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Stomach Cancer

Stomach Cancer

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Published by: bryantmaroney811 on Oct 27, 2008
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How and Where does the Stomach Work?The stomach is an expandable sack located mostly under the left lung, between the muscular "diaphragm" which pushes up the lung, and the coiled small intestine. The stomach is close- by important organs in the abdomen. To it's right is theliver, to it's lower left is the spleen,and underneath it is the pancreas . The esophagus enters the stomach at the "gastro-esophageal" junction, while the small intestine exits it at the lowermost "antrum".The front of the stomach rests on the abdominal wall, and lower parts of it also contact theupper left kidney and "transverse" colon. You can see that the stomach is in the midst of many vital organs, and infections or cancers can spread to these organs. Important areas of the stomach itself (besides the antrum and gastro-esophageal junction) are the "greater curvature" (basically the left wall of the stomach), the "lesser curvature" (the right wall), the"fundus" (main body of the stomach) and the "cardia" (uppermost portion). The stomach hasa delicate inner lining, made up of "columnar epithelial cells", and acid secreting cells called"parietal cells" . This lining is protected chemicals called"prostaglandins''.The stomach has an impressive blood supply, mainly from the "celiac artery" which comesoff of the main artery, the aorta . There is also venous drainage of blood to the spleen andliver. A secondary drainage system, called the"lymph system", filters the blood in normally pea-sized lymph nodes. These are connected to lymphatics in other abdominal areas by"lymph channels" . Lymph nodes are full of white blood cells that help purify the bloodserum; lymph nodes often enlarge when they detect spread of diseases.The point is that thestomach's rich blood supply and many drainage paths can act as conduits for spread of infections or cancers.Of course, the main purpose for the stomach is digestion of foods, a process that begins withthe saliva in the mouth. The stomach activates Vitamin B12 from our diet, secreteshydrochloric acid to break down food, and churns the food into pulp. It can also directlyabsorb substances like alcohol and caffeine. The stomach is susceptible to an increase in theconcentration of hydrochloric acid brought on by stress, certain foods, and the effects of tobacco smoke. While the stomach is normally protected against it's own acid by an inner membrane, breakdown of this membrane leads to inflammation of the stomach, called"gastritis". An area that loses it's membrane is also at risk to get an actual hole, called an"ulcer".An ulcer may be shallow, and heal quickly, or it may be very deep and even "perforate" theouter stomach wall. Perforation is a surgical emergency. Fortunately, there are manymedications now available which help reduce stomach acid concentration (i.e. Zantac,Pepcid, Tagamet), helping ulcers heal and preventing formation of new ones. Also, soothing protectants (Carafate) and even artificial prostaglandins can be given. These medications areoften given preventively ("prophylactically") when the body is under great stress, such as
after major surgery. While most stomach problems are minor ones, such as a mild virus or indigestion, occasionally serious disease strikes the stomach.What is Stomach Cancer?The stomach is composed of various "cells", which are intricately combined together into"tissues" which form the "organ" . These cells divide to produce new ones, and grow veryrapidly during womb life, early childhood and puberty. In adulthood, new cells are producedonly to replace those that die of old age, injury or disease. Normally, division of cells isunder very tight control. This control is exerted by the "genes" inside each cell, which arehoused in long clumps forming "chromosomes", which are visible under a light microscope.The genes themselves are made up of DNA, the master genetic code material. If the genesare damaged, say by chemicals or radiation, the control over cell division may be lost in one particular cell. Ultimately, cancer is considered a disease of the DNA. Stomach cancer startsin a single lung cell . That cell starts dividing haphazardly, making millions and billions of copies of itself. It takes up the nourishment needed by other cells, depriving them so thecancer can continue to grow. Quickly growing cells can clump up to form a "tumor".A tumor simply means a swelling, it can be caused by inflammation or infection. A "benign"tumor only grows in it's local area (although it may get quite large)-- it cannot spread and isnot cancer. By contrast, a tumor which can spread to other body areas is called "malignant"and this is cancer . The process of cancer spread to other areas is called "metastasis", so onlymalignant tumors (i.e. cancer) can metastasize. Theoretically, cancer can spread to any areaof the body, and it often grows better in it's area of spread than in it's area of origin ("primarysite"). It is this capacity for spread that makes cancer so dangerous. If not treatedsuccessfully, it ultimately kills by debility, anemia, infection, and compromise of normal body functions.How Common is Stomach Cancer?Stomach cancer is the most common cancer in the world (after skin cancer). In the U.S.A. itis much less common, with25,000 new cases per year causing14,000 deaths. This means it isabout 3% of new cancers in the U.S.A. each year. Stomach cancer hasdecreased 5-fold in theU.S.A. over the past 50 years. It is more common in males, extremely rare in children, andthe average patient is 55 years old.What Causes, or Increases the Risk for Stomach Cancer?As for any cancer, the exact reason why one person gets stomach cancer and another doesnot remains unknown . However, several things have been noted, when looking at groups of  patients, that increase cancer risk. These "risk factors" are:1. Lack of Refrigeration is seen in countries with a high level of stomach cancer, as used to be the situation in the U.S.A. prior to 1940 (when cases were very high). Preservatives likenitrates, which were commonly used before refrigerators, may be contributory.2. Increased Smoked and Salted Food intake appears related to stomach cancer, and may be related to lack of refrigeration in third-world countries today.3. Low Fruits and Vegetables in the diet, and high fat, is related to many "aerodigestive"
(mouth, throat, lungs and gastrointestinal system) cancers, possibly by depriving the body of vitamins like"A" and "E" which appear protective for cancers. On the other hand, lots of fruits and vegetables appear to lower risk.4. Chemical "Carcinogens" l ike rubber by products, coal tar and asbestos have increasedcancers in industrial workers. However, Alcohol and Tobacco do not seem to increasestomach cancer risk.5. Long Standing Ulcers, especially those on the lower curvature, may become malignantover time. A common bacteria, called Heliobacter Pylori, is found in many ulcers and mayincrease cancer risk over time. Overall, however, less than 2% of ulcers ever becomecancerous.6. Prior Stomach Surgery, where part of the stomach is removed ("partial gastrectomy") for  bleeding ulcers, has about a 5% chance of stomach cancer after a "latent period" of as muchas 40 years.7. Achlorhydria means no stomach acid, this is seen in a rare syndrome called"achlorhydria-gastric polyposis"-- these patients have a 30% chance of getting stomachcancer. Any ulcer in a patient with no stomach acid has almost a 100% chance of beingcancerous!8. Rare Genetic Diseases such as Plummer-Vinson syndrome (10% lifetime risk)and Peutz-Jeghers syndrome with multiple polyps have a higher risk. Any polyps in thestomach that are "villous" (as opposed to the more common harmatomatous type) haveincreased risk for becoming cancerous, just like for colon cancer. However, villous polyps inthe stomach are quite rare. Pernicious anemia is caused by the failure of parietal cells in thestomach to secrete the "intrinsic factor" needed by the intestine to uptake vitamin B12; thencancer risk is increased.9. Race-- Even after equalizing all of the above factors, Orientals, Blacks and Hispanicindividuals get stomach cancer more commonly than Whites. This may be due to some pre-existing genetic susceptibility to stomach cancer.What is the Location of Stomach Cancers?Overall, 50% are in the lower stomach ("pyloris and antrum"), 20% are in the body of thestomach ("fundus"), 20% are in the lesser curvature, 10% at the cardia, and 3% at the greater curvature. The lower stomach ("distal") is more commonly involved in Black individuals,while the upper stomach ("proximal") is more common for Whites.How Does Stomach Cancer Grow and Spread?As mentioned, stomach cancer starts in a single abnormal cell. This cell divides to makemillions and billions of copies of itself, forming a tumor. A malignant tumor erodes into thelining of the stomach, and into the "submucosal" and "muscular" layers. There, it sheds cellsinto the lymph channels which spread to local lymph nodes, causing them to swell("lymphadenopathy"). Cancer cells shed into the tiny draining veins of the stomach, wherethey can travel to the spleen, liver, bone, lung and brain.The original tumor (called the "primary site") continues to grow, it can penetrate the outer wall of the stomach to erode into the liver, kidney, pancreas or intestines. The cancer canactually encase the entire bowel by spreading via the intestinal surfaces ("peritoneal

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