Gastroesophageal junction cancer/Stomach cancer

Stomach cancer is an abnormal growth of cells that begins in the stomach. The stomach is a muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach receives and holds the food you eat and then helps to break down and digest it.

Stomach cancer, also known as gastric cancer, can affect any part of the stomach. In most of the world, stomach cancers form in the main part of the stomach (stomach body).

 Stomach cancer is more likely to affect the area where the long tube (esophagus) that carries food you swallow meets the stomach. This area is called the gastroesophageal junction.

Where the cancer occurs in the stomach is one factor doctors consider when determining your treatment options. Treatment usually includes surgery to remove the stomach cancer. Other treatments may be recommended before and after surgery.

Signs and symptoms of stomach cancer may include:

Difficulty swallowing

Feeling bloated after eating

Feeling full after eating small amounts of food

Heartburn

Indigestion

Nausea

Stomach pain

Unintentional weight loss

Vomiting

When to see a doctor

If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more-common causes of these signs and symptoms first. 

Causes

It's not clear what causes stomach cancer, though research has identified many factors that can increase the risk.

Doctors know that stomach cancer begins when a cell in the stomach develops changes in its DNA. A cell's DNA contains the instructions that tell the cell what to do. The changes tell the cell to grow quickly and to continue living when healthy cells would die. The accumulating cells form a tumor that can invade and destroy healthy tissue. With time, cells can break off and spread (metastasize) to other areas of the body.

Risk factors

Factors that increase the risk of stomach cancer include:

Gastroesophageal reflux disease

Obesity

A diet high in salty and smoked foods

A diet low in fruits and vegetables

Family history of stomach cancer

Infection with Helicobacter pylori

Long-term stomach inflammation (gastritis)

Smoking

Stomach polyps

Prevention

To reduce the risk of stomach cancer, you can:

Maintain a healthy weight.If you're overweight or obese, talk to your doctor about strategies to help you lose weight. Aim for a slow and steady weight loss of 1 or 2 pounds a week.

Choose a diet full of fruits and vegetables. Try to incorporate more fruits and vegetables into your diet each day. Choose a wide variety of colorful fruits and vegetables.

Reduce the amount of salty and smoked foods you eat. Protect your stomach by limiting these foods.

Stop smoking. If you smoke, quit. If you don't smoke, don't start. Smoking increases your risk of stomach cancer, as well as many other types of cancer. Quitting smoking can be very difficult, so ask your doctor for help.

Ask your doctor about your risk of stomach cancer. Talk with your doctor if you have an increased risk of stomach cancer. People with a strong family history of stomach cancer might consider tests, such as endoscopy, to look for signs of stomach cancer.

STAGES OF STOMACH CANCER

Each of these categories are rated on a numbered scale, with the higher numbers indicating increased severity. These categories are then grouped into stomach cancer stages from 0-IV:

Stage 0:  Early stage stomach cancer may also be referred to as carcinoma in situ because the cancer has not spread into any nearby tissue. In this stage, the cancer has not yet spread to the inner layer of cells that line the stomach.

Stage I (stage 1 stomach cancer): This stage of stomach cancer is divided into two categories:

Stage IA stomach cancer occurs when the cancer has grown beneath the top layer of cells in the mucosa but has not grown into the main muscle layer of the stomach. The cancer has not spread to any lymph nodes or anywhere else.

Stage IB stomach cancer occurs when one of the following conditions are met:

The conditions of stage IA are met, and the cancer has also spread to one or two lymph nodes near the stomach, but not to any other tissues or organs.

The cancer has grown into the main muscle layer of the stomach wall, but has not spread to nearby lymph nodes, tissues or organs.

Stage II (stage 2 stomach cancer): This stage of stomach cancer is divided into two categories:

Stage IIA stomach cancer occurs when one of the following conditions are met:

The cancer has grown beneath the top layer of cells. It has not reached the main muscle layer, but it has spread to between three and six lymph nodes near the stomach. Distant sites have not been affected.

The cancer has grown into the main muscle layer of the stomach. It has spread to one or two nearby lymph nodes but has not spread to distant sites.

The cancer has grown through the main muscle layer into the subserosa but has not grown through all the layers to the outside of the stomach. It has not spread to any nearby lymph nodes, tissues, or organs outside of the stomach.

Stage IIB occurs when one of the following conditions are met:

The cancer has grown beneath the top layer of cells but not into the main muscle layer. It has spread to seven or more lymph nodes near the stomach. Tissues and organs outside the stomach remain unaffected.

The cancer has grown into the main muscle layer. It has spread to between three and six lymph nodes near the stomach, but it has not spread to any tissues or organs outside the stomach.

The cancer has grown into the subserosa layer, but not completely through all the layers to the outside of the stomach. It has spread to one or two nearby lymph nodes, but has not spread to tissues or organs outside the stomach.

The cancer has grown completely through all the layers of stomach wall into the outer covering of the stomach but has not started growing into other nearby organs or tissues. It has not spread to any nearby lymph nodes or distant sites.

Stage III (stage 3 stomach cancer): This stage of stomach cancer is divided into three categories:

Stage IIIA occurs when one of the following conditions are met:

The cancer has grown into the main muscle layer of the stomach. It has spread to seven or more lymph nodes but has not spread to tissues or organs outside the stomach.

The cancer has grown into the subserosa layer, but not completely through all the layers to the outside of the stomach. It has spread to between three and six nearby lymph nodes but has not spread to tissues or organs outside the stomach.

The cancer has grown completely through all the layers of the stomach wall into the outer covering of the stomach but has not started growing into nearby organs or tissues. It has spread to one or two nearby lymph nodes but has not spread to distant sites.

Stage IIIB occurs when one of the following conditions are met:

The cancer has grown into the subserosa layer, but not completely through all the layers to the outside of the stomach. It has spread to seven or more nearby lymph nodes but has not spread to distant sites.

The cancer has grown completely through all the layers of the stomach wall into the serosa but has not started growing into nearby organs or tissues. It has spread to three to six nearby lymph nodes but has not spread to distant sites.

The cancer has grown through the stomach wall and into nearby organs or structures. It may also have spread to up to two nearby lymph nodes. It has not spread to distant sites.

Stage III C occurs when one of the following conditions are met:

The cancer has grown completely through all the layers of the stomach wall into the serosa but has not started growing into nearby organs or tissues. It has spread to seven or more nearby lymph nodes (N3) but has not spread to distant sites.

The cancer has grown through the stomach wall and into nearby organs or structures. It has spread to three or more nearby lymph nodes. It has not spread to distant sites.

Stage IV (stage 4 stomach cancer): This is the most advanced form of the disease. In stage IV, the cancer has metastasized, or spread, beyond the stomach into other areas of the body. About four out of five stomach cancers in the United States are diagnosed after the cancer has spread to other areas of the body. The five-year survival rate for those diagnosed with stage IV stomach cancer is 4 percent.

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