs as a result of chronic inflammation. This can be due to both external and internal risk factors. A risk factor is anything that increases your risk of getting a disease. Risk factors for the development of gastric cancer include the following:

• Having any of the following medical conditions:
- Helicobacter pylori (H. pylori) infection of the stomach.
- Chronic gastritis (inflammation of the stomach).
- Pernicious anemia.
- Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
- Familial adenomatous polyposis (FAP) or gastric polyps.
• Eating a diet high in salted, smoked foods and low in fruits and vegetables.
• Eating foods that have not been prepared or stored properly.
• Being over the age of 55 or male.
• Smoking cigarettes.
• Having a mother, father, sister, or brother who has had stomach cancer.

According to the National Cancer Institute (NCI), approximately 760,000 cases of stomach cancer are diagnosed worldwide and more than 24,000 cases are diagnosed in the United States each year. Incidence is highest in Japan, South America, Eastern Europe, and parts of the Middle East. Worldwide, stomach cancer is the second leading cause of cancer-related deaths. The overall prognosis of stomach cancer is poor because detection rarely occurs at the preclinical stage.

Diagnosis of stomach cancer involves taking a detailed medical history and performing a physical examination. Because of the size of the stomach, early symptoms are often non-specific and physical findings are not present until the advanced stages of disease. Symptoms in the early stages of gastric cancer include indigestion, stomach discomfort, a bloated feeling after eating, mild nausea, loss of appetite, or heartburn. In more advanced stages of gastric cancer patients may present with more intense stomach pain, vomiting, difficulty swallowing, weight loss for no known reason, blood in the stool, or a palpable mass on physical exam.

Upper Gastrointestinal Endoscopy (EGD) is the gold standard procedure for the detection and diagnosis of gastric cancer. In this procedure an endoscope (a thin, lighted tube containing a camera) is passed through the mouth and down the throat examining the inside of the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. Any unusual masses, protrusions, or ulcerations can be biopsied and sent for pathological analysis to determine if cancer cells are present.

Once the diagnosis of gastric cancer has been made, the progression of the extent of disease needs to be determined prior to any interventional treatment. This is done through a process called Staging. Once doctors have adequately staged the cancer and know the extent to which it has spread to other parts of the body, they can decide on the best course of treatment. CT Scans and PET Scans have been used for staging to detect the spread of disease to distant parts of the body. Recently, Endoscopic Ultrasound (EUS) has been used in assessing depth of tumor invasion, involvement of regional lymph nodes, or invasion of adjacent organs. Endoscopic Ultrasound allows for a more precise preoperative assessment of the tumor stage and permits the identification of the subset of patients who are candidates for preoperative chemoradiation therapy.

Surgery for Gastric Cancer
The extent of surgery for the treatment of stomach cancer depends on the extent of the disease. Endoscopic mucosal resection may be used to treat early stomach cancer (tumors smaller than 3 cm that have not invaded the innermost layer of the stomach lining called the submucosa). This procedure involves removing only the tumor and surrounding tissue.

Gastrectomy is the most common treatment for stomach cancer. In this surgery, the entire stomach (total gastrectomy) or part of the stomach (partial or sub-total gastrectomy) is removed. Parts of nearby tissues or organs (e.g., the spleen) may also be removed if involved with tumor. Surrounding lymph nodes are also removed.

Following total gastrectomy, the esophagus is attached directly to the small intestine. When a partial or sub-total gastrectomy is done, the remaining stomach is attached to the small intestine. The connection between these organs is called an anastomosis.

Like any major surgery patients may experience postsurgical pain, weakness, fatigue, and loss of appetite following surgery for gastric cancer. Recovery from the procedure varies depending on the patient's age and overall health, the type of surgery, and the stage of the disease.

Removal of a large part or all of the stomach usually requires permanent alterations in diet. Patients often must eat more frequently, eat smaller meals, reduce their sugar intake, and increase their intake of fat and protein. If a small section is removed, patients may be able to gradually return to previous eating habits.

Radiation therapy
Radiation therapy uses high-powered beams of energy to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table. Radiation therapy can be used before surgery (neoadjuvant radiation) to shrink a stomach tumor so it's more easily removed. Radiation therapy can also be used after surgery (adjuvant radiation) to kill any cancer cells that might remain around your stomach to prevent local recurrence. Radiation is often combined with chemotherapy. In cases of advanced cancer, radiation therapy may be used to relieve side effects caused by a large tumor.

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach. Chemotherapy can be given before surgery (neoadjuvant chemotherapy) to help shrink a tumor so it can be more easily removed. Chemotherapy is also used after surgery (adjuvant chemotherapy) to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Chemotherapy may be used alone in people with advanced stomach cancer to help relieve signs and symptoms.

Recent studies have shown that the combination of preoperative radiation and chemotherapy in patients with locally advanced stomach cancer leads to an increase in the likelihood of surgical resection, and an improvement in disease free and overall survival. The addition of radiation and chemotherapy postoperatively has also been shown to decrease tumor recurrence and positively affect patient survival.

Overall prognosis depends on the stage of the disease. Stomach cancer metastasizes to distant parts of the body in as many as 80% of cases, resulting in a very poor prognosis. In Japan, where stomach cancer is often diagnosed early, the 5-year survival rate is about 50%. In the United States and most of the Western world, the 5-year survival rate ranges from 5-15%.

By Chris Teo, Ph.D.

DS-M906, is a 69-year-old female from Indonesia. Sometime in July 2009, DS had problems with her stomach. She consulted an internist at a private hospital in Medan. A biopsy was performed and the result indicated an adenocarcinoma, i.e. cancer of the stomach. After this examination, DS decided not to do anything. Her problem escalated and she suffered more pains.

In December 2010, DS went to see another doctor in another private hospital in Medan. A biopsy was again performed. The histopathology result indicated a moderately differentiated adenocarcinoma. Not satisfied, in January 2011, DS came to a private hospital in Penang for further consultation. A CT scan did not show any focal lung lesion. Her abdominal organs were normal. A colonoscopy showed simple hemorrhoids while the rest of the bowels were normal. A biopsy of the pre-pyloric region was performed. The result indicated signet ring-type adenocarcinoma. There was also Helicobacter pyloriassociated chronic active gastritis. In short, for the third time, DS had been told that she had stomach cancer.

The doctor in Penang suggested two options - DS take medications or undergo an operation. DS declined further medical treatment and came to seek our help on 21 January 2011. Below is the video recording of our conversation.
Comments:

Since DS and her children had already made the decision not to undergo any surgery, DS had no other choice but to take our herbal teas. We cautioned her to reconsider her decision to decline surgery. She was adamant that she did not want any medical treatment. One of her children said: "After surgery, she has to undergo chemotherapy. And we know that is not the thing we want to do."

We posed this question to DS - and for that matter, to all patients. If she has already decided not to undergo surgery after a biopsy, why does she do one biopsy after another? It is understandable if only one biopsy is done - to determine what has gone wrong. But what does she expect to get by doing three biopsies?

This is one peculiarity we often notice among Indonesian patients. They come to Penang - bring all the money that they have. They spend their money on blood test, X-ray, CT scan, PET scan, biopsy, etc. When they are told that they have cancer and need to medical treatments, some of them just pack off and go home the next day. Is this not wasting money unnecessarily? Is there any logic in doing such thing?

This is our message to patient: If you don't want to proceed with medical treatments recommended by your doctor, there is no need to do a biopsy. A biopsy is done to confirm if you have cancer, so that you can move to the next step - be it surgery, radiotherapy or chemotherapy. If you did not want to do any of these, why do a biopsy?

Again we say - before doing a biopsy, ask yourself first: If it is cancer, do I want to undergo surgery / chemotherapy / or radiotherapy? If you agree to such treatment, go ahead with the biopsy to be sure that it is really cancer. But if you do not wish to undergo further medical treatment as in the case of DS, why do you spend so much of your money doing the biopsy in the first place?

Granted - some patients say, the medical treatments are expensive and they cannot afford it. Or, some may say they decline medical treatments because the doctors cannot guarantee a cure. If these are your concerns, why don't you ask the costs first or ask for a guarantee first before doing anything?