Stomach cancer in Singapore is one of the top 10 cancers and a silent killer disease. It begins when cells in any part of the stomach grow and divide abnormally. These cells can grow into a tumour. The cancer may spread along the stomach wall or may develop directly through the wall and spread into the bloodstream or lymphatic system. Once beyond the stomach, cancer can spread to other organs.
Stomach cancers are classified according to the type of tissue they start in.
- Adenocarcinoma – Adenocarcinoma is the most common type of gastric cancer, comprising more than 90% of all stomach cancers. Carcinoma occurs in the glandular tissue on the innermost lining of the stomach.
- Lymphoma – develops in the immune system tissues located in the wall of the stomach.
- Carcinoid Tumour – originates in the hormone-creating cells of the stomach and normally do not spread.
- Small Cell Carcinoma – an extremely rare type of neuroendocrine tumour that often develops in conjunction with other tumour types.
- Leiomyosarcoma – begins in the smooth muscle cells of the stomach.
- Gastrointestinal Stromal Tumour (GIST) – begin in interstitial cells of Cajal, which are cells in the wall of the stomach.
- Squamous cell carcinoma – occurs in the skin-like cells that make up the stomach lining
Stomach Cancer Singapore Statistics
Stomach cancer in Singapore has a relatively high incident rate. Based on Singapore Cancer Registry 2021 Annual Report data, it is the 8th and 10th most common cancer in men and women respectively for the period 2017-2021. Stomach cancer affects men more than women, but is more uncommon in people under 50 years of age.
Causes Of Stomach Cancer & Risk Factors
The actual cause of stomach cancer is not yet known. However, there are a number of known risk factors. The following are known risk factors for stomach cancer:
- Age – Stomach cancer presents most commonly in older people.
- Gender – Men are more likely to develop the disease than women.
- Family History/Genetics – Individuals who have a parent, child, or sibling who has had stomach cancer exhibit a higher risk of the disease. Additionally, certain inherited genetic disorders, such as Lynch syndrome, hereditary diffuse gastric cancer, hereditary breast and ovarian cancer (HBOC), and familial adenomatous polyposis (FAP) may increase the risk of stomach cancer.
- Diet – A high salt diet has been linked to an increased risk of stomach cancer. This includes foods preserved by drying, smoking, salting, or pickling and foods high in added salt.
- Tobacco – Smoking tobacco increases the risk of getting many types of cancer including stomach cancer.
- Occupational exposure – Exposure to certain dust, fumes, and particular chemicals may increase the risk of developing this cancer.
Certain health conditions may also increase the chance of a person developing stomach cancer. These include:
- Pernicious anemia – A decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12.
- Chronic gastritis (long-term inflammation of the stomach) – Individuals with a long history of gastritis may be at an increased risk of developing this cancer.
- Helicobacter pylori infection – If these bacteria in the stomach are left untreated, the risk of getting this disease may be higher.
Symptoms Of Stomach Cancer
Early stages of stomach cancer are hard to detect as they may be asymptomatic. It may alternatively only show in the form of non-specific symptoms similar to a number of common disorders of the digestive system. As it develops into its later stages though, the following signs and symptoms of stomach cancer may appear:
- Discomfort or chronic pain in the stomach or abdomen;
- Discomfort akin to indigestion (Dyspepsia);
- A burning sensation after meals (Heartburn);
- Bloated feeling after meals;
- Early feeling of fullness despite a small meal;
- Loss of appetite;
- Unexplained weight loss; or
- Unexplainable fatigue.
As stomach cancer progresses, more serious symptoms may include:
- Anemia (lack of red blood cells in the blood) due to blood loss from tumour;
- Ascites (build-up of fluid in the abdomen);
- Blood in stools or black tarry stools;
- Difficulty swallowing;
- Jaundice (yellowing of the skin and whites of the eyes); or
- Nausea and vomiting.
Most of these are quite common symptoms and are mostly due to other gastro-intestinal diseases.
Screening & Prevention
Stomach cancer screening is a medical procedure that is aimed at detecting stomach cancer at an early stage or in individuals at higher risk of developing stomach cancer, before the onset of symptoms. In Singapore, stomach cancer is more common among older men. The primary purpose of stomach cancer screening is to identify any abnormal changes or cancerous growths in the stomach lining as early as possible, when the disease may be more treatable or preventable.
There are various methods used for stomach cancer screening including GASTROClear, a biomarker blood test, tumour marker blood tests such as Carcinoembryonic Antigen (CEA) and CA 19-9, and gastroscopy. Gastroscopy is the gold standard for stomach cancer detection that detects and diagnoses abnormalities in the food pipe, stomach and upper part of the small intestine. During a gastroscopy, any polyps that are discovered can be removed for biopsy. Removal of these polyps before they turn cancerous may also help tp prevent cancer from developing.
Learn More: Silent Killer – Stomach Cancer Screening In Singapore >>
Stomach Cancer Treatments
Treatment for stomach cancer in Singapore includes the following:
- Surgery – Surgery is widely used, and can be an effective form of treatment for stomach cancer. If the tumour has not spread to other organs, a part of, or the whole of the stomach and the surrounding lymph glands may be removed via open or laparoscopic (key hole) surgery. Even in certain patients with advanced stomach cancer, surgery may be performed to reduce cancer complications such as blockage of the stomach or bleeding from the cancer.
- Partial Gastrectomy – The lower portion of the stomach is removed, and the remaining stomach is connected to the small intestine.
- Total Gastrectomy – The whole stomach is removed, and the esophagus is connected to the small intestine.
- Radiation Therapy (Radiotherapy) – Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. Patients might have radiotherapy as part of the overall treatment for stomach cancer. Patients with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiotherapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.
- Chemotherapy – Chemotherapy is the use of drugs to help kill cancer cells and minimize the size of the tumor. It can be given alone or combined with radiotherapy before or after surgery. Chemotherapy may also be used to alleviate symptoms, reduce the chance of cancer recurrence or improve the chance of surviving for patients with advanced stomach cancer that cannot be operated upon. The side effects depend mainly on which drugs and the amount administrated.
- Endoscopic Therapy – Endoscopic therapy removes the tumor via gastroscopy without the need for surgery. It is typically only applicable to the early stages of stomach cancer.
- Targeted Therapy – Targeted therapy is aimed at specific cancer cells to inhibit the growth and spread of a tumor. It is associated with milder side effects when compared to chemotherapy or radiotherapy.
- Immunotherapy – Immunotherapy is also called biological therapy. It is designed to boost the body’s natural defenses to fight the cancer. It uses substances made either by the body or in a laboratory to improve, target, or restore immune system function.
Costs
Learn More: Cost Of Gastroscopy & Stomach Cancer Treatment In Singapore >>
Survival Rate
Stomach cancer in Singapore has the sixth highest mortality rate among cancers for males. According to the Singapore Cancer Registry’s 2021 report, stomach cancer accounted for 5.4% (869 deaths) of cancer deaths in males between 2017-2021. In women, stomach cancer accounted for 4.7% (624 deaths) of cancer deaths, making it the seventh highest mortality rate among cancers. On average, it is responsible for about 300 deaths every year.
If stomach cancer is detected early, it is treatable. However, more than two-thirds of stomach cancer patients are diagnosed only at Stage III or IV. In many cases, stomach cancer is asymptomatic in its initial stages, causing many patients to be diagnosed at a late or advanced stage.
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FAQs
What are the common symptoms of stomach cancer?
Common symptoms of stomach cancer may include persistent indigestion or heartburn, difficulty swallowing, nausea, vomiting (sometimes with blood), unintentional weight loss, feeling full after eating small amounts of food, abdominal pain or discomfort, and fatigue. However, symptoms can be vague and may not appear until the cancer is more advanced.
Who is at risk for developing stomach cancer?
Risk factors for stomach cancer include chronic infection with Helicobacter pylori bacteria, long-term inflammation of the stomach (gastritis), smoking, a diet high in salty and smoked foods, a family history of stomach cancer, certain genetic conditions (like Lynch syndrome), being over the age of 50, and having a history of stomach polyps.
Can stomach cancer be prevented?
While not all cases can be prevented, reducing risk factors can help. This includes avoiding smoking, maintaining a healthy diet rich in fruits and vegetables, reducing intake of salty and smoked foods, treating Helicobacter pylori infections, and undergoing regular medical check-ups if you have a family history of the disease.
What is the survival rate for stomach cancer?
The survival rate for stomach cancer varies widely depending on the stage at diagnosis. Early-stage stomach cancer has a higher survival rate, while advanced-stage cancer has a lower survival rate.
How should I prepare for a gastroscopy?
Preparation for a gastroscopy usually involves fasting for at least six hours before the procedure to ensure a clear view of the digestive tract. You should avoid eating or drinking anything, including water, during this period. It is also important to inform your doctor about any medications you are taking, as well as any allergies or medical conditions you have.
Is a gastroscopy painful?
No, a gastroscopy is not painful. During the procedure, you will be given a sedative to help you relax, and a local anesthetic will be sprayed on your throat to minimise discomfort. The endoscope will be gently inserted through your mouth and into your digestive tract. The procedure usually takes between 15 to 30 minutes. After the procedure, you may experience a sore throat, but this is usually temporary. You will need someone to drive you home due to the sedative’s effects
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This article is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.