Stomach Cancer (cont.)

MEMBER QUESTION:
Does eating fresh foods help you avoid stomach cancer? We eat a lot of pickled fish and smoked fish, as well as smoked meats. Is this a problem? I'm concerned because of this disease being in the family (grandparents, etc.).

MACDONALD:
When you look at diet and cancer in general, it's very difficult to say that one particular person on a particular diet is going to get cancer. One of the things you can do is look at populations of people and for example, say that stomach cancer is significantly more common in countries like Japan where pickled and preserved foods in general are eaten; in the United States less pickled and preserved foods are eaten and stomach cancer is a less common disease.

In regard to the question about hereditary cancer, it's quite uncommon to find there's a genetic predisposition to a particular kind of stomach cancer. It can seem that cancers run in families, because families experience the same environment and it's not genetically mandated that people would get the cancer.

MODERATOR:
What symptoms might someone experience with stomach cancer?

MACDONALD:
There are several symptoms that may occur. People can have pain in their upper abdomen from the cancer. People can become anemic because there is slow blood loss from the cancer. When someone is anemic they feel tired, may get short of breath with routine activities. Occasionally people have difficulty swallowing because cancer is near the upper part of the stomach and partially obstructs food going down in the stomach. Those tend to be the main symptoms. People with more advanced stomach cancer will sometimes lose weight because they have been unable to eat well for long periods of time.

"The thing that we worry about stomach cancer is a symptom called early satiety. What this means is that a meal that normally would not fill you up makes you feel full so that you eat a lesser portion of food and feel full."

MEMBER QUESTION:
Is stomach cancer incidence increased or decreased by medications such as Prevacid or Protonix? Do they mask symptoms?

MACDONALD:
Again, this is a very good question. We know that in stomach cancer associated with gastritis, one of the common findings is that the acid level of the stomach goes down. Drugs like Prevacid and Protonix also decrease the acid level in the stomach. If decreased acid were likely to cause stomach cancer, you would expect a higher likelihood of the disease in people taking medicines like Protonix or Prevacid. That does not appear to be the case.

The other concern about the masking of symptoms is potentially a problem, although it doesn't appear to be significant. In other words, if someone had pain from an ulcerated stomach tumor, would decreasing the acid in the stomach by using these drugs decrease the pain? That is a possibility, but is not of real clinical importance.

MEMBER QUESTION:
What does mean if your stomach still feels empty after you eat a full meal and you feel tired after that?

MACDONALD:
If your stomach feels empty after you eat a meal you're probably healthy. The thing that we worry about stomach cancer is a symptom called early satiety. What this means is that a meal that normally would not fill you up makes you feel full so that you eat a lesser portion of food and feel full. The reason for this is the tumor is occupying part of the stomach so there's not room for the food. I wouldn't worry about eating a meal and still feeling hungry.

MODERATOR:
How is stomach cancer diagnosed? What tests are done?

MACDONALD:
These days probably the most important test for the diagnosis of stomach cancer is upper endoscopy. What this means is a passing of a scope through the esophagus and down into the stomach. The doctor is looking for the presence of abnormalities, ulcers, tumors, etc., and the doctor can biopsy through the scope to confirm a diagnosis.

There are other diagnostic tests that occasionally can be helpful, and these include CAT scans of the abdomen and also an upper GI radiograph series where the patient will be asked to swallow a dye like barium for the stomach to be outlined and for tumors to be defined.

MEMBER QUESTION:
Who should be getting tested? And how often?

MACDONALD:
This is another good question. Since stomach cancer is a relatively uncommon disease in this country there is no screening program for stomach cancer like we have with, for example, mammography for breast cancer. Generally people who have symptoms, such as early satiety, weight loss that is unexplained, anemia, difficultly swallowing, will get upper endoscopy and stomach cancers may be noted at that time.

MEMBER QUESTION:
Does blood in the stool mean stomach cancer? Or just colon cancer?

MACDONALD:
Blood in the stool can occur from any site of bleeding in the gastrointestinal tract. In the U.S., where colon cancer is far more common than stomach cancer, with about 150,000 new cases of colon cancer occurring each year compared to 20 to 25,000 cases of stomach cancer, blood in the stool of course is more likely from colon cancer. What a doctor will do if someone has blood in the stool -- particularly if they are above the age of 50 -- is first do a colonoscopy. Statistically it is more likely the blood is coming from some abnormality in the colon. If the colonoscopy is negative for any disease, then an upper endoscopy in the stomach will be done to rule out any blood coming from the stomach going into the stool.

"People who have chronic GERD can sometimes develop something called Barrett's esophagus, which is a change in the lining of the esophagus that can make cancer more likely."

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