Stomach Cancer and Nutrition Issues – Part 1
Stomach or gastric cancer is a top 10 cancer in Singapore from the Singapore Cancer Registry publication 2008 to 2012. It affects males more than females, and usually after 50 years old. Chinese ethnicity is a higher risk compared to Malays or Indians in the registry data. However, the incidence over the years is decreasing. Some countries like Japan, have an established screening program because of the high incidence of gastric cancer. Common symptoms at initial diagnosis are weight loss and persistent abdominal pain, although it is emphasized that not all weight loss is due to stomach cancer. Some people might wonder, “Is my weight loss due to stomach cancer?” It is often not easy to differentiate, as an upper gastrointestinal endoscopy is needed to visualize the stomach and if needed, a biopsy is taken. Barium studies are sometimes performed but a biopsy would have to be done separately if suspicious findings are seen.
Some patients may not have symptoms with early stomach cancer. However, with progression of disease, some of the following may bring the patient to seek treatment with his doctor or specialist.
Abdominal pain – Stomach pain or tummy pain can be mild at first and often vague. As stomach cancer progresses, this becomes constant, seems to be present all the time and increases in severity.
Difficulty swallowing or dysphagia, related to the proximal stomach tumour near to the food pipe or oesophagus
Weight loss – In stomach or gastric cancer, this is related to not eating rather than increase catabolism. The patient may have nausea, poor appetite, be easily full (satiety) or have difficulty swallowing (dysphagia).
Blood loss and anaemia – frank or overt bleeding from gastric cancer occurs in about 20% of cases but occult blood or invisible blood to the naked eye is more common. This may happen over a prolonged period of time resulting in anaemia and low iron. (Iron deficiency anaemia). Patients may present with fatigue or just looking pale with low energy.
Achalasia – When the stomach or gastroesophageal cancer is near to the opening of the oesophagus to the stomach, the relaxation of the lower end of the oesophagus muscle may be affected, resulting in the sensation of food not passing down or stuck in the oesophagus. This can also be a symptom of other diseases and not stomach cancer.
Spread of disease – Some patients have stomach ulcers diagnosed in the past discovered on endoscopy. There should be follow up of healing of the ulcer. Besides loco-regional symptoms, symptoms can arise from spread of disease to lymph nodes, liver, lungs, peritoneum or obstruction of other organs in the body. A common manifestation includes ascites or fluid in the peritoneum. This results in abdominal distension and patients may see their oncology doctor with an increasing tummy girth and increased weight, although the patient is not eating well.
There is a aggressive form of stomach cancer called diffuse-type gastric cancer or linitis plastic. There is poor distensibility of the stomach as if it is not able to hold food and distend. Symptoms can be nausea and early satiety. The tumour is often below the stomach lining rather than presenting with an obvious ulcer.
Paraneoplastic syndrome – Stomach cancer in some less common situations present with medically interesting signs affecting skin, blood vessels. These phenomenon are not explained by direct invasion of the cancer or spread via lymphatics or blood but rather products (such as protein products) that are produced by the tumour. These products can play havoc or interfere with normal body biology. For example, at OncoCare Cancer Centre, Singapore, we had a patient with unusual clotting in the lower limb veins (deep vein thrombosis), and later on developing upper limb vein thrombosis even though he had been started on blood thinning drugs, as a result of his gastric cancer.
Dr Benjamin Chuah
MRCP (United Kingdom) FRCP (Edinburgh)
FRCP (Medical Oncology)
Dr Wong Nan Soon
MMed (Int Med)
FAMS (Medical Oncology)