Cancer involves abnormal cells growing uncontrollably, invading nearby tissues, and spreading to other parts of the body through metastasis.
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The stomach is a strong, muscular organ in the upper abdomen. It acts as both a storage area and a site for breaking down food. The stomach is divided into several regions, each with its own job. The cardia is where food enters from the esophagus. The fundus and body store food and release acid and enzymes. The antrum grinds food, and the pylorus controls when food moves into the small intestine. Knowing these regions is important in cancer care because the location of a tumor affects how it behaves and how doctors treat it.
The stomach is built to handle a tough environment. Its inner lining, called the mucosa, makes acid and enzymes to digest food and kill germs. To protect itself, the stomach has a thick layer of mucus and bicarbonate. This balance between acid and protection is kept by the fast replacement of lining cells, which renew every few days. While this quick cell turnover helps with repair, it also means that mistakes can happen during cell division. Problems like long-term inflammation, infection, or genetic changes can cause these mistakes, which may lead to cancer.
Gastric cancer, or stomach cancer, begins when healthy cells in the stomach lining begin to grow out of control. These cells can form a tumor that spreads deeper into the stomach wall. The wall has four main layers: the mucosa (where most cancers start), the submucosa, the muscle layer, and the outer serosa. How far the cancer has grown through these layers helps doctors decide the stage and chances for a cure. If cancer cells break through the outer wall, they can spread to the abdomen or nearby organs like the pancreas, spleen, or liver.
Most of the time, when doctors talk about stomach cancer, they mean adenocarcinoma. This type starts in the gland cells of the stomach lining and makes up most stomach cancers. There are two main types of gastric adenocarcinoma, called intestinal and diffuse, based on the Lauren classification. Knowing the difference between these types is important for understanding the disease worldwide.
Intestinal-type adenocarcinoma usually affects older men and is linked to things like long-term Helicobacter pylori infection and certain diets. Under the microscope, the cancer cells look like those in the intestine. This type often develops in steps: first, long-term gastritis causes the stomach lining to thin, then the cells start to look more like intestine cells, then pre-cancer changes happen, and finally cancer develops. This step-by-step process gives doctors a chance to prevent or catch the cancer early.
Diffuse-type adenocarcinoma is more aggressive and often affects younger people and women. It is less tied to environmental causes and more to genetics. In this type, cancer cells do not form glands but spread out individually through the stomach wall. They often lose a protein called E-cadherin, which normally helps cells stick together. Without it, the cells invade the stomach wall quickly and widely. A severe form called linitis plastica makes the whole stomach wall stiff and unable to stretch, often without a clear lump.
Gastric cancer is a unique challenge in public health. In the past, it was the top cause of cancer death worldwide. Its rates have dropped in many Western countries, thanks to better food storage and treating H. pylori infection. However, it is still a big problem in East Asia, Eastern Europe, and parts of South America. These differences between regions show that genetics, diet, and environment all play a role.
Recently, there has been a shift in Western countries. Cancers in the lower part of the stomach are going down, but cancers near the top of the stomach and where it meets the esophagus are increasing. This is likely due to more obesity and acid reflux, not the usual risk factors for lower stomach cancer. Tumors in these areas need different, often more complex, surgical treatments.
Researchers have found that stomach cancer rates differ not only by region but also by the cancer’s molecular type. The Cancer Genome Atlas divides gastric cancer into four groups: EBV positive, MSI high, Genomically Stable, and Chromosomal Instability. This new way of classifying cancer is helping doctors develop treatments that target the cancer’s biology, not just where it is in the body.
Stomach cancer is dangerous because the stomach has many lymph nodes and blood vessels around it. Unlike the colon, where lymph flows in a set pattern, the stomach’s lymph drainage is complex and goes in many directions. Even small tumors can send cancer cells to distant lymph nodes. Because of this, surgeons need to remove a wide area of tissue and many lymph nodes to catch any hidden cancer cells.
Stomach cancer can also spread by shedding cells into the abdominal cavity once it breaks through the outer stomach layer. These loose cancer cells can settle on the lining of the abdomen, causing fluid buildup and small growths on organs and the intestines. This type of spread is often too small to see on regular scans, making it hard to detect and treat early.
Stomach cancer can also spread through the blood to the liver, lungs, or bones. Some patterns of spread have special names. For example, a Krukenberg tumor is when stomach cancer spreads to the ovaries, sometimes before the main tumor is found. A Sister Mary Joseph nodule is when cancer spreads to the belly button. These rare signs show how aggressive stomach cancer can be.
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A polyp is a growth of tissue protruding from the lining of the stomach. Most gastric polyps, such as fundic gland polyps or hyperplastic polyps, are benign and have a very low risk of becoming cancer. However, adenomatous polyps are considered pre-cancerous and can develop into adenocarcinoma, which is a malignant tumor capable of invasion and spread.
No, but the line is blurring. Stomach cancer starts in the stomach, while esophageal cancer starts in the tube connecting the throat to the stomach. However, cancers occurring at the Gastroesophageal Junction (GEJ), where the two organs meet, share characteristics of both and are often treated similarly to esophageal cancer, especially regarding the use of radiation.
This is primarily attributed to diet and infection rates. Regions with high rates of stomach cancer often have high rates of Helicobacter pylori infection strains that are more carcinogenic. Additionally, traditional diets in these areas may be high in salted, pickled, and smoked foods, which contain compounds that damage the stomach lining, while being lower in fresh fruits and vegetables.
The mucosal barrier is a thick layer of mucus and bicarbonate that prevents the stomach acid from digesting the stomach itself. Chronic damage to this barrier, from infection, alcohol, or inflammation, forces the cells to regenerate rapidly. This constant state of injury and repair increases the chance of DNA errors during cell division, leading to cancer.
Most stomach cancers are sporadic, meaning they occur by chance. However, about one to three percent of cases are part of a hereditary syndrome, most notably Hereditary Diffuse Gastric Cancer (HDGC). A mutation in the CDH1 gene causes this. Families with this mutation have a very high risk of developing diffuse gastric cancer at a young age.
Medical imaging tests, like CT scans, use contrast agents to make internal structures clearer. These substances are usually safe but can upset some people’s stomachs.
Can stomach cancer cause itchy skin? Many people are unaware that stomach cancer can present in unusual ways.. One of these is itchy skin. This
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