Stomach cancer

Stomach cancer accounts for almost 25% of all cancers in Europe and generally affects people 45 years of age and older.
In about 90% of cases it originates from the innermost part of the gastric wall, the mucosa, and is called "adenocarcinoma". Other forms of stomach cancer, far less frequent, originate from the deeper layers of this organ (sarcomas), lymphatic tissue (lymphomas), or cells that produce hormones (carcinoids).

Causes 
Over the years, researchers have identified numerous risk factors responsible for the onset of adenocarcinoma, the most common form of stomach cancer. These are:

• Chronic inflammation of the stomach due to Helicobacter Pylori infection. This is a bacterium that can damage the mucus that lines the stomach thus allowing the gastric juices to come into contact with the underlying wall of the organ and to facilitate the onset of tumours.
• Poor diet. In particular, eating foods that are partially carbonized and red meat is harmful. 
• Alcohol abuse and cigarette smoke.
• Pernicious anaemia caused by vitamin B12 deficiency.
• Presence of gastric polyps.
• Prior gastric resection for ulcer.
• Family history (alteration of genes including APC and p53).

Symptoms
A late diagnosis is often made for stomach cancer. This is the result of the asymptomatic nature of the disease, at least in its initial stages. Among the most common symptoms of stomach cancer, the following are worth mentioning:

• abdominal pain;
• digestion difficulties;
• nausea and vomiting;
• weight loss;
• fatigue;
• refusal to eat meat (sarcophobia);
• haemorrhage that manifests with vomiting blood (late symptom);
• pitch-coloured stools, with poorly digested food or with a lot of blood (late symptom).

Diagnosis
The clinical tests necessary to make a diagnosis of liver cancer are:

• Esophagogastroduodenoscopy - EGDS (gastroscopy): enables the tumour to be visualized, biopsy samples to be taken, resolutive resections to be conducted in the case of a tumour at the initial stages, and the disease to be monitored over time;
• Echoendoscopy: this is an ultrasound conducted during EGDS to analyze the inner wall of the stomach. It is very important to determine how much the tumour has infiltrated the gastric wall, to identify the presence of perigastric lymph nodes, and to assess whether it has reached neighbouring organs;
• CT: enables the presence of metastases to be diagnosed;
• Laparoscopy: through the introduction of a video camera in the abdomen, the status of the peritoneum can be verified.

Treatment
The treatment for stomach cancer depends on the stage of the disease and the patient's condition.
The main treatment is surgery for operable cases, currently most interventions can be performed laparoscopically. The role of chemotherapy and possibly of biological drugs is also fundamental; the sequence of treatments (first surgery and then chemotherapy, or chemotherapy first and then surgery) should be evaluated in a multi-disciplinary manner.