H Pylori And Your Stomach Cancer Risk
Most stomach cancers are caused by bacteria called helicobacter pylori or H. pylori. Having H. pylori doesnt mean youll get stomach cancer, but it does increase your risk.
We talked to Patrick Lynch, M.D., a gastroenterologist in Internal Medicine, about H. pylori and other stomach cancer risk factors, how to recognize symptoms and what you can do to reduce your chances of developing this disease.
Whats the link between H. pylori and stomach cancer?
H. pylori is a common bacterium. There are multiple strains, and different strains have different effects on the stomach. Most people never experience side effects or illness.
Most stomach ulcers are caused by H. pylori. Certain strains can also raise your risk for stomach cancer.
The whole process of stomach cancer risk associated with H. pylori is one of inflammation, says Lynch. With H. pylori, you have an infection, which causes inflammation, then healing, then more inflammation. Over time, this cycle of constant cell regeneration can result in mistakes that lead to cancer.
How do you know if you have H. pylori?
Symptoms of H. pylori infection include chronic dyspepsia or indigestion that may be accompanied by abdominal pain, bloating and the urge to burp. Lynch describes it as a sour stomach.
Dyspepsia should not be confused with heartburn, which feels like acid and food are coming back up from the stomach into the esophagus. This causes discomfort or pain in the chest.
Know the symptoms of stomach cancer
Causes Of Stomach Ulcer
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What Is Helicobacter Pylori
To survive in the harsh, acidic environment of the stomach, H. pylori secretes an enzyme called urease, which converts the chemical urea to ammonia. The production of ammonia around H. pylori neutralizes the acidity of the stomach, making it more hospitable for the bacterium. In addition, the helical shape of H. pylori allows it to burrow into the mucus layer, which is less acidic than the inside space, or lumen, of the stomach. H. pylori can also attach to the cells that line the inner surface of the stomach.
Although immune cells that normally recognize and attack invading bacteria accumulate near sites of H. pylori infection, they are unable to reach the stomach lining. In addition, H. pylori has developed ways of interfering with local immune responses, making them ineffective in eliminating this bacterium .
H. pylori has coexisted with humans for many thousands of years, and infection with this bacterium is common. The Centers for Disease Control and Prevention estimates that approximately two-thirds of the worlds population harbors the bacterium, with infection rates much higher in developing countries than in developed nations.
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What Triggers Stomach Ulcer Symptoms
Stomach ulcers are irritated by stomach acid. Some people notice this irritation more after they eat, and some people notice it more on an empty stomach. There are also certain irritants that seem to make ulcer symptoms worse and make them more difficult to heal. Smoking and alcohol are the biggest ones.
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How Is Stomach Cancer Diagnosed
Doctors typically don’t do routine screening for stomach cancer. That’s mainly because it’s not that common, so getting extra tests often isn’t helpful. In fact, the number of stomach cancer cases has declined over the past 60 years.
If you’re at higher risk for it though, talk to your doctor to see how to keep an eye out for it. You may get some of the same tests that you would get if you had symptoms and were looking for a diagnosis.
To find out if you have stomach cancer, your doctor starts with a physical exam. They’ll also ask about your medical history to see if you have any risk factors for stomach cancer or any family members whoâve had it. Then, they might give you some tests, including:
- Blood tests to look for signs of cancer in your body.
- Upper endoscopy. Your doctor will put a thin, flexible tube with a small camera down your throat to look into your stomach.
- Upper GI series test. Youâll drink a chalky liquid with a substance called barium. The fluid coats your stomach and makes it show up more clearly on X-rays.
- CT scan.This is a powerful X-ray that makes detailed pictures of the inside of your body.
- Biopsy.Your doctor takes a small piece of tissue from your stomach to look at under a microscope for signs of cancer cells. They might do this during an endoscopy.
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Surgery To Ease Your Symptoms
If your stomach cancer has spread beyond your stomach, it may not be possible to remove it using surgery.
However, if your stomach has been significantly affected by cancer it can cause a blockage, which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting and feeling very full after eating.
If your stomach is blocked, there are a few options:
- stenting a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic after being inserted, the stent will be expanded and open up the stomach
- partial or total gastrectomy to remove the blockage and improve your symptoms
What Evidence Shows That H Pylori Infection Causes Non
Epidemiologic studies have shown that individuals infected with H. pylori have an increased risk of gastric adenocarcinoma . The risk increase appears to be restricted to non-cardia gastric cancer. For example, a 2001 combined analysis of 12 casecontrol studies of H. pylori and gastric cancer estimated that the risk of non-cardia gastric cancer was nearly six times higher for H. pylori-infected people than for uninfected people .
Additional evidence for an association between H. pylori infection and the risk of non-cardia gastric cancer comes from prospectivecohort studies such as the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study in Finland . Comparing subjects who developed non-cardia gastric cancer with cancer-free control subjects, the researchers found that H. pylori-infected individuals had a nearly eightfold increased risk for non-cardia gastric cancer .
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What Are The Symptoms Of Stomach Polyps
Stomach polyps usually do not cause symptoms. They are usually found when a patient is being examined for another stomach issue.
Larger polyps may cause internal bleeding or abdominal pain. If internal bleeding continues, the patient may become anemic . Occasionally, the polyps may cause a blockage from the stomach to the intestine.
How Can You Treat Stomach Cancer
The treatments for stomach cancer vary depending on the type of cancer you have, its location in the body, if it is advanced and your personalized care plan. At The University of Kansas Cancer Center, we offer clinical trials that may provide new treatment options for stomach cancer.
Possible options include:
- Radiation: High-energy X-rays to destroy cancer cells, typically done using a machine outside the body.
- Chemotherapy: Using one or more drugs to destroy cancer cells by preventing cancer cell growth.
- Surgery: GI surgery is typically a minimally invasive procedure. The surgeon removes the tumor, as well as some surrounding healthy tissue to determine the extent of disease.
- Targeted therapy: Treatment that targets the genes, proteins or tissue that supports the cancerous cell growth and survival. Targeted therapy blocks the growth and spread of cancer cells and minimizes damage to healthy cells.
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What Are The Different Stages Of Stomach Cancer
Stomach cancer is staged based on the severity of cancerous cell growth and spread. Adenocarcinoma is initially evaluated by the tumor, node metastasis system.
- T: How deeply has the tumor spread into the stomach wall?
- N: Has the stomach cancer spread to the lymph nodes?
- M: Has the stomach cancer spread to other parts of the body?
After the TNM staging information has been taken into account, the cancer is staged at 0 or 1 to 4. Tumor classifications for staging are as follows:
- Stage 0 is early cancer on the surface of the stomach lining.
- Stage 2A or 2B, commonly with deeper stomach wall involved
- Stage 3A or 3B or 3C, commonly with lymph node involvement
- Stage 4 means cancer has metastasized elsewhere in the body outside of the stomach.
What Are The Different Types Of Stomach Cancer
Stomach cancer, also known as gastric cancer, is the name for a category of cancer. There are many different types of stomach cancer:
- Adenocarcinoma: Adenocarcinoma is the most common type of gastric cancer, comprising more than 90% of all stomach cancers. Carcinoma that occurs in the innermost lining of the stomach.
- Lymphoma: Cancer of the immune system that accounts for 4% of all stomach cancer, which is not from the mucosa of the stomach lining. It is broken up into primary and secondary lymphoma of the stomach.
- Primary lymphoma involves the stomach and can eventually affect the lymph nodes, bone marrow and other parts of the body.
- Secondary lymphoma initially involves other parts of the body, like circulating blood, lymph nodes, bone marrow and other organs. Secondarily, cancer spreads to the stomach.
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How Do You Get It
Although it is not known exactly how H. pylori enters the body, researchers believe that the spiral-shaped bacteria probably get into your body through your mouth. Then, they burrow into the mucus that lines your stomach.
You could pick up an H. pylori infection in several ways. The bug can be found in contaminated food or water. If a household member has H. pylori, it is more likely that others in the household also are infected. It has also been found in domesticated animals.
H. pylori is much more common in parts of the world where there’s poor sanitation, poverty, and overcrowding.
How Is Stomach Cancer Treated
Treatment depends on how far your cancers spread, your health and treatment preferences. It often involves a care team that includes your primary care provider, a cancer specialist and a gastrointestinal specialist . They can advise you on treatment options.
Depending on how much the cancers spread, your provider may recommend surgery to remove precancerous cells, a tumor, or all or part of your stomach.
- Upper endoscopy: In the early stages, when the cancer is limited to your stomach’s superficial layers, the cancer can be removed through an upper endoscopy. In this procedure , a gastroenterologist cuts the tumor from your stomach wall and removes it through your mouth.
- Gastrectomy. Once the tumor spreads beyond your stomach’s superficial layers, you’ll need surgery to remove all or part of your stomach. Subtotal gastrectomy removes the part of your stomach affected by the cancer. Total gastrectomy removes your entire stomach. Your provider will connect your esophagus to your small intestine so that you can still eat following total gastrectomy.
Additional treatments attack cancer cells directly.
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What Are Stomach Cancer Treatments
Many treatments can fight stomach cancer. The one you and your doctor choose will depend on how long youve had the disease or how much it has spread in your body, called the stage of your cancer:
Stage 0. This is when the inside lining of your stomach has a group of unhealthy cells that may turn into cancer. Surgery usually cures it. Your doctor may remove part or all of your stomach, as well as nearby lymph nodes small organs that are part of your bodys germ-fighting system.
Stage I. At this point, you have a tumor in your stomachs lining, and it may have spread into your lymph nodes. As with stage 0, youll likely have surgery to remove part or all of your stomach and nearby lymph nodes. You might also get chemotherapy or chemoradiation. These treatments can be used before surgery to shrink the tumor and afterward to kill any cancer thats left.
Chemotherapy uses drugs to attack cancer cells. Chemoradiation is chemo plus radiation therapy, which destroys cancer cells with beams of high energy.
Stage II. Cancer has spread into deeper layers of the stomach and maybe into nearby lymph nodes. Surgery to remove part or all of your stomach, as well as nearby lymph nodes, is still the main treatment. Youre very likely to get chemo or chemoradiation beforehand, and you might get one of them after, too.
You usually have surgery to remove your entire stomach, along with chemo or chemoradiation. This can sometimes cure it. If not, it can at least help with symptoms.
Are There Known Risk Factors For Gastric Cancer
As with any type of cancer, its important to consider that having certain risk factors may increase the odds of developing the disease, but its hardly a foregone conclusion. Knowing about the risk factors for stomach cancer is a good first step toward making informed lifestyle and health care choices.
With that said, the following factors are thought to raise a persons risk of developing gastric cancer:
- Age Most people diagnosed with stomach cancer are in their 60s and 70s.
- Gender Men are about twice as likely to develop stomach cancer as women.
- Medical history People with an H. pylori infection that has caused stomach inflammation and ulcers have a higher risk of developing stomach cancer. Those with close family members who have had stomach cancer or an H. pylori infection are advised to be tested for the bacteria and undergo treatment if it is discovered. Also, anyone who has had certain stomach-weakening conditions, including pernicious anemia or achlorhydria, has a higher risk of developing gastric cancer.
- Family history/genetics People with a close relative that has had stomach cancer are considered to have a higher risk for the disease, and certain inherited genetic disorders can increase the risk as well.
- Race/ethnicity Some studies have indicated that Black, Hispanic and Asian populations may have up to a 50% higher risk for gastric cancer than white people.
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Treatment For A Stomach Ulcer
Special diets are now known to have very little impact on the prevention or treatment of stomach ulcers. Treatment options can include:
- medication including antibiotics, to destroy the H. pylori colony, and drugs to help speed the healing process. Different drugs need to be used in combination some of the side effects can include diarrhoea and rashes. Resistance to some of these antibiotics is becoming more common
- subsequent breath tests used to make sure the H. pylori infection has been treated successfully
- changes to existing medication the doses of arthritis medication, aspirin or other anti-inflammatory medication can be altered slightly to reduce their contributing effects on the stomach ulcer.
- reducing acid tablets are available to reduce the acid content in the gastric juices
- lifestyle modifications including quitting cigarettes, since smoking reduces the natural defences in the stomach and impairs the healing process.
How Often To Screen
since your symptoms first appeared or you were diagnosed with UC.
People with UC are generally advised to have a colonoscopy . Some people may need to have this test more or less often based on factors such as:
- the age when they were diagnosed
- how much inflammation they have and how much of their colon it affects
- their family history of colorectal cancer
- whether they also have PSC
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What Other Diseases Conditions Or Complications Should I Look For In Patients With Peptic Ulcer Disease
Risk factors for PUD
The major risk factors for peptic ulcer include the use of NSAIDS and infection with H. pylori. Less commonly, peptic ulcer may be a manifestation of the Zollinger-Ellison Syndrome due to a gastrin-secreting tumor. Although most individuals with ZES present with symptoms similar to ordinary peptic ulcer, the diagnosis should be suspected in patients with peptic ulcer , accompanied by chronic diarrhea and/or severe GERD, and in patients with manifestations of the MEN-1 syndrome.
Gastric ulcer may be associated with adenocarcinoma, signet ring carcinoma, leiomyosarcoma, lymphoma, and other neoplasms. Rarer causes of gastric ulcer include Crohns disease , sarcoidosis, eosinophilic gastritis, fungal infections, secondary syphilis, and tuberculosis. The risk of an infectious etiology for gastric ulcer is significantly increased in immunocompromised patients .
Complications of PUD
The most common complication of PUD is upper GI hemorrhage other complications include perforation and gastric outlet obstruction, both of which are far less prevalent than hemorrhage.
If perforation is suspected , evidence of pneumoperitoneum should be sought with an upright chest or abdominal X-rays if these are negative and suspicion is still high, a CT scan can demonstrate small amounts of free air in the peritoneum. A gastrograffin UGI radiograph can also demonstrate perforation, but this test is rarely used at present.
List of complications of PUD