Tag Archive for: H. pylori infection

What Are Key Risk Factors for Stomach Cancer?

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What Are Key Risk Factors for Stomach Cancer? from Patient Empowerment Network on Vimeo.

What factors have strong links to stomach cancer? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses key factors linked to diet, certain population groups, and proactive patient advice to reduce stomach cancer risk.

[ACT]IVATION TIP

“…if you do come from Asia, one, try and minimize the salt in your diet if at all possible, try not to add any additional salts, and try and stick to a lower sodium diet, lower sodium content diet, and then number two, get tested for H. pylori. I think that H. pylori really is the main driver, and we do see a declining incidence of gastric cancer in Asia and that’s largely attributed to better recognition of H. pylori and treatment of H. pylori.”

See More from [ACT]IVATED Gastric Cancer

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Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

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Transcript:

Lisa Hatfield:

Dr. Hwang, are there any specific risk factors for gastric cancer that are more prevalent in Asian communities compared to other ethnic groups? Are there any hereditary factors?

Dr. Joo Ha Hwang:

I think the biggest risk factor that’s prevalent in Asian communities and also prevalent in wherever you see high incidence of gastric cancer, really the number one risk factor is H. pylori infection. So Helicobacter pylori infection, which is a bacterial infection of the stomach that’s usually obtained at a very young age, and basically persists in the stomach over decades and over decades someone can develop chronic inflammation that then changes the lining of the stomach to something called atrophic gastritis and gastric intestinal metaplasia.

And these are the precursors, or this is the pathway that many gastric, not all gastric cancers, but many gastric cancers take in their development. The other thing about Asian communities compared to other communities would be environmental things such as diet. So, I would say the Asian diet is probably saltier. There’s a higher salt content in the Asian diet than maybe the Western diet. And there was a recent study that showed that increased salt intake does affect your risk of developing gastric cancer. And we’ve actually known this for many, many years. Gastric cancer used to be one of the top three cancers in the United States and Europe back in the early 1900s. And I don’t think a lot of people know that.

And the two reasons that it’s gone down and the number one reason being refrigeration, so prior to refrigeration in order to preserve foods we salted everything. So there was an enormous salt content in our foods and you see, especially in Scandinavia, and you see a lot of the original gastric cancer research coming out of Scandinavian journals, and that just had to do with the fact that there was a lot of gastric cancer back then and so I think the rapid decline in the Western world can largely be attributed to both refrigeration and lower salt content and also the decreasing prevalence or the type of H. pylori that exists in the West.

And so I think that those are kind of the two primary risk factors that might be different in Asian communities versus the rest of the world. And so, my activation tip for this is if you do come from Asia, one, try and minimize the salt in your diet if at all possible, try not to add any additional salts, and try and stick to a lower sodium diet, lower sodium content diet, and then number two, get tested for H. pylori. I think that H. pylori really is the main driver, and we do see a declining incidence of gastric cancer in Asia and that’s largely attributed to better recognition of H. pylori and treatment of H. pylori.

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How Is Gastric Cancer Diagnosed and Staged?

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How Is Gastric Cancer Diagnosed and Staged? from Patient Empowerment Network on Vimeo.

What tests are involved in gastric cancer diagnosis and staging? Dr. Yelena Janjigian explains key testing and considerations that are used to determine gastric cancer staging for optimal care.

Dr. Yelena Janjigian is Chief of Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center. 

See More From INSIST! Gastric Cancer

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Transcript:

Katherine Banwell:

Could you tell us what tests are used to diagnose gastric cancer? 

Dr. Janjigian:

Most of our patients, when they come in to see me, by then the diagnosis of cancer has been made because I’m on oncologist.  

In clinical practice, patients often present with vague symptoms or no symptoms at all. And that’s an important point for our clinicians to understand. In patients who have chronic acid reflux or have, for example, other risk factors such as H. pylori infection, often they end up getting endoscopy at the time, for example, for their first colonoscopy. So, the age of colonoscopy, the first colonoscopy has is getting earlier and earlier with each update, because colon cancer is increasing in incidents in younger adults.

So, sometimes patients present and get first endoscopy, for example, which is an upper test with a camera when they’re getting their colonoscopies. In other patients, unfortunately, they present with more progressive symptoms. Often, it’s difficulty swallowing, regurgitation of food, and weight loss, which is obviously very dramatic.  

And so they end up getting an endoscopy because of that and referred by their doctors.  

Katherine:

How is gastric cancer staged? And what do the stages mean? 

Dr. Janjigian:

Yeah. So, the most important part of the staging of gastric cancer and what patients ask me, “What is my risk of cancerous recurrence? What is my stage?” Really what it comes down to is the depth of invasion. So, it’s not only the size of the tumor, but how deep is it going into the muscle of the stomach, because stomach and your esophagus are basically a muscular bag, right? And so how deep is the invasion of the tumor into the wall? And also how likely are the lymph nodes to being involved?

So, we assess it based on clinical symptoms such as swallowing difficulty and so forth. But in some patients, because the tumor is lower down in their stomach, they may not have very many symptoms, because there’s a lot more give in this muscular bag that our stomach is.  

And so we test the endoscopic ultrasound to look at the depth of an invasion and also other X-ray type imaging such as a PET scan, a P-E-T scan or a CAT scan, which gives us a sense of tumor location whether or not we think the lymph nodes may be involved. And ultimately the final way to assess, especially in patients who are undergoing surgery, is their microscopic involvement of the lymph nodes? Because that often drives the likelihood of cancer coming back after surgery.  

Katherine:

And how do the stages work for gastric cancer? 

Dr. Janjigian:

So, in gastric cancer it’s either early, intermediate, or late stage. And this goes from stage I to IV. So, stage IV  tumors is where most of the cancers are present. Over probably 50 percent of our patients present already at the time of diagnosis with more advanced stages. 

Biologically this cancer just tends to move quickly. So, even in between endoscopies in patients who get endoscopies frequently, often it goes from 0 to stage III or IV because of the lymph node involvement and also spread of microscopic cells, right? Tiny, tiny cells before we even see them, they spread through the bloodstream to other organs or lymph nodes outside of your abdomen. So, that’s considered to be stage IV. And then early, early stage disease is stage I. Those usually that we can just scoop them out using endoscopic procedures. They don’t even need to have full surgery. And then stage II and III is usually if there’s some involvement of the tumor through the muscle or into the muscle of the stomach and also some lymph node involvement. But that’s how we stage it.