Stomach cancer

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    ‘Stomach cancer is usually in stage III or IV by the time it is diagnosed and is the 6th most common cancer in the world and the 15th in the USA.’

    What is stomach cancer?

    Stomach cancer, medically termed gastric cancer, is a form of malignant tumor (mutation in cells’ DNA) that grows haywire, uncontrolled, disorganized, aggressive, killing normal cells and tissues, replacing them with abnormal, non-functional, hardened mass, with the malignant cells traveling to neighboring tissues and distant multi-organs, spreading like wide-fire. Stomach cancer is usually in stage III or IV by the time it is diagnosed and is the 6th most common cancer in the world and the 15th in the USA.

    How prevalent is stomach cancer?

    This varies among countries and by sex. South Korea has the highest prevalence of stomach cancer in the world, followed by Mongolia, Japan, Guatemala, and China. There has been an impressive decline in incidence in North America, New Zealand and Australia since 1930 but the reduction has been slower in Europe. The incidence also seems higher among those with type A blood. In the USA, cancer of the stomach is relatively more common among Japanese-American and Hispanic groups. The death rate in the USA for gastric cancer is from 14,000 to 15,000 a year. Sixty to 70 cases of these are men.

    Does kimchi cause gastric cancer?

    Kimchi, with its high sodium content, has been associated with many diseases, mainly gastric cancer. Salt-preserved foods (miso, pickled fish) appear to increase the risk of stomach cancer. Obesity, smoking, H. pylori infection, processed and grilled meats, smoked foods, soy foods, pernicious anemia, and stomach polyps, and gastroesophageal Reflux Disease (GERD) are all linked to increased risk for gastric cancer. As stated above, Korea, where kimchi and other salty foods are part of regular diet, has the highest incidence of stomach cancer.

    What are the other etiologic factors?

    Smoking is strongly related to cancer of the proximal portion of the stomach. This is one unhealthy habit people should stay away from because it kills in so many ways. This type of gastric malignancy is also associated with obesity, gastro-esophageal reflux, high fat intake, and seen more among the more affluent people. Those in the lower socio-economic bracket have been seen to be more prone to distal stomach cancer. Timely treatment of H. pylori infection and of the stomach reduces the risk for gastric cancer.

    Do spicy foods cause stomach cancer?

    Except for kimchi, there is no scientific evidence to prove that ingesting spicy food causes stomach cancer. There were some speculations that perhaps eating very hot food and drinking hot beverages (as most Asians do) day in and day out may increase the risk for the development of cancer of the stomach. The jury is still out there on this issue. Alcohol is a risk for the development of cancer of the food pipe. The caveat in almost everything is “moderation.”

    How about eating smoked or salted fish?

    Eating dried salted fish and smoked foods (or the nitrates in them) have been suspected to increase the risk of stomach cancer.  There seems to be a higher incidence in Asia, particularly in South Korea, Mongolia, Japan, Guatemala, and  China. As far as a good daily dietary regimen is concerned, there is nothing better and safer than fresh (unprocessed) fish, vegetables, fruits, high fiber foods, and abstaining from processed food items, red meat, and eggs, which are high in cholesterol and fats and low in fiber.

    Red meat has been implicated as a causative factor in colon cancer and other cancers, and shortened longevity, compared to those who do eat much less or no red meat at all.

    What are the symptoms to watch for?

    They vary from person to person. Most do not even have obvious symptoms before they are discovered. The symptoms could be a  sense of indigestion, upper stomach discomfort, gassy bloating feeling, loss of appetite or pain on eating, loss of weight, tarry black (blood in) stools, anemia, weakness and fatigue, depending on the stage of cancer.

    But any of these symptoms may also be caused by other illnesses, which may not be as serious and are curable. This is the reason why a regular medical check-up and seeing the doctor early are important practices to prevent serious illnesses. If in doubt, consult your physician.

    What is the survival rate?

    In the United States, the 5-year  survival rate (the number of patients alive after 5 years) is 90%  (nine out of ten) among those where the tumor is confined to the mucosa (early stage, involving stomach lining only) and 20% (one in five) among those with a large tumor and lymph node spread.

    Early-stage is mostly discovered by routine preventive upper endoscopy (e-gastroscopy), much like colorectal cancer via routine lower endoscopy (colonoscopy). The 5-year survival rate in Korea and Japan for gastric cancer is about 50% for those with an advanced stage of the disease, compared to 20% in the USA. The reason is unclear. It is postulated that the stomach cancer of those who were born and lived in Japan might be a “different” kind of pathology, and that there are other unexplained factors as well.

    But what is interesting is that the type of stomach cancer among Koreans and Japanese who were born and have been in the United States for a while behaves like gastric cancer among white Americans. Obviously, environmental factors do play a role.

    What surgery could be done?

    For stage 0, I, II, or III, among otherwise healthy persons, surgery, often with other therapy, offers a  probable cure. Endoscopic submucosal resection may be done for the very early stage, with no lymph node involvement. This is not performed much in the USA as in Japan or Korea, where the early stage of gastric cancer is discovered sooner because of intensive screening. Resection of a part of the stomach (partial or subtotal gastrectomy), if possible, together with lymph nodes, saving as much stomach as possible, is the choice if the pathology allows.

    If needed, total gastrectomy could also be done. Added surgical procedures may be needed for reconstruction of the GI tract and for feeding. Palliative resection (not for cure but to prevent future bleeding or blockage) may be done. For cancer of the gastro-esophageal junction (area connecting foodpipe to stomach) that tests positive for “PD-L1,” Keytruda, FDA approved medication may be used. How about chemotherapy? Chemotherapy may be given before surgery (neoadjuvant Rx) to shrink the tumor mass and make surgery easier, prevent recurrence and prolong survival.

    Chemo may also be given after surgery (adjuvant Rx) to kill cancer cells left behind undetected. Chemo is often given with radiation therapy (Chemoradiation Rx), especially beneficial for cancer that could not be completely resected. Chemotherapy alone as a  primary treatment is used for gastric cancer that has distant spread  (Stage IV) for symptom relief and lengthen survival a little.  There are various chemotherapeutic agents available today, and many under investigation. Hopefully, someday soon, the “perfect”  regimen will come along. Better yet, a vaccine to prevent gastric cancer. In the meantime, let us stay away from unhealthy habits and prevent diseases from coming our way, especially deadly cancers.

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    Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888. com Email: [email protected]

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