What Is Stomach Cancer?
Stomach cancer (gastric cancer) is a malignant tumour that originates in the stomach lining. It is the fifth most common cancer worldwide and the third leading cause of cancer death. The majority are adenocarcinomas arising from the mucosa.
Causes and Risk Factors
Helicobacter pylori infection: The leading risk factor, present in over 80% of gastric cancers. Diet: High intake of salted, smoked or preserved foods. Low consumption of fruits and vegetables. Smoking: Doubles the risk of gastric cancer. Family history and genetic syndromes such as hereditary diffuse gastric cancer (CDH1 gene). Chronic atrophic gastritis and pernicious anaemia.
Symptoms
Early gastric cancer is often asymptomatic. Advanced symptoms include: persistent indigestion or heartburn, loss of appetite, unexplained weight loss, nausea and vomiting, abdominal pain or discomfort, difficulty swallowing, and black or bloody stools. The non-specific nature of symptoms makes early diagnosis challenging.
Diagnosis
Upper gastrointestinal endoscopy: Essential for diagnosis. Allows visualisation, biopsy and staging. CT scan: Assesses extent of local and distant disease. Endoscopic ultrasound (EUS): Evaluates tumour depth and lymph node involvement. PET scan: Used in selected cases for staging.
Treatment
Surgery: The only potentially curative treatment. Subtotal or total gastrectomy with D2 lymphadenectomy is the standard. At Quenet Torrent Institute we perform minimally invasive gastrectomy using robotic and laparoscopic approaches. Perioperative chemotherapy: FLOT regimen is current standard for resectable cases. For peritoneal disease: HIPEC combined with cytoreductive surgery offers improved survival in selected patients with peritoneal metastasis.
When Gastric Cancer Has Spread to the Peritoneum
This is the scenario in which the surgical door is most often closed, and it deserves qualifying. The stomach spreads frequently to the peritoneum, and that diagnosis is often communicated as terminal disease without further discussion.
The reality is more nuanced. In selected patients, with limited peritoneal disease and good general condition, there are options that are not purely palliative:
• Cytoreduction with HIPEC for carcinomatosis of gastric origin: patient selection here is stricter than for other origins, with low PCI thresholds, but in the right group it alters the course of the disease.
• PIPAC: pressurised aerosol chemotherapy when complete cytoreduction is not achievable. It is a repeatable procedure with rapid recovery, aimed at controlling disease and ascites.
• Staging laparoscopy with peritoneal cytology: before ruling anyone out, it is worth knowing exactly how much peritoneal disease there is. Isolated positive cytology is not the same as established carcinomatosis.
The difference between one case and another is not visible on a CT report. It is seen by looking inside.
Have you been told your gastric cancer is no longer operable because of peritoneal involvement? This is one of the situations we assess most often, and the answer depends on precise staging. We review the case and tell you frankly whether a surgical option exists. Request an assessment.