Stomach and Oesophageal Cancer | Chris O'Brien Lifehouse

This information has been prepared to help you understand more about Stomach and Oesophageal Cancer.

Many people feel understandably shocked and upset when they are told they have cancer. This information is intended to help you understand the diagnosis and treatment of this type of cancer. We cannot advise you about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors or other health carers.

The oesophagus and stomach

The oesophagus and stomach are part of the digestive system. The digestive system (often called the gastrointestinal or GI tract) processes food, absorbs nutrients and disposes of solid waste.

The oesophagus is a tube that takes food and fluids from the mouth to the stomach. The stomach stores food that has been consumed and absorbs some vitamins and minerals, including iron.

The different layers of the tissue in the oesophagus and stomach are:

Mucosa: the innermost layer, which is moist to help move food into the stomach easily and start breaking it down.
Submucosa: surrounds the mucosa and produces some of the moistness in the oesophagus.
Muscle layer (muscularis): pushes food down the oesophagus into the stomach and helps mash it up.
Outer layer (serosa): surrounds the layers of the stomach only.

What are stomach and oesophageal cancers?

Stomach and oesophageal cancers are malignant tumours found in the tissues of the stomach or oesophagus. They are two different cancers that can develop in any part of either organ.

Stomach cancer, also known as gastric cancer, can spread through the stomach wall to nearby organs including the liver, pancreas or large bowel.

Oesophageal cancer is often found where the oesophagus meets the stomach. Oesophageal cancer can also spread to nearby lymph nodes and through the bloodstream to other organs.

Types of stomach and oesophageal cancers

Stomach cancer
Over 90% of stomach cancers start in the mucosa (stomach lining). This type of cancer is called adenocarcinoma of the stomach.

Oesophageal cancer
The two most common types of oesophageal cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the cells lining the oesophagus (mucosa), which are called squamous cells, and tends to occur in the middle and upper part of the oesophagus.

Adenocarcinoma begins in the glandular tissue of the submucosa, in the lower part of the oesophagus.

How common are they?

If you would like to read any facts or statistics about stomach or oesophageal cancers, please refer to the Cancer Institute NSW website:
http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-facts/stomach-cancer
http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-facts/oesophageal-cancer

What is the cause?

The exact causes of stomach and oesophageal cancers are not known, however some factors may increase your risk. You are more likely to develop both types of cancer if you smoke, consume a lot of alcohol, have a diet low in fresh fruit and vegetables, or are overweight or obese.

In addition, specific risk factors for stomach cancer include:

  • Eating smoked, salted, pickled or poorly refrigerated food.
  • Infection with Helicobacter pylori (H. pylori), a type of bacteria found in the stomach.
  • Having a low level of red blood cells (pernicious anaemia).
  • Having chronic inflammation of the stomach (chronic gastritis).
  • Inheriting a genetic change that causes bowel disorders – familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC).
  • Having a family history or previous personal diagnosis of stomach cancer.

Additional risk factors for oesophageal cancer include:

  • Having medical conditions, including gastro-oesophageal reflux disease (GORD) and Barrett’s oesophagus, coeliac disease, tylosis and achalasia.
  • Exposure to certain chemical fumes or dry-cleaning agents.
  • Frequent drinking of very hot liquids.

What are the symptoms?

In their early stages, stomach and oesophageal cancers may not cause symptoms. Therefore, they are often not diagnosed until the cancer is more advanced. Because both the oesophagus and stomach are involved in transporting and digesting food, cancers that start in these locations often cause changes in your ability to swallow and absorb food.

Symptoms of stomach cancer include:

  • a painful or burning sensation in the abdomen
  • indigestion
  • frequent burping
  • heartburn or reflux
  • a sense of fullness, even after a small meal
  • nausea and/or vomiting
  • loss of appetite and/or weight loss
  • swelling of the abdomen (ascites) or feeling bloated
  • blood in vomit
  • unexplained tiredness, which may be due to anaemia
  • black-coloured or blood in bowel movements

Symptoms of oesophageal cancer include:

  • difficulty swallowing
  • painful swallowing
  • significant weight loss
  • hoarseness
  • coughing or coughing up blood
  • pain behind the breastbone and/or heartburn (reflux)
  • vomiting of saliva, food or blood

You may have nothing to worry about if you experience these symptoms, as many of them can be caused by other non-cancerous conditions. However, if you notice one or more of these symptoms you should bring it to the attention of your doctor for further investigation.

Diagnosis

Your doctor may need to conduct several tests before they can diagnose stomach or oesophageal cancer. The most common diagnostic tests are an endoscopy (also called a gastroscopy, upper GI endoscopy or oesophagoscopy) or an endoscopic ultrasound.

Endoscopy (gastroscopy)
A thin, flexible tube with a camera on the end (endoscope) is passed into your body. The tube enters your throat and oesophagus and then goes into your stomach. The surgeon will look at your digestive tract and may remove tissue (a biopsy) that can be examined under a microscope. An endoscopy is done under a general anaesthetic and takes about 10 minutes.

Endoscopic ultrasound
An endoscope with a probe on the end is put down your throat. The probe releases soundwaves, which echo when they bounce off anything solid such as an organ or tumour. During the scan, a biopsy may be taken from the stomach, oesophagus and nearby organs.

Many people have other imaging tests to see if the cancer has spread from its original site.

Computerised tomography (CT) scan
A CT scan uses X-ray beams to take pictures of the inside of your body. Unlike a normal X-ray, you will be asked to drink a dye before the scan. The dye helps to make the pictures clearer. The scan itself is painless and takes around 10 to 30 minutes.

Laparoscopy
Laparoscopies are usually done as part of the diagnostic tests, but are sometimes used before major surgery. They are used more commonly in people with stomach cancer, but are sometimes used for oesophageal cancer.

The procedure is sometimes referred to as keyhole surgery and involves a thin tube called a laparoscope being inserted into your abdomen through small cuts. The surgeon can use this procedure to determine whether the cancer has spread into the liver or lining of the abdomen and may also take tissue samples for biopsy. A laparoscopy is useful for detecting cancers which are too small to be seen on CT or other imaging scans.

Staging and grading

Staging refers to how far the cancer has spread. Doctors commonly use an international staging system called TNM to describe different stages of stomach or oesophageal cancer.

T (Tumour) 0-4: refers to the size of the primary tumour. The higher the number, the larger the cancer.
N (Nodes) 0-3: shows whether the cancer has spread to the regional lymph nodes of the neck. No nodes affected is 0; increasing node involvement is 1, 2 or 3.
M (Metastasis) 0-1: indicates whether the cancer has (1) or hasn’t (0) spread (metastasised) to other parts of the body.

Grading describes how quickly the cancer cells are growing. This is determined by looking at their appearance and rate of growth. High-grade cancer cells look the most abnormal and grow or spread very quickly.

Prognosis

Prognosis means the expected outcome of a disease. You may want to discuss your prognosis with your doctor. It is important to understand that it is not possible for any doctor to predict the exact course of your disease. However, your doctor will be able to discuss your likely prognosis with you based on the stage of the cancer, the location of the tumour and other factors including your age, fitness and medical history.

Generally, the earlier that stomach or oesophageal cancer is diagnosed, the better the prognosis.

Which health professionals will I see?

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. Health professionals who may care for you include:

  • General practitioner (GP) – arranges the first tests to investigate your symptoms and refers you to specialists.
  • Endoscopist – a specialist doctor (surgeon or gastroenterologist) who diagnoses and treats diseases of the gastrointestinal tract.
  • Upper gastrointestinal surgeon – a specialist doctor who treats disorders of the digestive system using surgery.
  • Medical oncologist – a specialist doctor who prescribes and coordinates the course of chemotherapy.
  • Radiation oncologist – a specialist doctor who prescribes and coordinates the course of radiotherapy.
  • Cancer nurse coordinator or clinical nurse consultant – provides ongoing education, liases with other care providers, and supports you throughout diagnosis, treatment and recovery.
  • Dietitian – recommends an eating plan for you to follow while you are in treatment and recovery.
  • Speech pathologist – helps with your rehabilitation if the cancer treatment has affected your ability to talk or swallow.
  • Social worker – helps provide emotional support and practical assistance to you and your carers.
  • Psychologist or counsellor – helps you manage your feelings and cope with changes to your life as a result of cancer or treatment.

Treatment

The treatment that is given for oesophageal or stomach cancer depends on many factors, including the size and spread of the cancer, other illnesses that people may have and the patient’s wishes. A team that includes surgeons, medical and radiation oncologists, nurses and dietitians, usually provide treatment for these cancers.

Surgery for stomach cancer
About half of patients with stomach cancer have surgery. Some people have chemotherapy or radiotherapy as their only treatment or as additional treatment before or after surgery.

During an operation for stomach cancer, the surgeon will remove the cancerous tissue and part or all of the stomach. The type of operation you have depends on the location of the tumour and how advanced the cancer is. You will probably undergo one of the following procedures:


Endoscopic mucosal resection (EMR)

Very early-stage cancer is removed through a long, flexible tube (endoscope).


Subtotal or partial gastrectomy

The cancerous part of the stomach is removed, along with nearby fatty tissue, lymph nodes and part of the small bowel, if necessary. The upper stomach and oesophagus are usually preserved.


Total gastrectomy

The stomach is removed, along with nearby fatty tissue. The surgeon reconnects the oseophagus to the small bowel. Often, a small feeding tube is placed further down the small bowel and out through the abdomen. You can be given food through this tube while the join between the oesophagus and small bowel heals.


 

Surgery for oesophageal cancer
During an operation for oesophageal cancer, the surgeon will remove the cancerous tissue along with part of the oesophagus and other surrounding tissue. About one in three people with oesophageal cancer have surgery.

 


Endoscopic mucosal resection

Very early-stage cancer is removed through a long, flexible tube (endoscope).


Oesophagectomy

In this procedure, the cancerous sections of your oesophagus are removed, along with part of the upper stomach, lymph nodes and other tissue, if necessary. The remaining, healthy part of the oesophagus is reconnected to the remaining part of the stomach by raising the stomach into the chest. This will allow you to swallow and eat relatively normally.


 

Chemotherapy
Chemotherapy is the use of cytotoxic drugs to destroy cancer cells or slow their growth. Chemotherapy is usually given by injecting drugs into a vein (i.e. intravenously) and is sometimes given before radiotherapy. Most people receive a combination of drugs over a few days, followed by a rest period of 2-3 weeks. Others may have continuous treatment, given through a pump, for 5-7 days.

Radiotherapy
Radiotherapy uses high-energy X-rays to kill cancer cells or injure them so they cannot multiply. It is used to treat both stomach and oesophageal cancers, and is often combined with chemotherapy. Radiotherapy is usually given from Monday to Friday (as an outpatient) for about 2-6 weeks.

Palliative treatment

Palliative treatment helps to improve your quality of life by easing symptoms of cancer when a cure may not be possible. It involves managing pain relief, physical and emotional symptoms, and may include radiotherapy, chemotherapy or other medications.

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