Download Understanding stomach cancer

Understanding stomach cancer
AN EDUCATIONAL GUIDE
Visit www.DebbiesDream.org for additional resources.
Understanding your diagnosis
Learning you have stomach cancer can be overwhelming. There is a lot of information to consider
and there are many decisions to make with your doctor.
Playing an active role in your treatment may help you feel more in control of your treatment and more
confident about the choices you make together.
This brochure contains introductory information about stomach cancer and the different treatment
options available. Also provided is a list of websites that you can visit to get additional information about
stomach cancer and to gain access to helpful tools. You can also visit www.DebbiesDream.org.
If you ever feel scared or stressed, remember there is a community of individuals, including your family
members, your friends, counselors, support groups, and your healthcare providers, that is there to provide
you with emotional and medical support during your treatment. Do not hesitate to reach out when you are
in need of compassion, conversation, or answers.
Visit
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www.StomachCancerResources.com
for additionaland
resources.
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What is stomach cancer?
How common is it?
Stomach cancer is the fifth most common cancer in the world
• In 2012, nearly 1 million new cases were diagnosed worldwide
• It occurs nearly twice as often in men as in women
Stomach cancer, also referred to as gastric cancer, is located
in the lining of the stomach and typically develops slowly over
many years.
The stomach is a hollow organ that plays an important part
in the digestion of food. As food moves from the mouth into
the esophagus (a tube that runs from the back of the throat
to the stomach), the food passes into the stomach. The food
is then broken down in the stomach by digestive juices and
moves into the small intestine.
esophagus
stomach
In the United States, it is estimated that
more than 72,000 people are currently
living with stomach cancer and nearly
22,220 new cases were estimated for 2014
In the European Union,
there were an estimated
82,000 new cases in 2012
Eastern Asia has the
highest rate of people with
stomach cancer
small
intestine
It is more commonly found
in South and Central America
than in North America
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What are some of the symptoms?
How is it diagnosed?
Early-stage stomach cancer often does not cause
symptoms. However, as the cancer grows, the most
common symptoms include:
•Feeling full or bloated after a small meal
•Stomach pain or discomfort
•Vomiting blood
Several tests and procedures are used to diagnose stomach cancer.
Assessment begins with the recording of a medical history and the
performance of a physical examination by a doctor. Laboratory
testing, such as blood work, may also be conducted.
•Difficulty swallowing
As many of these symptoms may be associated with other
medical conditions, testing would need to be conducted
by a doctor to confirm diagnosis. Please discuss any
symptoms you may have with your doctor.
•Nausea
•Vomiting
•Weight loss
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•Having blood in the stool (may appear black
and tarry and have a foul-smelling odor)
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A medical procedure called an endoscopy is the most common
test used to diagnose stomach cancer. While the patient is under
sedation, an endoscope (a long, thin, flexible tube containing a
light and camera) is inserted down his or her throat and into the
stomach to look for signs of cancer. If any part of the stomach looks
suspicious, the doctor will remove some tissue from the stomach
so that it can be examined in a lab. This is called a biopsy.
Imaging tests, which are used to create pictures of the inside
of the body, such as a computerized tomography (CT) scan,
magnetic resonance imaging (MRI), ultrasound, or positron
emission tomography (PET), may also be used. Each test has a
specific medical application. Your doctor will determine which test
to perform. If you have any questions about why a certain imaging
test is conducted during diagnosis, please speak with your doctor.
What are the stages?
Once a diagnosis of stomach cancer has been made, the doctor will need to determine the stage,
or extent, of the disease. The doctor will use this information to make treatment recommendations.
Overall, there are 5 stages, ranging from 0 to IV. The higher the stage, the more advanced the
cancer. The staging is determined by using the TNM classification (stands for “tumor-nodemetastasis classification”) system.
Part of the classification is based on the extent of the cancer spread through the stomach wall.
The stomach wall has 5 layers:
•Mucosa: the innermost layer (contains 3 parts: epithelial cells, tissue called lamina propria,
and a thin muscle layer called muscularis mucosa)
•Submucosa: support tissue for the inner layer
•Muscularis propria: a thick layer of muscle
•Subserosa: support tissue for the outer layer
•Serosa: the outer layer that covers the stomach
As the cancer grows deeper in the layers, the staging advances.
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The TNM classification system
The stages of stomach cancer
The TNM classification system contains 3 key pieces of information. The “T” refers to information about the primary tumor, the “N” details
spread to regional (nearby) lymph nodes, and the “M” indicates whether the cancer has metastasized (spread) to other parts of the body.
Each factor is subdivided into smaller categories to help describe the cancer in as much detail as possible.
Your doctor will determine the stage of the cancer by combining all of the information from the TNM classification system.
There are a total of 5 stages ranging from 0 to IV, with some stages containing more than one possibility. The higher the stage,
the more advanced the cancer.
CATEGORIES
DESCRIPTION
PRIMARY
TUMOR (T)
How deeply the tumor has invaded the
stomach wall and nearby organs
TX: Cannot be evaluated because the information is not available
PRIMARY TUMOR (T)
Tis
N0
M0
STAGE IA
T1
N0
M0
T1:The tumor has spread through the inner layers of the stomach (into the lamina
propria, muscularis mucosa, or the submucosa)
STAGE IB
T1
T2
N1
N0
M0
M0
• T1a: Grown into the lamina propria or muscularis mucosa
• T1b: Spread deeper into the submucosa
STAGE IIA
T1
T2
T3
N2
n1
N0
M0
M0
M0
STAGE IIB
T1
T2
T3
T4a
N3
N2
N1
N0
M0
M0
M0
M0
STAGE IIIA
T2
T3
T4a
N3
N2
N1
M0
M0
M0
STAGE IIIB
T3
T4a
T4b
T4b
N3
N2
N1
N0
M0
M0
M0
M0
T2: Grown into the muscularis propria
T3: Spread into the subserosa
T4: Spread through all of the layers of the stomach and into the serosa. May have
grown into nearby organs
• T4a: Grown into the serosa
• T4b: Grown through the stomach wall and into nearby organs
DISTANT
METASTASIS (M)
DISTANT METASTASIS (M)
STAGE 0
T0: No signs of a tumor
Tis: Cancer is found only in the epithelial cells in the innermost layer of the stomach
and has not spread any deeper. Referred to as carcinoma in situ
REGIONAL
LYMPH
NODES (N)
REGIONAL LYMPH NODES (N)
Whether the tumor has invaded
nearby lymph nodes
NX: Cannot be evaluated because the information is not available
Lymph nodes: When cancer cells are found
in lymph nodes, it is a sign that the cancer
has spread from the original tumor in the
stomach. This is important because lymph
nodes are attached to a pipeline of lymph
vessels that run throughout the body. As a
result, the cancer cells that spread to the
nodes could potentially use these vessels to
travel to other parts of the body.
N1: Cancer has spread to 1 or 2 nearby lymph nodes
• N3a: Spread to 7 to 15 nearby lymph nodes
• N3b: Spread to 16 or more nearby lymph nodes
STAGE IIIC
T4a
T4b
T4b
N3
N3
N2
M0
M0
M0
Whether the cancer has spread
to other parts of the body
M0: Has not spread to other parts of the body
STAGE IV
Any T
Any N
M1
N0: Has not spread to nearby lymph nodes
N2: Spread to 3 to 6 nearby lymph nodes
N3: Spread to 7 or more nearby lymph nodes
M1: Spread to other parts of the body
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11
How is stomach cancer treated?
The recommendations provided by a doctor will be unique
for each patient based on the stage of the disease, its location,
and insights learned during discussions with the patient. The
treatment for stomach cancer may include surgery, radiation
therapy, chemotherapy, biologic therapy, or a combination of
these options.
Surgery
Consists of removing part or all of the stomach, and possibly
some lymph nodes. Several surgical options are available:
Endoscopic mucosal resection
This procedure is done only for some very early-stage cancers,
where the chance of spread to the lymph nodes is very low.
For this procedure, the skin is not cut. An endoscope is inserted
through the mouth, down the throat, and into the stomach.
The tumor is removed using surgical tools that are passed
through the endoscope.
Subtotal (partial) gastrectomy
Operation that removes part of the stomach where the cancer
is located.
Total gastrectomy
Recommended operation if the cancer has spread through
the entire stomach. The stomach is removed along with some
surrounding tissue. The end of the esophagus is then attached
to the small intestine, allowing food to move through the
digestive system.
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Lymph node removal
During subtotal or total gastrectomy operations, the nearby lymph
nodes are removed.
Palliative surgery
Operation to help patients with advanced stomach cancer control
their symptoms and to make them feel more comfortable.
Radiation therapy
Directs high-powered beams of energy from a machine located
outside of the body into the tumor to kill the cancer cells. May be
used before surgery to shrink a tumor, after surgery to kill cancer
cells that may remain, or to relieve symptoms in patients with
advanced cancer. Also may be combined with chemotherapy.
Chemotherapy
Drugs that are either injected into a vein or are taken by mouth
as a pill to kill the cancer cells. These chemicals act broadly by
traveling throughout the body so it is the main treatment for patients
whose stomach cancer has spread to distant organs. May be used
before surgery to shrink a tumor, after surgery to kill cancer cells
that may remain, or to relieve symptoms in patients with advanced
cancer. Also may be combined with radiation therapy.
Biologic therapy
A type of treatment that works with your immune system to help
fight cancer.
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Why is a healthy diet important?
When you are diagnosed with stomach cancer, nutrition becomes very important, especially
ingesting enough calories to sustain a healthy weight. However, that can be challenging. You may be
tired or just not interested in food. You may be experiencing side effects from treatment, such as
nausea or mouth sores, that leave you not wanting to eat.
Remember that selecting a balanced diet with healthy foods can actually help you feel better, help
you keep up your strength and energy, help you maintain a healthy weight, and help sustain the
body’s store of nutrients. Talk with your doctor or a nutritionist if you have questions about your diet.
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What does eating healthy mean?
Healthy eating means consuming a variety of foods that give your
body the nutrients it needs. These include protein, fat,
carbohydrates, water, vitamins, and minerals. Talk with your doctor
about how you can incorporate healthy eating into your diet.
Fat: Provides a rich source of energy, helps to transport certain
vitamins through the blood, and insulates the body. Some types of fat
are better than others. When considering the effect of fat on
cholesterol and the heart, choose the following:
Protein: Needed for growth, to heal tissue, and to keep the body’s
immune system healthy. When the body does not get enough
protein, it may obtain the fuel it needs elsewhere, such
as by breaking down muscle. Being low in protein can
slow healing and lower the body’s defenses against infection.
Patients undergoing treatment for cancer may require more protein
than other people. Good sources include fish, chicken, eggs, lean
red meat, nuts, low-fat dairy products, dried beans, and soy foods.
•Monounsaturated fats, which are found in vegetable oils (olive,
canola, peanut, sunflower, and sesame), avocados, peanut butter,
and many nuts and seeds
•Polyunsaturated fats, which are found in some oils (safflower,
sunflower, corn, flaxseed, and soybean), certain fish (such as
salmon, trout, mackerel, and herring), and some nuts and seeds
(including walnuts and sunflower seeds)
These types of fats may raise cholesterol and increase the risk of
heart disease:
•Saturated fats, which are found in animal sources like meat (fatty
beef, lamb, pork, and chicken with the skin) and dairy products
(butter, cheese, and whole or reduced-fat [2%] milk). They are
also found in some baked goods, fried foods, and some oils
(coconut, palm kernel, and palm)
•Trans fats, which are found in certain snacks and preserved
baked goods (such as pastries, pie crusts, cookies, and pizza
dough) and in fried foods (like doughnuts and french fries)
Carbohydrates: Important for energy. Carbohydrates give the body
the fuel it needs for physical activity and proper organ function.
Good sources include fruits, vegetables, and whole grains. Other
sources include bread, potatoes, rice, pasta, corn, peas, and beans.
Water: Cells require water to function. A person should drink about
eight 8-oz glasses of liquid each day, which can include items like
soup and milk. If you are experiencing side effects such as diarrhea
or vomiting, you may require more fluids to prevent dehydration.
Vitamins and minerals: Needed for proper bodily function. Most
are found naturally in food, but pill and liquid supplements are
available, if needed. Large doses of some vitamins and minerals
may impact the effectiveness of certain treatments, so talk with
your doctor before taking any supplements.
If you are losing weight or having difficulty
digesting certain foods, be sure to speak with
your nutritionist. If you do not have one, ask
your doctor whether working with a nutritionist
might help you. Each person is different and a
nutritionist can recommend a diet that meets
your specific nutritional needs.
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What questions should
I ask my doctor?
For a better understanding of your diagnosis and treatment, be prepared with questions before your appointment. Listed below are examples
to use as a starting point, but do not hesitate to ask any question that comes to mind.
About cancer
•What type of cancer do I have?
•Where is the cancer located?
•What stage is my cancer?
•Has it spread to my lymph nodes?
About treatment
•What are my treatment choices?
•Which do you suggest for me and why?
•What is the goal of my treatment?
•What are the benefits of treatment?
•What are the side effects and how can they be managed?
•How do I prepare for treatment?
•How often and how long will I need to be on treatment?
•How will I feel during treatment?
•Who will be coordinating my overall treatment
and follow-up care?
•What is a clinical trial?
•Am I eligible for a clinical trial?
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About lifestyle
•Will I be able to continue with my daily activities?
•Are there exercises I can do to keep up my strength?
•Will I need to change how I eat?
•Are there foods or drinks I should be avoiding?
•Should I take any food or liquid supplements?
•What other things can I do to be as healthy as possible
through my cancer treatment?
About support
•Are there support services available to me?
•Is there a support group available that will allow me to speak
with other patients with stomach cancer?
•Are there support services available to my family?
•Where can I find more information about stomach cancer
and its treatment?
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Some helpful resources
There are many websites that provide
support services for patients, their families,
and their caregivers.
Cancer Support CommunityTM
1-888-793-9355
www.cancersupportcommunity.org
Caregiver Media Group
1-800-829-2734
www.caregiver.com
This information is not intended to
serve as an endorsement of the listed
organizations. Lilly and Debbie’s Dream
Foundation are not responsible for the
content on third-party websites.
Circle of SharingTM
https://circleofsharing.cancer.org
Family Caregiver Alliance®
1-800-445-8106
www.caregiver.org
Support Resources
Debbie’s Dream Foundation:
Curing Stomach Cancer
1-855-475-1200
www.DebbiesDream.org
Association of Cancer Online Resources
www.acor.org
CancerCare
1-800-813-HOPE (1-800-813-4673)
www.cancercare.org
®
CancerCompass
www.cancercompass.com
®
Cancer Hope Network
http://cancerhopenetwork.org
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National Coalition for Cancer Survivorship
1-877-NCCS-YES (1-877-622-7937)
www.canceradvocacy.org
Education Resources
OncoChat
www.oncochat.org
American Cancer Society®
1-800-ACS-2345 (1-800-227-2345)
www.cancer.org
Patient Advocate Foundation
1-800-532-5274
www.patientadvocate.org
National Cancer Institute
1-800-4-CANCER (1-800-422-6237)
www.cancer.gov
PearlPointSM Cancer Support
1-877-467-1936
www.pearlpoint.org
Prevent Cancer Foundation
1-800-227-2732
www.preventcancer.org
What NextTM
www.whatnext.com
Diet and Nutrition Resources
TM
Support for Caregivers
LIVESTRONG Foundation
www.livestrong.com
Caregiver Action Network
1-202-772-5050
http://caregiveraction.org
Meals to Heal
1-888-721-1041
www.meals-to-heal.com
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Notes
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We are committed to supporting
patients with stomach cancer
About Lilly Oncology
Lilly Oncology is dedicated to delivering treatment and support resources
that may help improve the care of patients living with cancer.
About Debbie’s Dream Foundation
Debbie’s Dream Foundation is a nonprofit organization dedicated to raising
awareness about stomach cancer, advancing funding for research, and providing
education and support internationally to patients, families, and caregivers.
Together, Lilly Oncology and Debbie’s Dream Foundation have established a partnership to
improve patient and caregiver awareness of and access to stomach cancer resources.
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