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Stomach Cancer
Dr Kingsley’s comments When cancer develops in the stomach, it is inevitable that the process of digesting food will be disturbed in some way, because the stomach is the main organ that processes the food we swallow. The most common first symptom of cancer of the stomach, in my experience, is simply acid indigestion, that is, a sensation of acidity, discomfort, burning or fullness some time after a meal. To be fair these symptoms are suffered by probably millions of people all over the world, especially those in the so-called West, who have as much food available to them as they want, whenever they want it. Over-the-counter antacids are a very profitable item in Pharmacies, and, if they relieve the symptoms, strongly suggest that those symptoms were caused by too much acid in the stomach. So you might find it strange that I often recommend that such patients should actually take acid preparations with their meals. However, when I suggested in the last sentence in the paragraph above that those symptoms are caused by too much acid in the stomach, I should have said that that is what most doctors assume, which is why they prescribe drugs to suppress the production of acid in the stomach. You may have heard of names such H2-blockers (e.g. Zantac and Tagamet) and Proton Pump Inhibitors (e.g. Losec). What I should also have said is "too much acid in the stomach at the wrong time in relation to the meal". Mother Nature devised the process of digesting food millions of years ago, and the production of acid when food enters the stomach is part of that plan. So presumably it should still work like that in this day and age. The normal is as follows:- food enters the stomach which is stimulated to start producing acid, primarily to start digesting any protein. In a normal sized meal, food starts to leave the stomach in about twenty minutes, but can take much longer to empty completely. However, the biggest production of acid should be as soon as food enters the stomach, and the amount produced rapidly slows down, so that, by the time food starts to leave the stomach, there should be enough already in the stomach to do the job, and production stops, by a feed-back mechanism. The reason why people suffer from acid after a meal, is because the production of acid is either delayed until later, or something has stimulated the stomach to produce far more acid than is needed for a particular meal. Figure 1 shows what should normally happen, while figure 2 shows what is wrong, and why people suffer from acid indigestion after meals. In my experience, foods such as milk and milk products can suppress the production of acid, while alcohol, tea, coffee, smoking, sometimes citrus fruits especially oranges and orange juice and spicy foods can stimulate the production of acid. By giving a dose of acid after the first mouthful of food at meal times means that acid is immediately present. This sends a feedback message to the lining of the stomach telling it not to bother. If there wasn’t going to be much produced in the first place, then it is artificially provided to allow the process of digestion to proceed normally. At the same time, you need to change your diet in some way to allow the normal process to function properly. To be fair, this description is extraordinarily common, because so many people suffer in this way. So while these symptoms can be the first sign of cancer of the stomach, the vast majority of people who complain of them will probably never develop cancer in their stomach. However, people who do develop cancer of the stomach have nearly always suffered from these symptoms to some degree. It is when they have been there for a long time and somehow change that cancer should be suspected, especially if this is associated with a loss of weight. Other symptoms and signs are difficulty in swallowing, loss of appetite, abdominal pain not necessarily associated with meals or somewhat after meals and stomach feeling full after only a small amount to eat. A not uncommon presentation is fatigue which is found to be anaemia, usually iron-deficiency, but occasionally caused by a deficiency of vitamin B12. As the acid-producing part of the stomach is virtually the same as that part that produces intrinsic factor for marking vitamin B12 for absorption, this should be considered far more often than it is, in my experience. Because stomach cancer can bleed slowly, blood may be found in the stools. The blood is likely to be old, as it has had to pass from the bleeding stomach all the way along the whole length of the intestines to be excreted with the faeces. To begin with, however, you may only notice that your faeces have gradually become much darker than they were previously, but, in due course, it becomes obvious that something is not right. Bright blood is not an indication of stomach cancer, but suggests that the bleeding is from nearer the rectum, such as from plies. Risk Factors. Cancer of the stomach, sometimes known as gastric cancer, is the second most common form of cancer worldwide, for which reason it is logical to consider seriously that what is put into the stomach, i.e. food and drinks, is likely to be the main cause. It is the leading cause of death in Japan, and the fourth most common cancer in Europe. Although the overall incidence is gradually diminishing, there seems to be an increase at the top end of the stomach where it joins the oesophagus. Anything that causes gastritis predisposes you to stomach cancer, and there is now a clear association with a bug called Helicobacter pylori. It is strangely more common in people of blood group A (see the book entitled "Eat Right For Your Type" by Dr. Peter D’Adamo, which basically explains that certain foods should be avoided by people depending upon their blood group). Investigations. The two most common investigations are a barium meal, to which has been added endoscopy in the more recent years. A biopsy is most likely to be taken to confirm and stage the diagnosis. Sometimes the only way of making the diagnosis is by laparotomy, an operation when a surgeon opens you up to have a look inside. Conventional Treatment. Tumours are almost always described in medical language as adenocarcinomas. Surgery is the most common approach in 80% of patients in the United Kingdom. It is not likely to be significantly different anywhere else. Exactly what procedure is carried out mainly depends on where the tumour is and what other nearby organs it is affecting. Chemotherapy and radiotherapy are sometimes used, usually in combination with some form of operation. An Explanation by Dr Kingsley Before Your Consultation about your Stomach (Gastric) Cancer Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having cancer in your oesophagus. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of cancer in your stomach, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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