Recent developments in cancer research – Stomach Cancer

This is the eighth in a series of instalments devoted to breakthroughs for the more common solid and blood cancers; this week is dedicated to stomach cancer (SC).

The J-shaped stomach’s upper opening is joined to the lower part of the oesophagus (swallow tube) and forms part of the upper gastrointestinal tract. It serves as a temporary holding area for swallowed food, facilitating digestion with the aid of enzymes and hydrochloric acid secreted by glands in its wall. Its partially digested contents are subsequently emptied into the first part of the small intestine, the duodenum.

SC, also known as gastric cancer, begins in most instances at the junction of the stomach and the oesophagus. Almost 1% of persons will be diagnosed with SC during their lifetime. Most are 65 years or older at the time of diagnosis. If SC is diagnosed when confined to the stomach the 5-year survival rate is 70%, if it has spread to surrounding areas the 5-year survival falls to 33%.

The diagnosis of SC is made via one or more of the following modalities:

• Barium X-ray
• Endoscopy or gastroscopy
• Surgery
• CT Scan
• MRI

• The following increases the risk of developing SC: GERD (reflux), diets high in smoked and salty (e.g. pickled) foods, salt-preserved foods (e.g salt fish, pigtail, ham, bacon, etc), H. Pylori, being male, Black, being overweight, being older than 50, family history, alcohol abuse, cigarette smoking, previous stomach surgery, previous adenomatous stomach polyp, pernicious anaemia, previous Epstein-Barr infection, blood Group A, animal fats, processed foods, red meats, diets low in fruit, vegetables, and fibre.

• The following reduces the chances of developing SC: limiting alcohol intake, eliminating tobacco use, eradicating H. Pylori, regular exercise, maintaining a healthy weight, avoiding smoked, salt-preserved, and pickled foods, low-dose aspirin, green tea, diets rich in fibre, fruits, and vegetables, and reducing fat, red meat, and processed food consumption.

 Some recent discoveries, and advancements, regarding SC:

• Researchers in the UK are looking into using stool, blood, and possibly breath analysis to help detect SC in its early stage.
• Research has unequivocally shown that eliminating H.Pylori from the stomach can significantly lower the risk of developing stomach cancer. It is now under consideration to test for H. Pylori routinely as part of an annual medical.
• Chemotherapy (e.g. 5-FU, paclitaxel, docetaxel, irinotecan, oxaliplatin) is now being administered as neoadjuvant therapy in addition to post-operative chemotherapy (adjuvant therapy) and radiotherapy in order to reduce the chances of the recurrence of SC post-operatively.
• Various forms of immunotherapy (e.g. trastuzumab, rucaparib, ramucirumab, pembrolizumab) are showing promise in trials treating SC.
• Researchers are currently looking into the usefulness of genetically fingerprinting SCs in order to determine the most effective treatment regime for the various subtypes.
• Immunotherapies that unblock the pathways that SC cells use to hide from the body’s own immune system are currently under investigation. By unblocking these paths, the body’s own immune system can then directly attack and destroy the SC.
• There is an increasing body of evidence which is showing that using a daily low-dose aspirin lowers the risk of stage 1 cancer returning after treatment.

Recently diagnosed SC patients should attend their doctor with a close family member or friend, and below are some questions that need to be asked:

• Where in the stomach is the SC located?
• Has the SC spread? What is the stage? What is the prognosis?
• What are all the treatment options? Are all available locally? If not, what’s not?
• Would radiation and chemo/immunotherapy help in reducing the tumour’s size prior to surgery?
• Should additional tests be done before treatment is started?
• Would radiotherapy be required? If yes, where can such be accessed?
• Can copies of all the reports be provided?
• What are the goals and likely success of my treatment?
• Is there any additional treatment that can be beneficial even if it means having to travel or pay to bring it into the country?
• Are other doctors going to be involved in my treatment? If yes, who?
• What are the possible side effects of the proposed treatments?
• Is a second opinion locally or overseas recommended or worth pursuing?

Adult Leukemias will be covered next Friday.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.