Adenocarcinoma

What is adenocarcinoma of the stomach?
About 13,000 men and 8,000 women receive a diagnosis of stomach cancer each year in the United States, and almost all of these stomach cancers are adenocarcinomas. This stomach cancer usually starts in the superficial layer of the stomach and may spread over time into deeper or all layers of the stomach and into nearby organs, regional lymph nodes, or lymphatic and blood vessels.

Who is likely to have adenocarcinoma of the stomach?
Most people who have this type of stomach cancer are over age 70, and men are more susceptible than women. Long-standing infection with the H. pylori bacterium, which can cause stomach inflammation and peptic ulcers, increases the risk of this cancer. But most people with H. pylori do not get adenocarcinoma of the stomach. Other risk factors include long-term stomach inflammation; smoking; a family history of stomach cancer; a diet high in smoked, salted or pickled foods; a lack of exercise; and obesity.

What characterizes adenocarcinoma of the stomach?
Adenocarcinoma of the stomach usually develops slowly over many years. In early stages, this cancer does not cause symptoms. As it grows, common signs include loss of appetite, stomach discomfort or pain, difficulty swallowing, nausea and vomiting, anemia, weight loss, feeling full or bloated, vomiting blood, or having black stool. These symptoms often may not be caused by adenocarcinoma of the stomach. Ulcers, infection, or other health problems may produce the same symptoms.

How does the pathologist make the diagnosis?
The pathologist reviews the results of a clinical examination by the primary care physician or a gastroenterologist–a doctor specializing in diagnosing and treating digestive disorders. During the initial examination, the doctor checks the abdomen for abnormal fluid buildup and swelling and for swollen lymph nodes in the neck, underarm, and groin area. Blood and/or stool samples may be collected to be examined through laboratory tests for bacterial infection, anemia, and other reasons of the illness.

What else does the pathologist look for?
The doctor may also perform a procedure known as endoscopy to see into the stomach by passing a lighted tube through the mouth and esophagus. During this procedure, the doctor can obtain a biopsy specimen–a sample of the tumor’s cells–for the pathologist to examine under a microscope. Or a surgeon may make small incisions in the abdomen and insert a laparoscope to view the liver, lymph nodes, and possible tumor deposits on the inside surfaces of the abdomen. The surgeon may then take biopsy specimens if suspicious lesions are identified.

What is meant by the stage of the cancer?
The pathologist and primary care doctor or oncologist determine the cancer’s stage to plan the best treatment. Stage I adenocarcinoma tumors are small and confined to one local area of the stomach. Stage IV cancers have spread beyond the original area into other parts of the body. Stage II and III describe conditions in between these two extremes.

If the cancer may have spread, the doctor may order blood tests and other tests that may include a chest x-ray or a CT scan to examine the liver, pancreas, or other organs.

How do doctors determine what treatment will be necessary?
The recommended treatment will depend on the size and location of the cancer, the stage of the cancer, and the patient’s general health condition. The pathologist consults with the primary care physician or specialist. Together, using their combined experience and knowledge, they determine treatment options most appropriate for each individual patient. It’s important to learn as much as possible about treatment options and make the decision that’s right for you.

What kinds of treatments are available for adenocarcinoma of the stomach?
Adenocarcinoma of the stomach is treated with surgery, chemotherapy, and radiation therapy. These options can be used individually or in combination. For example, chemotherapy may be given before (neoadjuvant) or after (adjuvant) surgery, or along with radiation therapy.

Depending on where the cancer is located, the surgeon may remove the entire stomach or a part of it. If the tumor is in lower part of the stomach, the surgeon will perform a partial/distal gastrectomy. After removing the lower part of the stomach and possibly nearby lymph nodes or other tissue, the surgeon will attach the remainder of the stomach to the small intestine.

For tumors in the upper part of the stomach, the surgeon will likely remove the entire stomach, parts of the esophagus and small intestine, and lymph nodes and tissues near the tumor in a procedure called a total gastrectomy. The spleen is removed in rare cases. The surgeon then connects the esophagus directly to the small intestine.

Chemotherapy is a very common treatment for adenocarcinoma of the stomach, given before or after surgery and along with radiation therapy. Chemotherapy kills cancer cells with anti-cancer drugs given intravenously. Radiation therapy uses pinpointed, high-energy beams to kill cancer cells.

In addition, people with adenocarcinoma of the stomach may receive other treatments to control pain and other symptoms, relieve side effects, or to ease emotional problems.

Management of patients with adenocarcinoma of the stomach raises many nutritional challenges because this disease makes it difficult to eat. For this reason, it’s important to work closely with a dietitian to choose the best foods and nutrition and to minimize weight loss and discomfort while eating. Some people with stomach cancer need intravenous nutrition if food intake is limited.

After treatment for adenocarcinoma of the stomach, patients require regular check-ups to check for the status of residual or recurrent cancer and other health problems. The type of follow-up treatment can include physical exams, blood tests, x-rays, CT scans, endoscopy, or other tests. Patients must be vigilant about reporting any unusual symptoms.

Clinical trials of new treatments for stomach cancer may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature with uncertain outcome, which are usually offered to patients with advanced cancers. For more information about clinical trials, talk to your doctor or call the National Cancer Institute’s Cancer Information Service at 1–800–4–CANCER.

For more information, go to www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society) or www.medicinenet.com  (owned and operated by Web MD). Type the keywords stomach cancer into the search box.

What kinds of questions should I ask my doctors?
Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:

  • Please describe the type of cancer I have and what treatment options are available.
  • What is the stage of my cancer?
  • What are the chances for full remission?
  • What treatment options do you recommend? Why do you believe these are the best treatments?
  • What are the pros and cons of these treatment options?
  • What are the side effects?
  • Is your medical team experienced in treating the type of cancer I have?
  • Can you provide me with information about the physicians and others on the medical team?
  • If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would recommend?

DEFINITION OF TERMS


Adenocarcinoma: A type of cancer that originates in glandular mucosa of the stomach.

Lymph nodes: Small, immune system organs that help fight infections and other diseases. Lymph nodes are found in the underarm, neck, abdomen, and groin along the channels of the lymphatic system.  Cancer cells often travel through these channels from their initial site and grow in the regional lymph nodes, e.g. lymph node metastasis.

Malignant: Cancerous.

Metastatic: Spreading beyond the original tumor location to other parts of the body.

Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.

 

Images

Stomach adenocarcinoma cells  NORMAL

Stomach adenocarcinoma cells
Normal
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This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.

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