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Stomach Cancer Blog

 

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What are My Risks of Getting Stomach Cancer?

Did you know that there are certain risk factors that can play a role in stomach cancer?  It’s true!  There are not really any set in stone factors that have been pinpointed to cause this type of cancer, but there are definitely a few things that put you at higher risk.  Take a look at these risk factors, and if you notice that you have any of them, it may be time for you to see your doctor.

Age, Gender and Ethnicity

There are some people who are just more prone to stomach cancer than others.  Most of the time, men are more affected than women with stomach cancer.  It is also more likely for people to get this type of cancer when they reach the age of 50 or higher, but that doesn’t mean that you can’t get it younger.  In fact , it’s on the rise in young people ages 25-39.  Hispanics, African Americans and Asian people are also at a higher risk than Caucasians.

It is really important for you to take these risk factors into consideration.  You don’t just need to go in early for a screening if you have the risk factors, but you also need to go in more often.  It can arise at any time, sometimes without any signs or symptoms.  If you want to have the opportunity to treat it effectively, you need to make sure that you catch it with enough time to treat it.

Life Style

People who drink or smoke are at a higher risk of getting stomach cancer.  If you are obese, your risks are higher too.

Family History

Any time you have a family history of cancer, no matter the type, it is very important for you to go ahead and do what you can do prevent the cancer.  This is because family history can play a big role in whether or not you will develop cancer within your lifetime.  The more people in your family that have had it before, the higher your risks.

What Is Stomach Cancer?

What is Stomach Cancer?

Stomach cancer is actually a type of cancer that affects the stomach, much like what it seems that it would be.  Your stomach is actually a muscular sac that is found in your abdomen underneath your ribs.  It is where your food is stored until it is ready to be digested.  Stomach cancer can also be called gastric cancer. 

Types of Stomach Cancer

There are a few different types of stomach cancer, but the most common one is Adenocarcinoma.  This is where your cancer starts in the lining of the stomach, rather than consuming the entire stomach.  Stomach cancer is not really that common, at least not in the United States, but it is more common around the world- especially in the Asian countries. 

Symptoms of Stomach Cancer

There are a few different signs and symptoms that you may want to be aware of.  Most people will usually feel fatigued or bloated, and may experience heartburn, indigestion, nausea and pain.  It may also lead to vomiting and weight loss.  The problem is, these are also symptoms of many other conditions, so it will require tests to make sure that is what it is. 

Treatment Options

There are a few different treatment options when it comes to stomach cancer.  Perhaps the most common treatments include chemotherapy, surgery and radiation but that will depend upon what stage your cancer is diagnosed.  Your doctor can talk to you about what is right for you.  Also, consider asking your doctor how many cases of stomach cancer he/she treats each year.  If you can count them on one hand, you may want to travel to a larger cancer center that sees more cases of stomach cancer a year.

Gastric Cancer Risk and Preventive Factors - An Update

Gastric Cancer Risk and Preventive Factors - An Update

By Michael Perez, MD



Below are the compiled risk and preventive factors for gastric cancer with updates from the most recent journals and trials:

Risk factors:
1.       Family History of gastric and esophageal cancer7
2.       History of having of H. pylori infection4, 7, gastric ulcers7, gastric polyps7
3.       Heartburn7
4.       Alcohol5, 7
5.       Smoking5
6.       High salt diet4,5
7.       Irregular eating habits – A recent study showed that omission of breakfast and the failure to refrigerate food resulted in an increased risk of gastric cancer in the Mexican population.2, 7
8.       Eating too fast7
9.       Smoked food7
10.   Meat – A recent study in Iran showed that red meat4 increases the risk of getting gastric cancer while white meat decreases the risk 1, 7
11.   Fried food6
12.   Spicy food7
13.   Very hot food and drink5, 7
14.   Mouldy and leftover food 3
15.   Pickled food 8

Preventive factors:

1.       Eradication of H. Pylori infection4
2.       Vegetables and fresh fruits particularly tomatoes, broccoli, garlic, citrus fruit and pomegranate4
3.       Soy Products (low salt) – especially for women and smokers6
4.       Vitamin C and selenium9
5.       Korean red ginseng10

IMPORTANT NOTE: These are from recent scientific journals. This article should in no way be construed as giving medical advice. Always discuss with your doctor before making lifestyle changes.

References:
1.       http://www.ams.ac.ir/AIM/NEWPUB/13/16/6/004.pdf
2.       http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581834/
3.       http://www.ncbi.nlm.nih.gov/pubmed/23803050
4.       http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468701/
5.       http://www.apocpcontrol.org/paper_file/issue_abs/Volume13_No5/2291-97%204.6%20Emine%20Yasibass.pdf
6.       https://www.jstage.jst.go.jp/article/jea/advpub/0/advpub_JE20120232/_article
7.       http://www.cancerjournal.net/article.asp?issn=0973-1482;year=2013;volume=9;issue=2;spage=205;epage=209;aulast=Wu
8.       http://cebp.aacrjournals.org/content/21/6/905.long
9.       http://www.ams.ac.ir/AIM/NEWPUB/13/16/6/0010.pdf
10.   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659584/

Nutrition

Nutrition
By Stacy Roberts, RD

When you are diagnosed with cancer, nutrition becomes even more important. Good nutrition can help you feel better, reduce the risk of infection, keep your strength up, and help you heal faster. Maintaining a healthy body weight and your body’s store of nutrients can help tolerate treatment-related side effects as well. All nutrients are good for you and will help.

Protein - Protein is important for growth, to repair body tissue, and to keep our immune systems healthy. Not getting enough protein can slow down healing and break down muscle for fuel which can cause weakness. Extra protein may be need for chemotherapy, radiation and surgery. Some sources of lean protein are beans, nuts, seeds, chicken, fish, turkey, meat, dairy and lentils.

Fat - Yes fat is important! Fats and oils are made of fatty acids and serve as a rich source of energy for the body. When fat breaks down, and our body uses it to store energy, insulate the body and transport vitamins.

There are many different types of fats and some are better than others.

Monounsaturated fats are found mainly in vegetable oils like olive, canola, and peanut oils. They are typically liquid at room temperature. Monounsaturated fats can help reduce bad cholesterol levels in your blood and lower your risk of heart disease and stroke. They also provide nutrients to help develop and maintain your body’s cells.

Polyunsaturated fats are found mainly in vegetable oils like safflower, sunflower, corn, and flaxseed. They are also the main fats found in seafood. These fats are high in omega 6 and omega 3 which can play a crucial role in brain function and in the normal growth and development of your body

Saturated fats are mainly found in animal sources like meat and poultry, whole or reduced-fat milk, cheese, and butter. Some vegetable oils like coconut, palm kernel oil, and palm oil are saturated. Saturated fats can raise cholesterol and increase your risk for heart disease. Less than 10% of your calories should come from saturated fat.

Trans-fatty acids are formed when vegetable oils are processed into margarine or shortening. Sources of trans fats include snack foods and baked goods made with partially hydrogenated vegetable oil or vegetable shortening. Trans fats also are found naturally in some animal products, like dairy products. Trans fats can raise bad cholesterol and lower good cholesterol.

Carbohydrate - This is the nutrient I find most people scared of and avoid. CARBS ARE GOOD FOR YOU J It just depends which ones you are talking about. Carbohydrates are important for energy which gives the body the fuel it needs for physical activity and proper organ function. “Good Carbs” are fruits, vegetables, and whole grains. “Bad Carbs” are your simple sugars like cookies, cakes candies, sugar drinks which give you little nutritional benefit.

Fiber is the part of plant foods that the body cannot digest. There are 2 types of fiber. Insoluble fiber helps to move food waste out of the body quickly, and soluble fiber binds with water in the stool to help keep stool soft. Fiber is found in fruits, vegetables and whole grains. When eating fruits or vegetables with a thin skin, like an apple or pear, leave the skin on. That’s were all the fiber is located. 

Water, water, water and did I say water, is extremely important to drink. All your cells need water to function properly. If you having some side effects like diarrhea or vomiting, you want to make sure you’re staying hydrated to prevent dehydration which can be dangerous. Drinking eight 8oz glasses of water a day is suggested. Some of the food you eat like soup, ice cream and milk contain fluid and can used toward your fluid goal. If you don’t like the taste of water, you can always flavor up your water with fruit. I like to add a mango peel or sliced strawberries to a pitcher of water. Now I have flavored water with no added calories or artificial sweeteners.

Vitamins and Minerals - These are also important for body function. Yes they come in pill form also, but are better absorbed through food. Sometimes if you are not eating well, the doctor may suggest talking a multivitamin. People think the more the better with vitamins; however, vitamins can sometimes interact with treatment so speak with your Doctor or Registered Dietitian before starting any supplements.

This is just an over view of basic nutrition. All these nutrients are good for you. Remember, your plate should look like a rainbow. The more colors, the better.

References:
http://www.cancer.org/treatment/survivorshipduringandaftertreatment/nutritionforpeoplewithcancer/nutritionforthepersonwithcancer/nutrition-during-treatment-benefits

www.heart.org/HEARTORG/GettingHealthy/FatsAndOils/Fats-Oils_UCM_001084_SubHomePage.jsp

Clinical Trials

My Search for Clinical Trials

By Eric Grush (Stomach Cancer Patient)

 

 

I am a patient who was diagnosed with Stage 4 cancer at the GE junction in October 2010.  Although I am no medical expert, this post outlines what I have learned searching for and participating in clinical trials.


I have been encouraged by my doctors to participate in clinical trials, which they say can provide potentially helpful treatments.  It was clinical trials that led to the approval of the drug Herceptin for HER2-overexpressing stomach cancer, for example, which has been a very positive development.

Clinical trials might be available at any stage of disease or treatment.  Your own hospital may offer clinical trials for your cancer - although you may have to ask your doctor to learn about them.  Sometimes you may have to look for trials at other hospitals, either with the help of your doctor, or by yourself.

Aside from talking to my doctor about clinical trials at my hospital, I have also looked for trials at other hospitals in my area.  Debbie's Dream Foundation has an interactive map that shows the clinical trials for gastric cancer in each state (see
http://debbiesdream.org/portal/web/guest/clinical-trials1).  Even a trial that requires travel, however, could be a good treatment option - for example, if it targets your specific genetic tumor profile.  I live near Chicago and am participating in a trial in Philadelphia now.  How often you may need to travel varies from trial to trial.  

Because many trials are for targeted therapies directed at specific gene alterations, amplifications, deletions or over expressions, it is often necessary to have your cancer tissue tested for the relevant alteration.  As it has been explained to me, cancer is often driven by alterations in genes that are not inherited, but instead develop since birth, and it is those alterations that are often the targets of clinical trial drugs, as was the case with Herceptin and HER2.  

To have your tissue tested for the genetic alteration or modification relevant to a clinical trial, you can send a sample of your cancer tissue to the trial.  Or you can be tested for hundreds of different genetic alterations at the same time by sending your cancer tissue to a company that specializes in such testing.  I had testing done by Foundation Medicine in Boston, which provided a summary of my alterations and clinical trials with drugs that address them.  This led me to the clinical trial I am in today.  There are other companies that provide the same sort of services as well, which your doctor may be able to recommend.

Once you know about the amplifications or alterations in your cancer tissue, you can also look for relevant clinical trials by searching for the name of the gene at
clinicaltrials.gov or at the website mycancergenome.org.  The trials do not always need to be specific to gastric cancer (although many are); some instead are open to all patients with solid tumors.

Other clinical trials do not address these types of alterations, but may nevertheless require testing of your cancer tissue.  For example, the trial for an immunotherapy drug targeting PDL-1, which has received a lot of press coverage lately, requires testing of tissue by the trial sponsor.  Other trials may not require any testing of your cancer tissue, for example, if they are not targeted at specific alterations.

For those trials that do require tissue testing, it is better to use a more recent biopsy rather than an older one, I've been told, because cancer mutates over time.


Participating in a clinical trial has also given me satisfaction that I am playing a part (however small) in the development of new treatments for cancer.

Oral Parity

Last month, the Florida Legislature passed HB 1159 Cancer Treatment Fairness Act, which equalizes cost-sharing for patients who take their cancer medications orally with those who are treated in a clinical setting. Today we are excited to announce that Florida Governor Rick Scott has signed the bill into law. Florida now becomes the 25th state to pass an oral parity law.  A very special thanks to all who have championed this issue and made this possible and thank the bill sponsors: Senator Lizbeth Benacquisto and Representative Debbie Mayfield.

Chemo Brain

By Randy Hillard, MD

I was not sure whether or not I believed in Chemo Brain before I started suffering from it.  Chemo Brain or “chemo fog” was first described by breast cancer patients receiving chemotherapy.  The symptoms are mainly trouble concentrating and trouble with short term memory.  Initially, most doctors did not believe in Chemo Brain.  However, over the last five years, there has been a lot of research into cognitive functions in chemotherapy patients, and nearly all doctors now know about the condition.  Stomach cancer patients are at risk for Chemo Brain just like every other cancer patient.  Fortunately, only about 20% to 40% of chemo patients get serious symptoms.   These are the symptoms of Chemo Brain:

 

Symptoms: (Taken from the Mayo Clinic website)

·         Being unusually disorganized

·         Confusion

·         Difficulty concentrating

·         Difficulty finding the right word

·         Difficulty learning new skills

·         Difficulty multitasking

·         Fatigue

·         Feeling of mental fogginess

·         Short attention span

·         Short-term memory problems

·         Taking longer than usual to complete routine tasks

·         Trouble with verbal memory such as remembering a conversation

·         Trouble with visual memory such as recalling an image or list of words

 

Causes:  Although the name is Chemo Brain, chemotherapy is probably not the only cause.  Other causes that may contribute to Chemo Brain may include radiation, vitamin deficiencies, malnutrition, depression, and other physical illnesses such as anemia.

 

My Experience:  I was diagnosed with stage 4 stomach cancer in December 2010.  I received Oxaliplatin for seven cycles during early 2011 and radiation therapy to my abdomen.  I have been getting Herceptin infusions every three weeks since early 2011, along with Xeloda over the same period.  I might continue to receive the Xeloda and Herceptin indefinitely.  I missed eight months of work while getting treated.  Neither my wife nor I noticed that I had problems thinking during this time, probably because I was not really trying to do very much other than lie around and complain.

 

When I went back to work fulltime in September, I noticed that I was forgetting things and sometimes forgetting to do things.  In the past, I have tended to measure my self-worth in terms of how smart I thought I was.  I also prided myself on how I could “multitask.”  I could be talking on the phone, replying to emails, planning for my next meeting, worrying about a patient, and thinking about what I wanted for dinner, all at the same time.  Now I found that if I tried to do or think about more than one thing at a time, I was at risk of only finishing one (or neither).  Initially, I thought that maybe I was just imagining the problem, then I went into joking about it, and then I went into being almost panicked about it.  As a doctor, I was frightened that I might make a mistake with a patient’s care and would have to immediately put myself on disability.  So far, I have not made any real mistakes, but only because I now check everything I do at least four times, rather than the twice like I used to do.  In addition, I sometimes have to go back and ask patients questions that I forgot to ask initially.  Needless to say, this has slowed me down and decreased the number of patients I can see in a day.

 

I think that my forgetfulness and inattentiveness have increased over the time that I have been on chemotherapy and that it is still continuing.   My wife has told me that I was acting like a fool around the house and asking her to repeat things over and over (which I have had a tendency to do anyway due to my poor hearing).  Initially, she did not believe that I had a real condition and did not always have a lot of sympathy for me.  At home, but not at work, I have tended to start projects  without really having thought them through, and I have occasionally said things that, in retrospect, just did not make much sense.

 

My symptoms and how they have affected me at work and at home are pretty typical.  Most people with cognitive problems during and after chemo worry about their ability to do their work and have to deal with frustrated spouses at home.

 

How I have Coped with Chemo Brain:  Here are some of the strategies I have used:

1.     I have stopped even trying to do more than one thing at once.

2.     I make sure that I have completely finished one task before starting the next one.

3.     I write down or note on my beloved iPad everything I promise to do, or realize that I have to do, and even things that I want to do.

4.     Whenever I have what I consider an insight I write that down too.

5.     I have accepted that I need to give myself more time to do everything.

6.     I have stored all my internet passwords, phone numbers, etc. in a secure (I hope) place that I will not forget (I hope).

7.     I try to leave my wallet, keys, hearing aids, and glasses in the same place every day, although, needless to say, I sometimes forget to do that.

8.     I have bought an extra pair of glasses and an extra set of keys.

9.     I have adjusted my Facebook privacy settings (probably a good idea anyway) in case I post something really stupid.

10.   I double check all my outgoing emails twice to make sure that I am sending them to the right people.

11.   I have found that the internet “autocorrect” functions can be both friend and foe.  My spelling has deteriorated, and it helps with that.  It also makes some incorrect changes, like having changed the name of my oncologist, Dr. Zalupski, to Dr. Alaska.

12.   I have gotten protective containers for my iPad and iPhone and gotten the insurance for them because I sometimes forget I have them and drop them.

13.   I have a list of what I need to do every day and review it every morning.

14.   I also have a list of what I need to do every weekend (like filling up my weekly pill container).

15.   I have a running list of projects I am working on with what I hope will be the completion date, and I remove each task when finished.

16.   I have printed out some articles about the condition and had a heart-to-heart with my wife about what my problem is and how I was trying to compensate for it.  I knew that conversation had gone well when she said “Oh, I had something like that when I was going through menopause.”

17.   I have tried to be more patient with myself and tried to keep in mind that my worth as a human being was not so dependent on being “productive” or “sharp.”

18.   There probably were other coping strategies I have used, but (sigh) I cannot quite recollect them right at the moment.

 

Other possible treatments:

1.     Some people have found that systematic relaxation or meditation help.  These have not actually helped me, but maybe I am just not doing them right.

2.     Some patients have found that Ginko Biloba and Vitamin E help.  I have not tried them yet.

3.     Since the symptoms of Chemo Brain are similar to those of attention deficit disorder (ADD), treatments used for ADD often help, such as Adderall and Ritalin.  I have not tried these either and you should always consult your doctor before taking any medications or supplements.

4.     Some people have found that Aricept , originally used for Alzheimers or donepezil, originally used for excessive daytime sleepiness may help.  Have not tried.  Do not intend to try.  Again, this is not medical advice, so do consult your doctor!

5.     Exercise, both physical (such as walking) and mental (solving puzzles) may also help.

 

Prognosis:  Some people get over these symptoms shortly after treatment.  Others have residual symptoms for two years or more.  Some people, even ten years later, report that they still have difficulty thinking more so than they did before treatment.  On the positive side, practically everyone is able to function OK both at home and at work if they follow some of the suggestions above, and very few people need to go on disability for the condition.  A supportive family, as always, is crucial.  If you have loved ones who just do not understand what you are talking about, ask them to read this article!

 

Further reading:

-          http://www.mayoclinic.com/health/chemo-brain/DS01109/DSECTION=coping-and-support

-          http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffects/chemo-brain

The challenges of a gastrectomy and how it helped me win my battle with stomach cancer

The Challenges of a Gastrectomy

By Gae Rogers

In July 2007, just two months after my 50th birthday, I was diagnosed with stage 2 stomach cancer--a very aggressive, fast-growing, signet ring cell type. Shocked and frightened, I quickly made appointments with surgeons and oncologists.

As anyone having a cancer diagnosis knows, your initial reaction is "cut it out as soon as possible!" But not everyone is a surgical candidate. I met with the doctors, got second opinions and the consensus was to perform a gastrectomy--hopefully a partial because the cancer appeared to be contained to a localized area. If there was any evidence the cancer had spread, surgery would be followed by chemotherapy and radiation.

Now I had to decide which surgeon was going to perform this very scary surgery. As much as I wanted it "out," I was scared to death about having my stomach removed. What would eating be like? What kind of complications could arise? In the face of a cancer diagnosis though, this really wasn't elective surgery, and I would have to deal with any after effects of the surgery. The more pressing issue was who was going to perform this surgery. Both surgeons were equally skilled and came highly recommended, but the one who could do it sooner, didn't give me the "warm fuzzies." I decided to go with my gut. I'm a person who needs the "warm fuzzies," so my instincts were that I would have a better outcome if I felt cared for emotionally as well as physically.

It seemed like an eternity, but just one month after diagnosis, I had my surgery. The surgeon was able to perform a partial gastrectomy, removing two-thirds of my stomach with clear margins. Thankfully, there was no evidence of spread to any other organs, but 3 of 11 lymph nodes were positive, so chemotherapy and radiation would still be necessary after I recovered.

After a five-day hospital stay, I went home to recover and learned to eat a whole new way. Rather than three large meals, I ate six small meals with no liquids at meal time. At first the meals were very small, maybe just a few bites at a time. The key was to listen to my body--eat when I was hungry and more importantly, stop when I was full.

Chewing well and eating slowly were also key to avoiding any discomfort or nausea. The nutritionist I met with recommended starting out with bland, easy-to-digest foods and then slowly introduced other foods to see what I could tolerate. Trust me, you quickly find out what you can't tolerate. Everyone's different, but for me it was sweets, fried foods and creamy, rich foods. If I had any of those, if I ate too fast, or if I ate too much, I became extremely nauseous. I would begin to sweat, my heart would race, and inevitably, I'd vomit. Not fun, but you learn by trial and error.

One of the biggest challenges though, was getting adequate nutrition during chemotherapy and radiation. The treatments themselves made me very nauseous and took away my appetite. Eating became an even bigger challenge since just about any food I ate would not stay down. It was a very trying time, to say the least. Over the course of six months, I lost 60 pounds, and often felt as though I'd never be "normal" again. But the human body has amazing healing powers. Once my treatments ended in February 2008, I slowly, but surely, got my appetite back, kept foods down, gained my strength back and began to heal.

My husband never left my side and wouldn't let me quit. My teenage sons kept brave faces, kept things light and made me laugh. Friends and family from all over the country took turns coming to stay with us and help out.

It's now been more than five years after my initial diagnosis. I'm cancer-free, feel great, eat normally and am grateful for the experience. Cancer taught me to live in the moment and be grateful for every day I'm given.

For that reason, I committed myself to helping others facing stomach cancer and to help them find information and support that I didn't have when I was facing my surgery and treatment. At the time of my diagnosis, no such organization existed. There was plenty of cancer support, but none specific to stomach cancer.

I am now a resource contact for the Patient Resource Education Program (PREP) of Debbie's Dream Foundation: Curing Stomach Cancer and founder of the Maryland chapter. I am honored to be part of such a wonderful organization and able to offer support and hope for survival to other stomach cancer patients and their families.

Gae Rogers is a stage 2 stomach cancer survivor and advocate with Debbie's Dream Foundation: Curing Stomach Cancer (DDF), an organization founded by Debbie Zelman, a stage 4 stomach cancer survivor. DDF is a non-profit organization dedicated to raising awareness about stomach cancer, advancing funding for research, and providing education and support internationally to patients, families and caregivers. DDF seeks as its ultimate goal to make the cure for stomach cancer a reality. If you or someone you know is battling stomach cancer, you can find more resources at www.DebbiesDream.org or by calling its toll-free hotline at 855-475-1201.

HER2 Biomarker Testing

HER2 (Human Epidermal Growth Factor Receptor 2) also known as HER2 Neu is a protein and amplification or over-expression of this gene has been shown to play an important role in the pathogenesis and progression of certain aggressive types of stomach cancer and in recent years it has evolved to become an important biomarker and target of therapy for the disease.  There hasn't been much progress made in stomach cancer in the past 20 years except for the HER2 biomarker.  Therefore, every stomach cancer patient should be tested for the HER2 biomarker.  Even if you are only a little positive (ratings are 0, +1, +2 or +3) you could benefit from being on Herceptin - ask your doctor.  If you test negative, ask about getting re-tested since the test is subjective, there are several different testing methods to try, and the sample tested may have been from a spot that was HER negative. Herceptin is the targeted chemotherapy agent used on HER2 positive stomach cancer patients.  Call (855) 475-1200 for more information about this.

Helicobacter Pylori and Stomach Cancer - What You Can Do About It

Helicobacter Pylori and Stomach Cancer - What You Can Do About It

By Randy Hillard, MD

Helicobacter pylori (h pylori) is a bacterium that inhabits the lining of the stomach in 20% of the US population and in 50% of the world’s population.   At least three quarters of stomach cancer worldwide are associated with helicobacter infection.  Adenocarcinomas, which are the kind of stomach cancer most closely associated with helicobacter infection, make up 90% of all stomach cancers.  Helicobacter has been recognized internationally as a Grade 1 (the most serious) carcinogen.

Helicobacter is also the primary cause of gastric ulcers and of severe dyspepsia (chronic upset stomach).  Chronic infection leads to chronic inflammation, chronic inflammation leads to abnormal cell growth, and abnormal cell growth leads to cancer.  Most people are infected in childhood, but it takes many years for ulcers or cancer to develop.

A large percentage of stomach cancer is associated with helicobacter infection but very few people who have helicobacter infections go on to develop stomach cancer (about 2%).  The reasons that some people with helicobacter go on to develop stomach cancer are:  (1) Some strains of helicobacter are more virulent than others; (2) some people are more genetically at risk for stomach cancer when they are infected; and (3) some people are exposed to more environmental risks than others, such as cigarettes, high salt diets, and a diet low in fruits and vegetables.

The populations in the US with the highest rates of stomach cancer are also those with the highest prevalence of helicobacter infections which include (1) first generation immigrants to the US (particularly those from Asia); (2) African Americans ; (3) Hispanics; (4) lower socioeconomic status people; and (5) close relatives of patients with stomach cancer.

The goods news is that Helicobacter can be eradicated in 90% of all cases easily by treatment with antibiotics and acid reducers.  Recent analysis of all studies on the subject have concluded that eradication of helicobacter decreases the incidence of stomach cancer and that the earlier the helicobacter is eradicated, the greater the beneficial effect.   In both Europe and Asia, official recommendations are that first degree relatives (parents, children, brothers and sisters) of stomach cancer patients be tested and treated for helicobacter.  This is not currently an official recommendation in the US but if you or someone you know has stomach cancer, you should ask your doctor to test all first degree relatives for helicobacter and treat the infection if present.  There is also data suggesting that patients with stomach cancer have a lower risk of relapse if they, themselves, are tested and treated for helicobacter.  Ask your doctor about that, too.  Since a large percentage of doctors in the US were trained before helicobacter was even discovered, your doctor may not think of this unless you ask.

By Randy Hillard, MD

Although I am a licensed physician, this blog entry does not constitute medical advice.  It does, however, constitute what I have concluded as a fellow stomach cancer patient.

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