What Is Gastric Cancer?

Gastric cancer refers to cancers that arise in the cells of the mucosa, which line the stomach. Risk factors include Helicobacter pylori infections, chronic gastritis, Epstein-Barr virus infections, salty diets, diets that don’t include plant fiber, and smoking cigarettes. The cancer generally begins in the mucosa, but it can spread through the other layers of the stomach lining as well as metastasizing (spreading to other organs).

Early symptoms of gastric cancer are difficult for patients to identify as very serious, as they can have multiple causes and patients often assume they are caused by diet. They include heartburn, loss of appetite and indigestion. That’s why it’s so important to consult your physician if such “mild” symptoms persist. At more advanced stages, gastric cancer causes noticeable issues, including vomiting, jaundice, difficulty swallowing, and sudden weight loss. Advanced stage metastasis causes other symptoms as other organs are affected.

Gastric cancer is the third leading cause of cancer-related death. Unfortunately, partially due to the ambiguous early symptoms, it is often diagnosed when it is at an advanced stage, which precludes surgery as an option. Advanced gastric cancer has a poor prognosis with a very low five-year survival rate.

What Are the Treatment Options?

Most first-line chemotherapy options for gastric cancer combine fluoropyrimidine and platinum, although there are several EMA(European Medicines Agency)- and Swissmedic-approved options. However, newer options are emerging. Adding monoclonal antibodies substantially improves the clinical outcome of treatment. Immuno-oncology is evolving as a strong option, with immunochemotherapy showing significant survival benefits in advanced gastric cancer patients.

The open access paper “Advanced Gastric Cancer: Current Treatment Landscape and a Future Outlook for Sequential and Personalized Guide” states that molecular profiling is recommended for all patients prior to systemic treatment. At a minimum, such profiling should check for the expression of HER-2 (a gene that plays a role in the development of multiple cancers, including breast cancer), Epstein-Barr virus, and programmed death ligand-1 (a molecule with immunoregulatory functions). It’s also recommended to check for predisposition to mutation, which is assessed by looking at the stability of certain short, repeated sequences of DNA called microsatellites. The reason for this recommendation is that the results can influence the treatment regime. If certain targets are identified, immune checkpoint inhibitors can be used. These are drugs that block the protein–protein binding that prevents T cells from killing tumor cells. In other cases, antibodies can be added to the treatment to boost immune responses.

The paper goes on to detail everything that is known about the possible targets for treatment that could improve outcomes in this serious disease. If your physician hasn’t read it, they may be interested in the trials and treatment options mentioned.

What Can I Do?

Gastric health should never be taken lightly. If you have heartburn, nausea, indigestion, or loss of appetite lasting more than a few days, see your doctor. If you have a sudden and unexplained weight loss, see your doctor. If you see blood in your stool or vomit, if you’re vomiting frequently, if you’re bloated or retaining water, see your doctor.

Too often, people accept gastric symptoms as normal or blame them on their last meal. We should all be more conscious of our stomachs: what we put into them and how they feel.

Note: Some of the authors declared that they have scientific consultancy roles with pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest. For more detail, see the Conflict of Interest Statement at the end of the paper.