Stomach cancer

Dr. med. Julia Schwarz is a freelance writer in the medical department.

More about the experts All content is checked by medical journalists.

Stomach cancer (gastric carcinoma) is a malignant tumor disease of the stomach. It usually starts from the gastric juice-forming gland cells. Stomach cancer is a relatively common type of tumor that mostly affects older people over the age of 50. The disease is often recognized late. The earlier stomach cancer is discovered, the better the chances of recovery. Read more about stomach cancer.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C16

Gastric cancer: description

Stomach cancer occurs when cells in the stomach begin to divide uncontrollably. Depending on which cell type the tumor originates from, a distinction is made between different types of gastric cancer:

Mostly, gland cells of the gastric mucosa, which form the gastric juice, degenerate. Doctors then speak of a so-called adenocarcinoma. In rare cases, the tumor originates from lymphatic cells (MALT lymphoma) or from muscle and connective tissue cells (sarcoma).

Gastric cancer: incidence

The incidence of stomach cancer has decreased in recent years, but it is still a very common cancer. Men are affected somewhat more often than women. Stomach cancer is the fifth most common cancer in men and the sixth most common in women.

Stomach cancer is a disease of old age. The peak incidence of gastric cancer is beyond the age of 50. The incidence of gastric cancer has been linked to diet and lifestyle habits. This is why the incidence of stomach cancer differs between different continents: In Japan and parts of South America, stomach cancer is far more common than in Germany or the USA.

Gastric cancer stages

Gastric cancer is classified according to its malignancy and how the cancer cells spread in the stomach itself, as well as in the lymph nodes or other parts of the body:

Malignancy: The extent to which gastric cancer cells differ from healthy gastric cells is recorded using a so-called “grading” with four stages (G1 to G4). In the G1 stage, gastric cancer cells are still very similar to healthy cells. In the G4 stage, gastric cancer cells are already very undifferentiated and very different from healthy cells. The more advanced the stage, the more aggressively the tumor usually grows.

Spread of the tumor: How far the tumor has already spread to the surrounding tissue is recorded with the help of the TNM classification (T = tumor, N = lymph nodes, M = metastases).

Tumor size (T):

• T1: Early tumor that is limited to the innermost layer of the mucous membrane
• T2: tumor also affects the smooth muscle layer of the stomach
• T3: tumor also affects the outer connective tissue layer (serosa) of the stomach
• T4: tumor also affects surrounding organs

Lymph nodes (N):

• N1: One or two regional lymph nodes are affected by cancer cells
• N2: Three to six regional lymph nodes are affected by cancer cells
• N3: Cancer cells affect more than seven lymph nodes

Metastases (M):

• M0: There are no distant metastases in other organs
• M1: There are distant metastases in other organs

Example: A T2N2M0 tumor would be a gastric carcinoma that has already penetrated the muscle layer of the stomach (T2), has affected three to six surrounding lymph nodes (N2), but has not yet caused gastric cancer metastases (M0).

Stomach cancer: symptoms

You can read everything you need to know about the signs of stomach cancer in the article Stomach Cancer: Symptoms.

Stomach cancer: causes and risk factors

A clear cause for the presence of gastric cancer is not yet known. However, there are numerous risk factors that favor the development of gastric cancer.

Eating habits

Frequent consumption of highly salted food and low consumption of fiber (fresh fruits and vegetables) are known risk factors for stomach cancer. In addition, smoked, cured and grilled foods seem to increase the risk of stomach cancer. When smoking and grilling food, carcinogenic substances, so-called carcinogens, are produced. Nitrate and nitrite salts are used for curing. Strong carcinogens also develop from these when heated and in the stomach.

Mold toxins (aflatoxins) are also carcinogenic, which is why moldy foods should not be consumed.

Smoking and alcohol

Nicotine and alcohol are also cancer-causing substances that encourage stomach cancer (and other types of cancer) to develop.

Other diseases

Certain diseases have been linked to the development of stomach cancer:

• some types of gastric polyps (usually benign, bud-like growths of the stomach lining)
• Stomach ulcer (a wound in the lining of the stomach caused by too much acid in the stomach)
• Ménétrier's disease ("giant folds of gastric mucosal inflammation" with proliferating gastric mucosa)
• Infection with the "stomach germ" Helicobacter pylori (this bacterial infection (also leads to inflammation of the stomach lining)
• Chronic atrophic gastritis (chronic inflammation of the stomach lining with associated tissue atrophy)

Genetic factors

There is an increased incidence of gastric cancer in some families, which is based on a genetic predisposition for this type of tumor.

Gastric cancer: examinations and diagnosis

If stomach cancer is suspected (e.g. due to vomiting or blood in the stool = black tarry stool), a gastroscopy should be performed first. As part of this examination, not only can the stomach be examined from the inside - a tissue sample (biopsy) can also be taken. This is examined in the laboratory for the presence of gastric cancer cells. Gastroscopy can also provide information about the spread of an existing tumor.

A blood test can show iron deficiency anemia (anemia caused by a lack of iron) in stomach cancer. The reason: stomach cancer can cause bleeding in the stomach. The escaping blood can turn the stool dark (tarry stools) and lead to anemia. However, iron deficiency anemia can have numerous other causes and is not specific to gastric cancer.

In contrast to other cancer patients, no suitable tumor marker for diagnosis can be detected in the blood of gastric cancer. The tumor markers are only used to monitor the progress of gastric cancer. Occasional tumor markers (gastric carcinoma) are: CEA (carcinoembryonic antigen), CA-72-4, CA 19-9 (CA = cancer antigen).

An ultrasound examination of the abdomen can be informative in gastric cancer. It can be done in the form of endoscopic ultrasonography by inserting a thin tube with a transducer and a camera at the tip through the esophagus into the stomach. This examination can determine which tissue layers are affected by the stomach cancer. A general ultrasound examination of the abdomen from the outside through the abdominal wall can help in looking for any metastases.

An x-ray of the lungs and computed tomography (CT) can also be used to search for metastases. A laparoscopy is a surgical procedure in which an endoscope (with an optical system and light source) is inserted into the abdomen through a small skin incision in order to examine it more closely.

Stomach cancer: treatment

The therapeutic measures depend on the stage of gastric cancer. The more advanced the tumor, the more radical the therapy is usually.

Operative measures for gastric cancer

If stomach cancer is detected very early, minimally invasive surgery can be performed. This procedure is also called "keyhole surgery" because the tumor can be removed through very small skin incisions as part of a gastroscopy. However, this procedure is only possible if the stomach cancer has not yet spread beyond the stomach lining.

In more advanced gastric cancer, the stomach should be partially or completely removed (gastric resection). To ensure that food can still pass through, the remaining stomach or esophagus (if the stomach is completely removed) is connected directly to the small intestine. If the gastric cancer has already affected the surrounding lymph nodes or the spleen, these are also removed.

Digestive function and nutrient utilization can be impaired after gastric resection. As a rule, those affected initially lose a lot of weight. However, this weight loss usually stops on its own after a while. To ensure digestion, digestive enzymes must be replaced with medication. The supply of minerals and vitamins is often necessary, for example vitamin B12: In order to be able to absorb this from food, the body needs a sugar-protein complex that is produced in the gastric mucosa (intrinsic factor). In gastric cancer patients, gastric resection can therefore lead to a deficiency in vitamin B12.

Chemotherapy and radiation therapy for gastric cancer

After an operation for gastric cancer, patients often receive chemotherapy, and less often radiation therapy. Chemotherapy is often started before the operation in order to reduce the size of the tumor before the operation and thus make it (better) operable. After the operation, chemotherapy is designed to prevent relapse.

Antibody therapy for gastric cancer

In some cases, gastric cancer has progressed so far that a cure is no longer possible (end-stage gastric cancer). Then only palliative measures can be used to extend the life of the patient and to alleviate the symptoms.

Antibody therapy can be used as a more recent treatment approach: around 20 percent of all gastric cancer patients have more so-called HER2 receptors on the surface of the cancer cells - docking points for growth factors that are important for tumor growth. In the case of such HER2-positive gastric carcinomas, the administration of HER2 antibodies can be useful. These occupy the HER2 receptors to interfere with tumor growth.

The antibodies are given as an infusion every three weeks. In addition, the patients receive chemotherapy.

Feeding tube & medication

Some stomach cancer patients need artificial nutrition in the medium or long term in order to be adequately supplied with nutrients and vital substances. Then a so-called PEG probe (PEG = percutaneous endoscopic gastrotomy) can be applied. This artificial feeding tube is placed directly into the stomach through the abdominal wall and supplies the patient with nutrients. Many patients have severe pain in the advanced stages of gastric cancer. Pain reliever medication can then significantly improve the quality of life of those affected.

Gastric cancer: disease course and prognosis

Can Stomach Cancer Be Cured? The answer to this question depends on the stage of the cancer. The chances of a cure for gastric cancer are good if the tumor is detected at an early stage. However, this is often not the case. The further the gastric cancer has spread at the time of diagnosis, the worse the gastric cancer prognosis looks. Five years after diagnosis, gastric cancer life expectancy averages 31 percent for women and 35 percent for men, according to current research.

If there is no longer any hope of a cure, the remaining time should be made as pain-free and comfortable as possible for those affected. In Germany there are specialists in palliative medicine who, among other things, specialize in providing optimal care for patients with gastric cancer and their relatives.

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