Thursday, 17 November 2011

Introduction - Cancer


Cr: alternative-cancer.net

Cancer is the general term for the abnormal growth of cells. Our body cells contain millions of genes, all carrying information on how body should grow, function and behave. Normally our genes work properly and send right messages, so our body remains healthy and working the right way as it should. Since there are millions of genes carrying large number of messages, some mistakes might occur during cell divisions or damage from external factors which causes mutations that would alter the genes. Cancer results from the genetic change or damage to a chromosome within a cell. This causes the altered gene to send wrong messages, leading to the rapid growth of the particular cell. It multiplies again and again until it forms a lump that is called a malignant tumor, or cancer.

Cr : MedicaLook.net
All cancers begins in cells, the basic unit of life in our body. The abnormal cells are also known as cancer cells, maglinant cells and tumour cells. Human, animals and other living organisms can get cancers. When the cancer cells develop, they can break away from the original mass of  cells, travel through the blood and finally lodge in other organs and then repeat the uncontrolled growth.  Fast growing cancers may double over one to four weeks; slower growing cancers may double over two to six months. After the cancer has started to grow, there will a ‘silent period’ where there is no lump or mass. After a few months or years, the doubling process has occurred thirty times or so, the lump might have reach a size where it can be felt, seen on an X-ray, or cause pressure symptoms such as pain or bleeding.

There are two types of tumors. The benign tumors can appear in any part of the body, but they don’t cause any problems. They can be removed or left alone. They do not destroy the surrounding cells. While for malignant tumors, they have no clear-cut border, they put down roots and directly invade the surrounding cells. Besides, they have the ability to spread to other parts of body.

It is estimated that the annual incidence of cancer in Malaysia is 30 000 with the majority of patients found to be at a late stage of the disease. A total of 26,089 cancers were diagnosed among all residents in Peninsular Malaysia in the year 2002, comprising 11,815 males and 14,274 females with an estimation of 10,656 unregistereed cases. 1 in 5.5 Malaysians can be expected to get cancer in his/her lifetime. Taking into account unregistered cases, the risk would be 1 in 4 Malaysians.

Introduction - Stomach Cancer



Cr : MedlinePlue Medical Encyclopedia
Stomach cancer, also known as gastric cancer or gastric carcinoma, is a treatable cancer that can often be cured when it is found and treated at a local stage. The stomach lies along the digestive tract between the oesophagus and the small intestine. It is where the process of digestion takes place besides acting as a storage of food eaten during meals. Its inner walls are composed of glands that secrete hydrochloric acid and digestive enzymes.

In Malaysia, stomach cancer incidence starts to increase after 40 years of age.  The rates in males were about 1.5 times higher than in females. Chinese had the highest rates, more than 4 times that of Malays who had the lowest rates. Indians had rates about 3 times that of Malays. However among Indians, the men had an incidence rate only10% more than women. Stomach cancer is also common on Japan and China but is less common in the United Kingdom where about 8500 people suffer from it. 

Adenocarcinoma is the most common form of cancer that affects the stomach which arises from the gland that produces mucus and stomach juice in the innermost layer of the stomach. It is believed that more than 90%  of stomach cancer is caused by adenocarcinoma.

There is some rare types of stomach cancers:


Lymphomas - cancers which arise from lymphatic tissue within the wall of  stomach. Maglinant lymphoma of stomach is an immunoblastic type where the cells are loosely arranged and have prominent nucleoli as well as abundant cytoplasm.


Sarcomas -  arise from the muscle or connective tissue within the wall of stomach.


Carcinoid cancer -  arise from cells in the stomach lining which produces hormone. There won't be any significant symptoms until 15 years later. Gastric carcinoids may cause the secretion of 5-hydroxytryptophan when it results in the secondary deposition in liver.


Spheroidal-cell carcinoma –   The cell forms a signet-ring as a result of the secretion and accumulation of mucin in the cytoplasm which eventually lead to these cancer. 


Gastrointestinal Stomal Tumors (GIST) - cancers developing in the tissues which support the digestive organs.

The most widely accepted system of classification was developed by Lauren which divide the stomach cancer into 2 groups :

a.     Intestinal gastric cancer : different degrees of differentiation im glandular structure.
b.    Diffuse gastric cancer : cells that infiltrate the gastric wall. These cells are usually poorly differentiated cells.

Stomach cancer takes a few years to develop. Therefore, it is often detected only until the later stages of this cancer and can be heredity or caused by multifactorial, which is the combination of genetic and environment. Stomach cancer ranked as the ninth most common cancer in Malaysian males and fourteenth among Malaysian females, comprising 4.1% and 2.5% of all cancers reported in males and females respectively. In Malaysia, Chinese were at highest risk, followed by Indians and Malays in both sexes. 

Part of Body Affected and Symptoms



Cr : Allhealthsite.com
Gastric Carcinoma affects the digestive system with organs like stomach, pancreas and small intestines. It may also spread to surrounding organs like the oesophagus and indirectly affects the lymphatic system. 

The cancerous cells lining the inner wall of stomach from a mass within the stomach and spread diffusely throughout the entire wall of the stomach. This tumour tends to spread to the adjoining organs such as spleen, pancreas and lymph nodes. The  tumour cells may also spread up to the oesophagus (gut) or down to the small intestine as stomach is part of the digestive system. As the cancer cells multiply, some cells may break off into the lymph channels and spread to lymph nodes and other parts of the body. Tumors may also break off into bloodstream and spread through blood to the liver, lungs and other organs.



Symptoms :
Cr : Womanhealthzone.com
Abdominal painThe most common symptom of stomach cancer is abdominal pain. It ranges from mild discomfort to severe pain in the upper abdominal area. If the abdominal pain is persistent, you may need to seek for doctor. 



·       Loss of appetite
 If you suffer from loss of appetite and difficulty in swallowing for many days, you may need to inform the doctor as this symptom is related to many other health conditions besides stomach cancer. This may also lead to sudden weight loss.

·       Nausea
Nausea is another symptom regarded the stomach cancer. It can be a serious health problem and needs to be checked by doctor immediately.

·       Abdominal bloating or fullness
Abdominal bloating also cause us to feel fullness easily after consuming only a small quantity of food. This is because cancer forms a mass in the stomach and therefore block the passage of food ingested. Heartburn most probably occurred.

·                  ·    Fatigue
Fatigue also indicate high probability of getting stomach cancer. Stomach cancer can cause our body to loss large amount of blood and lastly lead to iron deficiency resulting in anaemia.

·       Blood in stool
When you see blood in the stool, it is most probably that the person is suffer from stomach cancer. This is an indication of bleeding in stomach. 

·       Change in bowel habits
Sometimes, stomach cancer can cause changes to bowel habits. It may lead to constipation or diarrhoea. You may also feel the body become weak and malaise.

 ·         Indigestion
Stomach is part of the digestive system. Hence, the sign of stomach cancer is indigestion which cause a lot of discomfort.

 ·         General weakness
Pain and uneasiness in the body make the person feel sick and their general health starts deteriorating. They feel weak all the time carrying out daily activities.

 ·         Swollen stomach
A lump or swelling could be felt in the upper abdominal region at the advanced stage of stomach cancer. Fluids start to get accumulated in the patients stomach.

Cr : James Waters
Anemia

As a result of bleeding in the stomach and the elimination of blood through blood vomit or through digestive system, the body suffer a great loss of blood. As the level of red blood cell count falls dramatically, it makes the patient look pale and weak.


Factors



Cr : Getwellzone.com
The main cause of stomach cancer is found to be the infection by Helicobacter pylori. Helicobacter pylori is the organism that causes ulcers and other diseases of the upper digestive system, and responsible for a tremendous amount of illness and suffering worldwide. Helicobacter pylori is a helical or spiral-shaped bacterium that lives in the stomach. It is identified as a “group 1” by the International Agency for Research on Cancer (IARC), a subordinate organization of World Health Organization (WHO) in 1994.

The infection of Helicobacter pylori often goes undetected or misdiagnosed as the symptoms such as burping, nausea and burning or aching in the stomach are easily confused with other diseases. Helicobacter pylori often cause inflammation and damage to the inner layer of the stomach, causing ulcer and stomach cancer.  

Cr : Regina B.

           Our diet can be the important risk factor of stomach cancer. The cancer is not a single disease, but an expression of multiple alterations of in a normal process of cells growth and death. Therefore, food can affect cancer risk and lead to carcinogenesis and cancer. Consumption of food rich in salted, pickled and smoked products increases the risk of stomach cancer as these foods contain high content salt and nitrates and low content of antioxidants. This is because they are stored for a long time at room temperature before being consumed. Nitrates and nitrites are substances commonly found in cured meats and can be converted by certain bacteria, such as H. pylori, into compounds that have been found to cause stomach cancer in animals. The nitrates with the salt in acidic stomach form the reactive carcinogens. Low consumption of vegetables and fruits also leads increases the risk of stomach cancer. The antioxidants in vegetables and fruits can destroy the oxygen species, which gives a protective effect.


Shelly Jones
           
 Alcohol and tobacco smoking is also one of the reason leading to stomach cancer. Alcohol associates with Helicobacter pylori infection, which may cause inflammation of the gastric mucosa. Development of gastric carcinogenesis is divided into a few stages: chronic atrophic gastritis, intestinal metaplasia, and dysplasia. The risk for both metaplasia and dysplasia increases significantly together with the tobacco consumption and also the increasing of smoking duration. It is estimated that smoking causes 35% of incident cases of stomach cancer of the United States

        
 Furthermore, the stomach cancer can happen due to the gene mutations in the E-cadherin gene (CDNI). Mutations in gene have been reported in heredity diffuse gastric cancers. It has been estimated that mutation in E-cadherin gene is causal in at least 30% of cases of diffuse gastric cancers with a penetrance of approximately 75% to 80%. Thus, people having CDNI have 75% to 80% chances of having stomach cancer.

As a summary, you are at risk of having stomach cancer if  you :
  1. Consume food rich in salted, pickled and smoked products.
  2. Do not consume enough vegetables and fruits
  3. Have a stomach 
  4. Smoke
  5. Drink alcohol
  6. Are exposed to long-term radiation
  7. Have a family with a history of stomach cancer

Treatment



The most common treatment for stomach cancer are radiotherapy, chemotherapy and surgery.
Neo-adjuvant therapy is a treatment given as a first step to shrink a tumor before the main treatment is given. It includes chemotherapy, radiation therapy, and hormone therapy and is a type of induction therapy. 

Cr : Alternative-cancer.net
Radiotherapy:
This treatment can be used to relieve the stomach blockage in stomach cancer patient and is also useful in stopping the bleeding in stomach. There will be some side effects caused by radiotherapy such as gastrointestinal toxicity from dose-limiting structures surrounding the stomach (intestines, liver, kidneys, spinal cord, and heart).



Chemotherapy:
It is used to reduced symptoms from an advanced cancer as well as to prolong the time of spreading of cancer cells throughout the body. It is usually as a follow-up investigation for patients who undergo surgery. Chemotherapy will also cause adverse effects like nausea, hair loss and decrease in the white blood cells count.

Cr : Higa F.
Surgery:
It is performed to reduce complications of the cancer such as blockage of the stomach or bleeding from the cancer. Gastric cancer is classified according to its location in the proximal, middle, or distal stomach which is useful for determining the extent of resection. The surgical procedure in patients with stomach cancer including primarily adjust to the location of the tumor, the growth pattern seen on biopsy specimens, and the expected location of lymph node metastases.



An example of surgery is laparoscopic surgery. It is commonly used to remove small stomach cancers and is the examination of the inside of the body using a tube-shaped instrument that can be inserted through the wall of abdomen. Advantage of this type of surgery is that it does not require a large incision in the abdomen, so recovery time will be shorter.

Another treatment which involves surgery is gastrectomy. First of all, the affected part of the stomach is removed and then the small intestine is joined to the stomach so that the digestive tract can function normally. Once the digestive tract has recovered, they can resume their normal diet.
                    

Targeted therapy:

Chemotherapy drugs are involved in this kind of therapy. The drugs target against the cancer cells that divide rapidly and uncontrollably so that the treatment is effective. Some examples of drugs approved by the Food and Drug Administration (FDA) for stomach cancer are:
-          Adriamycin PFS (Doxorubicin Hydrochloride)
-          Adriamycin RDF (Doxorubicin Hydrochloride)
-          Doxorubicin Hydrochloride
-          Efudex (Fluorouracil)
-          Fluoroplex (Fluorouracil)


Cr : Indel J.
Immunotherapy:
This treatment also uses drugs to treat cancer by stimulating the body’s immune system fight against the cancer. Combining chemotherapy with immunotherapy slows down the recurrence of stomach cancer cells  helps to extend lifetime.

A new option for stomach cancer treatment was introduced in year 2006 according to a British study in the New England Journal of Medicine. They had discovered that patients may survive longer if they receive chemotherapy before and after the surgery to remove tumor.

Intraoperative electron-beam therapy:
An alternative method of delivering high-dose radiation to the tumor bed is intraoperative electron beam therapy (IORT), a technique that permits delivery of a high dose to the tumor bed while minimizing the exposure to the surrounding normal tissue. IORT doses range from 10-20 Gray and the toxicity is acceptable. It has been shown to produce long-term survival in one or two-tenth of the studies.



Survival Rate



Stomach cancer is one of the most fatal type of cancer. It causes 1 million deaths annually worldwide and is the 4th most common cancer in the world. The survival rate mostly depends on the location condition of the cells, age, and the stage of development of the cancer. Once patients are diagnosed with stomach cancer, they usually live up to only about 6 months. It accounted for about 6.3% (1500) out of 23,965 deaths in Malaysia for the year 2002.  

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. The overall 5-year relative survival rate of people with stomach cancer in the United States is about 28%. If the cancer cells are not spread to the lymph node, the 5-year survival rate will be increased.  Some can live much longer than 5 years and some are even cured.

The 5-year survival rates for stomach cancer by stage are shown in the table below. These data are obtained from the National Cancer Institute's SEER database and are based on people diagnosed with stomach cancer and treated with surgery between 1991 and 2000.

Stage IA
71%
Stage IB
57%
Stage IIA
45%
Stage IIB
33%
Stage IIIA
20%
Stage IIIB
14%
Stage IIIC
9%
Stage IV
4%

Organisation and Support Groups


Gastric cancer is dominant in many Asian countries, such as China, Japan, and Korea. The high mortality from gastric cancer is mainly due to late presentation. Early detection and treatment is an important way to reduce death from gastric cancer. Screening for gastric cancer is not commonly practised and there is a paucity of data in Asia to lend support to such a programme.

Cr : OMED.net
Cr : A-PSDE.net
The Asia Pacific Working Group on Gastric Cancer,     supported by the World Organization of Digestive Endoscopy (OMED) and Asian Pacific Societyof Digestive Endoscopy (APSDE), was formed to determine the current practice of gastric-cancer screening in Asia. Experts on gastric cancer in the Asia Pacific region including gastroenterologists, surgeons, and endoscopists formed Experts from eight Asian countries—China, Japan, Korea, Malaysia, Philippines, Singapore, Taiwan, and Thailand—were invited to join the working-group meeting in Cebu, Philippines, during Asia Pacific Digestive Week in November, 2006, to discuss the epidemiology, screening, and prevention of gastric cancer. Participants complete a written-opinion survey on screening for gastric cancer, which included questions on who to screen, when to screen, and how to screen including eradication of Helicobacter pylori and cost-effectiveness of screening.


Cr : NetApp.net
On the other hand, to address the significant need for gastric cancer research and to improve the detection, treatment, and prevention of gastric cancer, NetApp  and Stanford Genome Technology Center are building the country's first comprehensive gastric cancer registry powered by NetApp storage technology. NetApp donated more than $600,000 in hardware, software, and services to the Stanford Genome Technology Center on behalf of the Gastric Cancer Fund. A comprehensive gastric cancer registry would aggregate all pertinent clinical and genetic data on gastric cancer patients and serve as a resource in developing strategies for this cancer's detection, treatment, and prevention. It leverages a high-performance computing system which will be integrated into state-of-the-art genomic DNA sequencing of gastric cancer tumors and patient DNA samples to better understand the genetic make-up of the gastric cancer cell. 


Cr : Gastric Cancer Fund
The Gastric Cancer Fund is the first non-profit organisation dedicated to helping poeple fight gastric cancer. It aims to increase the public’s consciousness around gastric cancer.  The Gastric Cancer Fund is dedicated to increasing both local and national awareness around gastric cancer, as well as the helping other cancer organizations increase the collective focus on all types of cancer research.


Cr : MACA.com.my
Malaysian Anti-CancerAssociation (MACA) is a non-profit cancer organization, providing comprehensive information and professional support to improve the lives of cancer patients and their families so that they will not be lonely the face of cancer operating in Malaysia. It is free of charge and is a charity body.
MACA was approved by the Malaysian Registrar of Societies this year (2011).

At the beginning, they only provided free cancer information and support before branching out to different comprehensive care to cancer patients and their family in need.

MACA is looking to set up a charitable foundation of cancer and cancer recovery club, and establish branches at all cities and towns across the country.

Their services include: organizing public education activities to support cancer research, home care services, assisted therapy programs, psychological counseling, assistance in patients with medical expenses, so that patients and their families will live more better.


Cr : NSCM.com.my
The National Cancer Society of Malaysia (NCSM) does not receive government funding and was founded in 1966. Voluntary contributions from the public finances NCSM.
NCSM aims to preventing cancer, saving lives from cancer and improving the quality of life of those living with cancer through patient care and education, allowing the society to pursue new and innovative services for patients with cancer.
They give talks and organize seminars and lectures as NCSM is involved in Public Awareness and Education Programmes besides Medical Education; providing education to graduates and undergraduates and inviting eminent specialists from overseas to update medical specialists here in Malaysia on the latest trends in the management of cancer patients.



Cr : IGCA.net
International Gastric CancerAssociation (IGCA), was founded on March 29, 1995 by the members of the International Preparatory Committee.

It aims to provide an international forum for the advancement of research into the prevention, diagnosis and treatment of gastric cancer besides facilitating the eradication of gastric cancer worldwide.

A branch in Japan, the Japanese Gastric Cancer Association (JGCA) is promoting basic and clinical study with cooperation of IGCA and WHO Collaboration Center for Gastric Cancer. All the members contribute in activities of JGCA and gets information from these international organizations.