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Stomach and Esophageal Cancer

    Both of these organs belong to the upper gastrointestinal tract, responsible for processing the food we eat and passing it along to the intestines for digestion and absorption. When you place food in your mouth, three pairs of salivary glands go to work moistening the food, leaving a rounded mass, or alimentary bolus. Once swallowed, the bolus travels down the esophagus. Muscles in the esophageal walls automatically contract and relax to propel the food along its approximately 15-inch length, which is lined with mucus-secreting glands for facilitating traffic flow. The curved, saclike stomach receives the food from the esophagus through an opening controlled by a muscle called the gastro-esophageal sphincter. When empty, the stomach clenches together almost like a fist. But as materials enters, its four-layer walls expand.
    In an agitating, contractile action, the stomach's muscles begin to contract rhythmically from top to bottom. This churns the bolus into smaller fragments and mixes it with digestive juices containing enzymes and hydrochloric acid to form a soupy liquid. The waves gradually intensify, pushing the contents through the pylorus and into the intestines, where further digestion and absorption take place before the remaining waste products are disposed of by way of the excretory system. What we call hunger pangs are in reality an emptied stomach continuing to contract, stimulating nerves in the gastric wall.
    Through adjoining, the stomach and the esophagus have different cell characteristics. The former is composed of tall columnar cells, while flat, platelike squamous cells make up most of the esophageal epithelium. Most gastric tumours arise in glands and are classified as adenocarcinoma. Stomach cancer may advance along the gastric wall into the esophagus or small intestine. More often, however, it burrows through the wall infiltrate neighbouring organs and tissues such as the liver, pancreas, colon ovaries and peritoneum, the membrane that lines the abdominal and pelvic cavities. Other routes include the lymphatic system and the bloodstream, which can whisk cancerous cells to any organ in the body.
    Esophageal cancer presents itself as adenocarcinoma in the lower third of the gullet, near the stomach, but as squamour-cell carcinoma in the upper and middle sections. It too may travel though the lymphatic system and bloodstream, affecting other organs.

Signs and symptoms of esophageal cancer

1) difficult or painful swallowing
2) chronic indigestion
3) persistent heartburn

Treatment

    Surgery is currently the only successful method for treating gastric cancer, although the usefulness of both chemotherapy and radiation is being investigated in clinical trials. A subtotal gastrectomy removes part of the stomach, along with nearby lymph nodes. In a total gastrectomy, the entire stomach is taken out, as well as a section of the esophagus.
    If part of the stomach remains, it is connected to a segment of the small intestines; if no stomach is left, the esophagus is then joined directly to the small intestine. Patients can anticipate a hospital stay of ten days to two weeks, and another two to four weeks of convalescence at home. Patients with smaller stomachs are more comfortable eating smaller, more frequent meals.
    One infrequent side effect of this surgery is "dumping", the rapid absorption of nutrients. Normally the stomach delivers foods at a controlled rate to the small intestine, where it is absorbed. When you have no stomach, and food goes directly from your mouth into the small intestine, or can get rapid absorption in large quantities. And you will experience a rapid increase in your blood glucose and insulin, which can produce palpitations and a feeling of weakness.
    Esophageal cancer patients usually require surgery or radiation therapy. In an operation called an esohagectomy, the tumour and all or part of the gullet are removed. It is replaced by a stomach. Therefore, instead of swallowing from the mouth and into the esophagus, the food is swallowed directly into the stomach.

Risk Factors for Stomach Cancer

Hereditary risk factors
1) family history of gastric cancer
2) type A blood

Personal health history risk factors
1) personal history of pernicious anemia
2) personal history of chronic atrophic gastritis
3) personal history of achlorhydria or hypochlorhydria
4) personal history of partial removal of the stomach to treat a
noncancerous condition
5) personal history of Helicobacter phlori

Lifestyle risk factors
1) a diet high in salt-cured, smoked and salt-pickled foods

Risk Factors for Esophageal Cancer

Hereditary risk factors
1) none identified at present

Personal health history risk factors
1) severe, persistent heartburn
2) barrett's esophagus
3) untreated achalasia
4) caustic trauma to the esophagus

Lifestyle risk factors
1) excessive alcohol use
2) tobacco use
3) a diet high in salt-cured, smoked and pickled foods

Primary Prevention Guidelines for both Gastric and Esophageal Cancers

1) Cut down on salt-cured, nitrate-cured or smoked foods such as hot dogs,
ham and bacon

Secondary Prevention Guidelines
For Stomach Cancer

    For asymptomatic men and women with No Special Risk Factors
- none recommended at present

    For Asymptomatic men and women at increased risk
- none recommended at present


For Esophagus Cancer

    For Asymptomatic men and women with No Special Risk Factors
- none recommended at the present

    For Asymptomatic men and women at increased risk
    For those with Barrett's esophagus:
- Annual upper GI endoscopy with biopsy



Suggested reading about Stomach and Esophagus Cancers

- From the National Cancer Institute ( 800-4-CANCER): "What You Need to Know
about Cancer of the Esophagus"