Stomach cancer happens when normal cells in the stomach change into abnormal cells and grow out of control. There are different kinds of stomach cancer, depending on the type of cells and part of the stomach involved. Stomach cancer is the fourth most commonly occurring cancer in men and the seventh most commonly occurring cancer in women. There were over one million new cases in 2018; with the highest prevalence seen in Eastern Asia. It is twice as common in men and it increases with age, peaking in the seventh decade of life (70’s). Diet and infection with bacteria called H. Pylori are thought to be the two most important environmental factors in the development of stomach cancer. H. pylori is a type of bacteria that can infect the stomach and intestines and may sometimes cause symptoms such as belly pain, bloating, nausea, or vomiting. Diets rich in pickled vegetables, salted fish and smoked meats are also linked to a higher risk of developing cancer of the stomach. Fruits and vegetables have a protective effect against cancer of the stomach. Cigarette smoking, obesity, family history of stomach cancer, past history of stomach surgery, longstanding history of stomach ulcers and Japanese ancestry history all have been found to have an increased risk to developing cancer of the stomach. Stomach cancer usually causes noticeable symptoms late and is associated with a poor outcome. The overall 5-year survival of 12 per cent for stomach cancer has shown little change over the last 10 years despite advances in investigation techniques and treatments. Early diagnosis offers the best chance of prolonged survival, and identification of larger numbers of patients with localised disease must be the aim in surviving stomach cancer. Early on, stomach cancer might not cause any symptoms. When stomach cancer causes symptoms, they can include; weight loss, belly pain, especially in the upper belly, trouble swallowing , lack of appetite, or feeling full after eating a small amount of food, nausea or feeling tired or shortness of breath (from a condition called “anaemia,” which is when people have very few red blood cells). It is important to know that all of these symptoms can also be caused by conditions that are not stomach cancer. But if one has these symptoms, it is recommended to seek proper medical check up to rule out the possibility of cancer. The diagnosis of stomach cancer is made by history taking of the patient and their complaints, doing a physical examination and medical investigations. Endoscopy is the most common investigation done in establishing a diagnosis. This is a test most often done for conditions in oesophagus, stomach and upper portion of the intestines. During this test, the doctor puts a thin tube with a camera and light on the end into the mouth and down into the stomach. This lets the doctor look at the stomach lining for any suspicious masses, ulcers. The doctor can then take off a sample from any abnormal masses seen during the same procedure which is taken for analysis to determine the condition, whether cancerous or non-cancerous. For stomach cancer to be detected at an early curable stage, routine endoscopies are done for people with the slightest suspicion of stomach cancer. These include any person at any age with complaints of indigestion (indigestion can present as upper abdomen pain or discomfort, bloating, feeling of fullness with very little intake of food, feeling of unusual fullness following meals, nausea, loss of appetite, heartburn, regurgitation of food or acid, and belching) who at the same time also present with complaints of bleeding from the stomach or intestines, difficulty in swallowing, weight loss, vomiting or features of anaemia (such as dizziness, chronic fatigue), or a mass felt on the upper abdomen. Endoscopy is also recommended for any patient aged 55 and above with unexplained and persistent recent-onset indigestion. Other investigations such as ultrasound scan and CT imaging might be done in case the diagnosis of stomach has been made to determine the degree of spread of the cancer, which will determine the modality of treatment to offer the patient depending on the type of cancer, location in the stomach and degree of spread to the nearby or far structures. It is important to know that endoscopy facilities which are a major step in detection of early curable stomach cancers are currently widely available in Rwandan public hospitals, at affordable prices and supported by most insurances, both Government and private. Hence, for people with above mentioned symptoms, medical care should be sought and this could help in better treatment outcome in case the symptoms are caused by an early stomach cancer. Dr. Ian Shyaka , Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
