Stages of Stomach Cancer

After gastric cancer has been diagnosed, tests are done to find out if cancer cells have spread within the stomach or to other parts of the body.

The process used to find out if cancer has spread within the stomach or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process: B-hCG (beta-human chorionic gonadotropin), CA-125, and CEA (carcinoembryonic antigen) assays: Tests that measure the levels of ß-hCG, CA-125, and CEA in the blood. These substances are released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, they can be a sign of gastric cancer or other conditions. Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to remove lymph nodes or take tissue samples for biopsy. PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells. ******

The following stages are used for gastric cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, cancer is found only in the inside lining of the mucosal (innermost) layer of the stomach wall. Stage 0 is also called carcinoma in situ.

Stage I

Stage I gastric cancer is divided into stage IA and stage IB, depending on where the cancer has spread. Stage IA: Cancer has spread completely through the mucosal (innermost) layer of the stomach wall. Stage IB: Cancer has spread: completely through the mucosal (innermost) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or to the muscularis (middle) layer of the stomach wall.

Stage II

In stage II gastric cancer, cancer has spread: completely through the mucosal (innermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or to the muscularis (middle) layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or to the serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs.

Stage III

Stage III gastric cancer is divided into stage IIIA and stage IIIB depending on where the cancer has spread. Stage IIIA: Cancer has spread to: the muscularis (middle) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or the serosal (outermost) layer of the stomach wall and is found in 1 to 6 lymph nodes near the tumor; or organs next to the stomach but not to lymph nodes or other parts of the body. Stage IIIB: Cancer has spread to the serosal (outermost) layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor.

Stage IV

In stage IV, cancer has spread to: organs next to the stomach and to at least one lymph node; or more than 15 lymph nodes; or other parts of the body.

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More information on stomach cancer

What is Stomach Cancer?
Symptoms of Stomach Cancer
Diagnosing Stomach Cancer
Treating Stomach (Gastric) Cancer

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Information adapted from the National Cancer Institute

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Symptoms of a Hiatal Hernia

Fifty percent of hiatal hernia patients don't experience any symptoms. For the other fifty percent of patients, the following symptoms may occur. Heartburn (which is worse when bending over or lying down shortly after eating) Regurgitation (backflow of stomach contents into the back of the throat Vomiting Gastric reflux (backflow of stomach contents into the esophagus) A sour or bitter taste in the mouth Frequent belching Frequent hiccups Chest pain radiating from below the breastbone (the sternum) Feeling of pressure in the chest A bloated feeling after eating Abdominal discomfort Abdominal pressure, especially soon after eating Discomfort or pain in the stomach Discomfort or pain in the esophagus Gas Unexplained coughing Difficulty swallowing

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Stomach Pain Symptoms Tell You

If you are suffering from stomach pain, you need to find the cause before you can start a treatment. Listed below are a few of the conditions that can cause stomach pain. As always, you should discuss your symptoms with your doctor for an evaluation to diagnose the cause.

Heartburn

Heartburn is a digestive symptom that occurs when stomach acid comes into contact with the lining of the esophagus, causing irritation.

The symptoms of heartburn include a burning sensation behind your breastbone that may also travel to your throat. Other symptoms may include chest pain, difficulty swallowing, persistent cough, and a sour taste in the mouth. Symptoms can get worse soon after you eat or if you lie down shorty after eating.

There are various causes of heartburn. These causes include eating foods that can trigger heartburn, pregnancy, asthma, diabetes, and hiatal hernias.

You can eliminate the heartburn in a number of ways, including chewing gum (although for some patients this worsens the pain), drinking seltzer, or taking an antacid. If you have frequent heartburn, you should see your doctor for evaluation. If you are diagnosed with gastroesophageal reflux disease (GERD), your doctor may suggest the use of H2 blockers or proton pump inhibitors (PPIs) for relief from heartburn. First steps, however, will be to make some lifestyle modifications and avoid foods that can cause heartburn.

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Peptic Ulcer

A peptic ulcer is an erosion or sore that forms either in the lining of the stomach (gastric ulcer) or in the lining of the duodenum (duodenal ulcer).

Symptoms of a peptic ulcer vary from patient to patient, but can include a burning or gnawing pain in your stomach that often feels worse when your stomach is empty, and better after you have eaten.

The most frequent cause of a peptic ulcer is Helicobacter pylori (H. pylori). Other causes of peptic ulcers may include alcohol and non-steroidal anti-inflammatory drugs (NSAIDs). The most common NSAIDs are aspirin, ibuprofen, and naproxen sodium.

Treatment of peptic ulcers depends on the cause. If the cause is H. pylori, the standard treatment is antibiotics. A proton pump inhibitor may also be prescribed. If NSAIDS are the cause of your ulcer, you should stop taking them. During the healing process for an NSAID-induced ulcer, your doctor may recommend the use of antacids to neutralize the acid, and H2-blockers or proton pump inhibitors to reduce stomach acid production.

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Gallstones

There are two types of gallstones -- cholesterol stones and pigment stones. Cholesterol stones are the most common type of gallstone, occurring in approximately 80% of patients with gallstones. Cholesterol stones are made mostly of hardened cholesterol, and are usually yellowish-green in color. Pigment stones are made of bilirubin, and are usually small and dark in color.

Symptoms of gallstones can include pain in the upper abdomen that rapidly worsens and can last from a few minutes to a few hours, nausea and/or vomiting, and heartburn. Gallstone pain often feels sharper and more localized than heartburn or ulcer pain. If the pain doesn't go away within a few hours, or if you are vomiting or have a fever, you should go to your doctor.

Causes of gallstones are usually the result of too much cholesterol or bilirubin in the bile. There are risk factors for developing gallstones, and these can be a combination of factors, including heredity, body chemistry, body type, gender, and maybe even diet.

Treatment of gallstones depends partly on whether you are experiencing symptoms or not. If you have symptoms, especially severe pain, surgical removal of the gallbladder is the most common treatment. If you have no symptoms, you and your doctor may decide that no treatment is needed.

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Vegetarian Recipes

All these recipes are meatless, but still contain a lot of flavor, and are heartburn-friendly.

Artichoke and Olive Quiche
Instead of a meat and tomato quiche, this recipe a vegetarian version that is also heartburn-friendly.

Baked Broccoli and Rice Casserole
This is an easy recipe that promises good taste but is still heartburn-friendly.

Baked Spinach and Artichoke Casserole
If your family doesn't want to eat their spinach, try this casserole recipe. It makes a great meal while being heartburn free.

Bean and Cheese Burritos with Avocado
Burritos are an all-time favorite in many families. With this recipe, you dont' need to worry about heartburn.

Cashew Vegetable Fried Rice
Rice is the staple food, and is nutritious while being ideal for special diets. The vegetables add more flavor.

Cheese and Olive Manicotti with Mushroom Sauce
A filling pasta dish that is also heartburn-friendly.

Cheese Topped Vegetable with Rigatoni
This pasta dish can either be served as a side dish, or served as a complete meal.

Creamy Potato Soup with Herb Croutons
This hearty soup makes a great first course to an evening meal, or a satisfying lunch. The ingredients also make it heartburn-friendly.

Lentil and Vegetable Barley Soup
The lentils, barley, and vegetables make this soup tasty and filling, not to mention low-fat and heartburn-friendly.

Parmesan-Mushroom Penne with Herb Sauce
This pasta dish is a great addition to any meal, and with the low fat ingredients, is heartburn-friendly.

Pasta and Vegetable Frittata
Fat can be a heartburn trigger for some people. This pasta recipe uses fat-free ingredients, making it a safe choice for heartburn sufferers.

Skillet Zucchini with Pasta Shells
Prepared with a minimal amount of oil, with no added fat when preparing the pasta, makes this a tasty, heartburn-friendly recipe.

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What to Eat With Peptic Ulcers

For some people, certain foods seem to aggravate their symptoms. For them, they need a diet that is designed to accomplish the following: Restrict or avoid those foods that may cause irritation to the digestive system Reduce excessive acid production Prevent unpleasant side effects, such as heartburn. Eat 5 to 6 small meals a day instead of 3 larger meals. It is important that you avoid overeating. Frequent, smaller meals will be more comfortable and easier on the stomach than two or three large meals a day. Eat a diet rich in fiber, especially from fruits and vegetables Rest and relax a few minutes before and after each meal, as well as remaining relaxed during meals. Eat slowly and chew you food well Avoid eating within 3 hours before bedtime Eat foods that are low fat Avoid foods that are fried Avoid foods that are spicy Cut down on the following foods: Coffee Decaffeinated coffee Tea Cola drinks Carbonated beverages Citrus fruits Tomato-based products ChocolateAvoid alcohol Quit smoking

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The Ulcer-Friendly Diet

Some people who have peptic ulcers can eat whatever they want with no problems. For many others, however, eating certain foods can cause irritation, excessive acid production, and heartburn. For them, they need to know what foods are safe, and what foods to avoid. They need to know how to prepare foods to avoid ingredients that will cause a flare-up of their symptoms. If you are a ulcer patient and need to make some dietary changes, the following resources will get you started. There are lists of what you can eat and what you shouldn't. There are heartburn-free, ulcer-friendly recipes. There are also links to menus suggestions.

Foods Recommended for the Peptic Ulcer Diet
The foods listed in this table are the most common foods that are usually pretty safe for heartburn sufferers to eat.

Foods to be Avoided on the Peptic Ulcer Diet
The foods listed in this table are the most common foods that can produce heartburn.

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Recipes For the Peptic Ulcer Diet
These recipes that will help ulcer-sufferers prepare food that will aide in good digestion. It isn't just the foods you select. It is also important how the foods are prepared. Categories of recipes include:

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Weekly Menus - Index
These charts are arranged Sunday through Saturday. You can try them all in the order given, rearrange them, or choose the ones that appeal to your palate. These are suggestions only, and not the only foods you may be able to eat. You can add or subtract foods according to your preferences and what may or may not be your heartburn triggers.

Daily Menus - Index
This index gives sample menus featuring heartburn-friendly foods and recipes. Each daily menu for this acid reflux diet includes breakfast, lunch, and dinner selections, along with 2 snacks. Each dinner menu gives an Entree with a link to the recipe for its preparation.

Breakfast Menus - Index
These links give sample breakfast menus featuring heartburn-friendly foods for the acid reflux diet.

Lunch Menus - Index
These links give sample lunch menus featuring heartburn-friendly foods for the acid reflux diet.

Dinner Menus - Index
Each dinner menu gives an Entree with a link to the recipe for its preparation, along with suggestions for side dishes.

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Treating Infants with GERD

Treatment of infant reflux depends on the severity of the problem. Your baby's doctor may decide no treatment is needed, that the reflux will disappear on it's own as your baby grows older. For most babies, reflux will resolve itself during the first year of life. If your baby is otherwise healthy, happy, and growing, your doctor may recommend a few lifestyle changes for your baby in order to ease her reflux problem. These include:

Hold Baby Upright
Keep infants upright during feedings, and for at least 30 minutes after feedings. This will decrease the amount of gastric reflux.

Nighttime Sleep Position
As noted above, position your infant on his back, and elevate the head of the bed 30 degrees. Gravity will help keep stomach contents where they belong.

Try Smaller, More Frequent Feedings
Feedings every two to three hours when the infant is awake will reduce the occurrence of gastric reflux. Overfeeding can increase abdominal pressure, which can lead to gastric reflux.

Rice Cereal May Help
This can reduce the amount an infant will regurgitate. Start with one teaspoon of rice cereal to each ounce of formula. If the baby is breast-feed, try pumping and then adding rice cereal to the breast milk.

Diet Modifications for Mothers who Breastfeed
Certain foods -- such as caffeine, chocolate, and garlic -- can promote reflux, so if you breastfeed your infant, you should consider cutting these foods out of your diet.

Infant Seats and Car Seats
The way the infant is positioned in the car seat can cause regurgitation to increase. If the infant slouches over, it causes abdominal compression, increasing the risk of reflux. Using simple supports to keep the infant upright will prevent this.

Burping the Infant
Burping your infant several times during the feeding will help minimize gastric pressure, and the reflux it can cause. Waiting to burp your infant until after she has a full stomach can increase the chances of regurgitation.

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If the reflux is more serious, or if your baby has been diagnosed with GERD, the doctor may prescribe a prescription medication or over-the-counter remedy to help treat the reflux. These remedies include: Acid Suppressers - These suppress acid production in the stomach. These include Tagamet, Pepcid, Zantac. and Axid. Acid Blockers - These completely block acid production in the stomach. Prilosec and Prevacid have been approved for children over certain ages. It is very important to discuss treatment options with your baby's doctor before beginning any treatment method, especially before using any over-the-counter remedy.

Sources:

"Gastroesophageal Reflux in Infants." NIH Publication No. 06-5419 August 2006. National Digestive Diseases Information Clearinghouse (NDDIC). 06 Mar 2008

"Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD)." NIH Publication No. 03-0882 June 2003. National Digestive Diseases Information Clearinghouse. Accessed on 06 Mar 2008

Marsha Kay, M.D., Vasundhara Tolia, M.D. "COMMON GASTROINTESTINAL PROBLEMS IN PEDIATRIC PATIENTS." The American College of Gastroenterology. 06 Mar 2008

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