Stomach Cancer: Prevention and Treatment
The goal of screening is to discover early cancers that have a greater than 90 percent chance of cure. Most often, the first thing physicians do when a person comes to their office is to take a history. They ask about symptoms that could be related to stomach cancer. A comprehensive family history is also taken asking the patient if anyone in their family has ever had stomach cancer. Ultimately, a complete physical examination is performed.
Although screening of the general population for Helicobacter pylori infection and treating those who are infected would be expected to reduce the incidence of stomach cancer, it is not felt to be cost effective in the United States at this time. Furthermore, no one has yet proven that eradicating Helicobacter pylori after twenty to forty years of infection would prevent the development of stomach cancer.
Avoidance of stomach cancer may also be possible by proper diet and vitamin supplementation. Smoked foods, pickled vegetables, salted fish, excessive dietary salt, foods with nitrates such as lunch meat and hotdogs as well as charcoal broiled foods, produce nitrosamines that cause cancer. Vitamin C can prevent nitrosamine formation and therefore fresh fruits should be substituted in the diet for foods that produce nitrosamine. Recent studies in animals show high dose folic acid may play an important role in prevention of stomach cancer. Helicobacter pylori may increase the formation of nitrosamine by preventing the secretion of vitamin C in the stomach. Taking supplemental vitamin C (250 to 500 mg per day) is advised for those with a family history of stomach cancer and those who have been infection with Helicobacter pylori.
Once the diagnosis of stomach cancer is made, surgery is the treatment of choice. If it has spread to the lymph nodes or to the liver, you may also need chemotherapy. When stomach cancer is diagnosed early and thought to be cured by surgery, a careful search for Helicobacter pylori should also be made. When the bacteria is not found in the stomach by biopsy, a serological blood test should also be obtained. If evidence of Helicobacter pylori infection is found, intensive antibiotic therapy should be given and treatment success proved by endoscopy or breath test. A Japanese study of stomach cancer patients surgically treated and cured demonstrated that getting rid of Helicobacter pylori prevented another stomach cancer from forming. In individuals who did not receive treatment for Helicobacter pylori, a substantial percentage developed a second stomach cancer within a few years.
Helicobacter pylori cancer can also cause other forms of stomach cancer. Non-Hodgkin’s lymphoma of the stomach is probably related to Helicobacter pylori most of the time and MALT lymphoma of the stomach (a low grade lymphoma) is always associated with Helicobacter pylori. Patients with severe gastritis should have biopsies taken looking for MALT lymphoma. In cases of early MALT lymphoma, treatment of Helicobacter pylori may completely cure the patient. In more advanced cases surgery, radiation therapy, or chemotherapy may be necessary. Non-Hodgkin’s lymphoma of the stomach can often be treated with radiation therapy alone. Occasionally chemotherapy with or without surgery is also necessary.