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Dr Hsieh Wen-Son (Medical Oncologist from Icon Cancer Centre) answers your frequently asked questions on stomach cancer (also known as gastric cancer).

Stomach cancer occurs when abnormal cells in the lining or wall of the stomach multiply and spread. There are many different kinds of stomach cancer, with adenocarcinoma, the type arising from the glands lining the surface of the stomach, being the most common.

How do I prevent stomach cancer?

The risk factors for stomach cancer include high intake of salt and salted foods, infection with Helicobacter pylori, obesity, tobacco use, and a family history of stomach cancer. While there is no certain way to prevent stomach cancer, living a healthy lifestyle can help reduce your overall risk of developing cancer.

Here are some recommendations on how you can decrease your risk of developing stomach cancers as well as other cancers:

• Avoid a diet high in smoked and pickled foods, and salted meats and fish
• Consume a balanced diet high in fresh fruits and vegetables
• Avoid high levels of alcohol consumption
• Quit smoking
• Exercise regularly. The Health Promotion Board recommends 150 minutes of moderate-intensity activity in a week for an adult
• Treatment of the Helicobacter pylori infection

What are the symptoms of stomach cancer?

Symptoms usually do not appear in the early stages of stomach cancer and only appear when the cancer is more advanced. If you are experiencing these symptoms below, please seek medical attention as soon as possible to ensure a prompt diagnosis.

• Pain and discomfort in the abdomen
• Heartburn or indigestion (dyspepsia)
• Gastrointestinal bleeding (which may appear in vomit or bowel motions)
• Frequent vomiting
• Appetite loss
• Rapid and unexplained weight loss

Is stomach cancer hereditary?

The risk for developing stomach cancer can be passed down from your parents, as you may inherit certain genetic mutations that increase your risk of stomach cancer. About 10% of all patients with stomach cancer have a family history of stomach cancer.  Known genetic syndromes that are known to increase the risk for stomach cancer include:

• Hereditary diffuse gastric cancer (HDGC)
• Lynch syndrome
• Li-Fraumeni syndrome
• Familial adenomatous polyposis
• Gastric adenoma and proximal polyposis of the stomach (GAPPS)
• Peutz-Jeghers syndrome (PJS)

How is stomach cancer diagnosed?

Stomach cancer can be detected by an upper endoscopy, during which a biopsy of any abnormal areas is done to confirm the presence of cancer cells.  CT scan or PET/CT is done to check if the cancer has spread throughout your body.

• Upper Endoscopy – Examines the lining of the food pipe and stomach with a fibro-optic camera and detects any potentially cancerous areas
• Stomach Tissue Biopsy – Analyses potentially cancerous areas and confirm whether cancer is present.
• CT scan or PET/CT – Identifies the extent of the cancer and whether there is any spread of the cancer to lymph nodes or to other organs of the body

What are the chances of surviving stomach cancer?

Stomach cancer can be cured at high rates when detected early. However, as symptoms typically only appear when stomach cancer has become advanced, many patients with stomach cancer are only diagnosed with advanced cancer, when cure rates are much lower and/or the cancer can only be controlled.  Treatment options will depend on the stage of the cancer and the patient’s preference.

• Surgery – The main treatment for stomach cancer where part or all of the stomach is removed
• Radiation therapy – Uses high-energy particles to target and destroy cancer cells and can be used to improve with cure rates after surgery or to reduce symptoms in patients with advanced stages where surgery is not suitable
• Chemotherapy – Involves the use of anti-cancer drugs which are taken orally (by mouth) or injected into the body. It can be used to reduce the size of tumours prior to surgery and to decrease the risk of recurrence. Chemotherapy is also used to control stomach cancer that has spread to prolong the patient’s life and to reduce symptoms caused by the cancer.
• Targeted therapy – Some cancer cells over-express proteins such as HER2. Anti-HER2 targeted agents such as HERCEPTIN can be used to treat these cancers either by itself or together with chemotherapy.
• Immunotherapy – Stimulates your immune system to attack the cancer cells to control the cancer

In Singapore, the survival rate for all patients diagnosed with stomach cancer is 46.2% (2015-2019) based on the Singapore Cancer Registry Annual Report 2019.  However the probability of survival depends greatly on the stage of the stomach cancer at the time of diagnosis

If you have more questions on stomach cancer, please tune in to our Facebook Live with Dr Hsieh Wen-Son on 20 August (Saturday) at 8.30pm. Dr Hsieh will be speaking more on the signs and treatments for stomach cancer in Mandarin.