By EndoPro Staff
Helen Shipstad thought she had an ulcer.
The woman from Derbyshire, England said in an interview with the Stomach Cancer Awareness Network, “I started getting heartburn, and burning, and just discomfort.” Those symptoms were appearing in February of 2021.
When over-the-counter remedies didn’t help, she scheduled an appointment with a GI specialist. To Shipstad’s surprise, an endoscopy and CT scan revealed not only an ulcer, but also Stage 2 gastric cancer. “It was just a whirlwind after that,” she said.
In the medical industry, cancer is the elephant in the room. It lingers, often unspoken, in many patient conversations about “those weird symptoms I’ve been having” or a doctor’s solemn pronouncement that, “We need to discuss your test results.”
As medical professionals know, cancer isn’t just one disease, and it can start anywhere in the body. According to the American Cancer Society, tumor-related cancers are found in places such as the breast, lungs, prostate or colon. Hematologic cancers are found in the blood cells, and manifest as leukemia, lymphoma or multiple myeloma. What’s worse, cancer can metastasize: infected cells break loose from the original tumor and settle elsewhere in the body, and the proliferation process starts all over again.
Gastric cancer—also known as stomach cancer—starts like most other strains of the disease: a proliferation of cells grows out of control, like some kind of runaway horror film, “Cells Gone Wild.” But there’s nothing even remotely humorous about it—by any stretch of the imagination—that’s for sure. The culprit lies in the cells’ genes: disease development can arise from an inherited genetic flaw, environmental influences, or lifestyle habits. Unfortunately, researchers often don’t know exactly what flips the switch.
In Shipstad’s case, it was a prior Helicobacter pylori infection—innocent enough in itself, but it kicked her up the risk ladder for gastric cancer. According to Wroblewski, et al., H. pylori is found in fully half of the world’s population, and the chronic inflammation it causes wreaks so much havoc that it’s now known as the strongest risk factor for gastric cancer. One of the big problems with H. pylori is that the immune system is incapable of destroying it without help. A Gram negative bacterial pathogen, H. pylori is as comfortable in the harsh, inhospitable environment of the gut as we are in a backyard swimming pool.
The good news about gastric cancer is that it tends to develop slowly. Indeed, it can take years. The bad news is, these cellular changes often don’t cause symptoms, so the disease can easily be overlooked. Liu and Deng call gastric cancer “an important global health problem due to its overall high prevalence and high mortality rate.”
Symptoms
While symptoms can be elusive, they may include dyspepsia and reflux. There may also be signs that “could indicate advanced disease, such as dysphagia, weight loss, gastrointestinal bleeding, anemia, and emesis,” according to a review article titled “Current Treatment and Recent Progress in Gastric Cancer,” which ran in a January 2021 issue of ACS Journals (from the American Cancer Society).
According to the Mayo Clinic, possible symptoms are as follows:
- trouble swallowing
- belly pain
- feeling bloated after eating
- feeling full after eating small amounts of food
- not feeling hungry
- heartburn
- indigestion
- nausea
- vomiting
- losing weight without trying
- fatigue
- stools that look black
Risk Factors
Age and Gender: Men over 60 are at higher risk.
Diet: Foods high in salt or nitrosamines (a preservative found in smoked meats)
Family History: Genetics play a part in GC risk.
Smoking: Small amounts of toxins are swallowed during smoking.
Medical Conditions: Pernicious anemia, atrophic gastritis, helicobacter pylori infections, and Type A blood have all been associated with an increased risk for gastric cancer.
According to World Cancer Research Fund International, additional risk can include chemical exposure, drinking too much alcohol, and being overweight or obese. Grilled or barbecued meat and fish may also be a culprit, as well as consuming little or no fruit. Consumption of citrus in particular may decrease the risk of stomach cardia cancer, the World Cancer Research Fund International posits.
Early screening can be helpful in populations where gastric cancer is prevalent, as well as in high-risk individuals, “including older adults with chronic gastric atrophy or pernicious anemia and patients with gastric polyps, partial gastrectomy, familial adenomatous polyposis, and hereditary non-polyp colon cancer,” write Liu and Deng.
Depending on where in the stomach the cancer starts, treatment can vary. Most often, gastric cancer is found in the stomach’s mucosa, manifesting as an adenocarcinoma. If the patient has an intestinal adenocarcinoma, targeted drug therapy may be an effective treatment. More challenging is the diffuse type of adenocarcinoma, which spreads quickly and is harder to treat.
Less common types of cancer include gastrointestinal stromal tumors, or GISTs; neuroendocrine tumors (NETs); or lymphomas. The rarest types of gastric cancer are squamous cell carcinomas, small cell carcinomas, and leiomyocarcomas.
Global Impact
Worldwide, gastric/stomach cancer is the fifth-most-common cancer. Countries with the highest rate of gastric cancer are Mongolia, Japan, South Korea, Tajikistan and China, cites the World Cancer Research Fund International.
According to the nonprofit Debbie’s Dream Foundation: Curing Stomach Cancer, “Each year nearly 950,000 people worldwide are diagnosed with stomach cancer, and approximately 700,000 die of the disease. Approximately 28,000 Americans will be diagnosed with stomach cancer each year and over 11,000 will die within a year.” A theory presented on the DDF website for why certain countries have a far higher rate of gastric cancer is that the residents of those countries eat a diet heavy in smoked, salted and pickled foods.
Treatments and Procedures
As the sources and types of cancer differ, so do the treatments. In a 2021 review, Puhr and Ilhan-Mutlu itemized advanced and innovative therapies that show great promise in helping those with advanced gastric tumors. They wrote, “… a major issue concerning immunotherapy is that only a subset of patients achieve responses. Thus, the identification of underlying mechanisms for primary resistance to immunotherapy are of major concern.”
Puhr and Ilhan-Mutlu concluded, “Despite the improvement of modern cancer medicine including immunotherapies and targeted therapies, new therapeutic approaches seem to be [efficient] in only specific subgroups of patients. To improve patient outcome with these new treatment options, it is of highest importance to define these subgroups more accurately. The evaluation and implementation of new biomarkers seems to be the key for adequate patient selection leading to high treatment efficacy.”
According to the aforementioned ACS Journals article, the peritoneum may be an effective target for novel therapeutic approaches since it is “the most common site of metastatic disease at diagnosis but also the most common site of recurrence after potentially curative surgery.” The authors continue, “Existing systemic chemotherapy has been shown to improve survival for peritoneal disease, but only at a median of four months according to population-based studies. There has been some enthusiasm for applying heated intraperitoneal chemotherapy (HIPEC) in patients with gastric cancer based on the improved survival in peritoneal disease from other primary sites, such as appendiceal mucinous tumors, ovarian cancer, and mesothelioma.”
In Shipstad’s case, her treatment plan started with six rounds of chemotherapy, two weeks apart, for three months. She underwent a partial gastrectomy and additional chemotherapy, and subsequent pathology indicated that her tumor had shrunk to Stage 1.
These days Shipstad, who now lives in Southern California, is proactive about her health, insisting on quarterly routine scans and an endoscopy every nine months to ensure the cancer hasn’t spread.
“I just think when people have symptoms, it should be taken seriously,” she said. “Because a lot of the time, with the GI tract, there are so many things going on. I never thought it would happen to me. I was told, ‘Oh, you’re too young to have cancer.’ Doctors need to take it more seriously, because as we know, a lot of people are diagnosed when it’s too late. If I had left it another year, I might not be here.”
Debbie’s Dream Foundation: A Resource for Gastric-Cancer Patients and Caregivers
Nonprofit advocacy can go a long way in supplementing medical industry efforts. An example is the nonprofit organization “Debbie’s Dream Foundation: Curing Stomach Cancer,” which is based in Fort Lauderdale, Florida. The nonprofit aims to raise awareness about stomach cancer, to advance research funding, and provide education and support internationally to patients, families, and caregivers. DDF’s main goal is to “make the cure for stomach cancer a reality.”
According to the DDF website, “Our vision is that stomach cancer will no longer be fatal. If not curable, it will be a manageable disease.” Further DDF beliefs on its website are as follows:
- The concerns and needs of patients must always be front and center with everything we do.
- Patients deserve the latest knowledge about their disease, treatment options and available support.
- Doctors must be knowledgeable about the disease, the need to consider it as a diagnosis, the latest treatment options, and the sources of support available to patients, their families and caregivers.
- We have a responsibility to be transparent to our donors and the community at large.
- We have a responsibility to remain independent of outside influences that may potentially be biased.
- Working in collaboration with other nonprofits, businesses, government agencies, scientists and others enhances what we can do.
- Supporting collaboration within the scientific community will help us achieve our mission and vision more quickly, thus saving lives.
- Because research holds the key to disease management and the cure, funding is essential.
- Capturing the imagination and commitment of young scientists early in their careers will result in more focused attention to this disease.
- Awareness building and advocacy are critical to combating this disease.
- We as a board must stay educated in order to be as effective as possible and provide valuable direction
The website is a wealth of information and resources for caregivers and for caregivers to recommend to patients. For instance, there is a patient helpline, and a patient resource education program, part of which can include patients being assigned to a mentor. Patients can also join a stomach cancer support community or sign up for clinical trials.
Another benefit medical professionals can recommend is the Dream Makers Miracle Fund for stomach cancer patients and families.
“The initiative is part of our patient resource education program and aims to spread joy within the stomach cancer community by providing patients and families with bucket-list-inspired experiences,” according to the website. The program has made many wishes come true. For example, one woman with gastric cancer was given the opportunity to swim with dolphins, a male patient went skydiving, and several families of patients have received dream vacations. There are also scholarship programs available.
Other sections of the site include information about stomach cancer risk factors, symptoms, screening, early detection, diagnosis, staging, choosing a treatment facility, treatments, chemotherapy, nutrition, surgery, radiation, molecular testing, genetics, and the latest in updates regarding diagnosis and treatment.
Medical professionals and research peers may be interested in the section about research grants. The Debbie’s Dream Foundation has given more than $1,450,000 in research grants, and interested parties can apply through the DDF website. For more information, visit www.debbiesdream.org.
