Stomach & oesophageal cancer

Sunday 1 November, 2015

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On this page:  The oesophagus and stomach | What is stomach cancer? | How common is stomach cancer? | What is oesophageal cancer? | Is oesophageal cancer common? | What are the risk factors? | GORD and Barrett’s oesophagus | What are the symptoms?


The oesophagus and stomach

The oesophagus and stomach are part of the upper gastrointestinal (GI) tract, which is part of the digestive system. The digestive system helps the body break down food and turn it into energy.

The oesophagus (food pipe or gullet) is a long, muscular tube that delivers food, fluids and saliva from the mouth and throat to the stomach. A valve (sphincter) at the end of the oesophagus stops acid and food moving from the stomach back into the oesophagus.

The stomach is a hollow, muscular organ in the upper left part of the abdomen, located between the end of the oesophagus and the beginning of the small bowel (small intestine). The stomach expands to store food that has been swallowed. It also helps with the absorption of some vitamins and minerals.

In the stomach, acidic (gastric) juices are released from glands in the stomach lining (mucosa). These juices break down food into a thick fluid, which then moves into the small bowel. In the small bowel, nutrients from the broken-down food are absorbed into the bloodstream. The waste matter moves into the large bowel (large intestine), where fluids are reabsorbed back into the body. The solid waste matter is passed out of the body as a bowel movement.

The oesophagus and stomach

Layer of tissue
In the oesophageal wall In the stomach wall
Mucosa (moist innermost layer)
  • made up of squamous cells
  • contains glands that produce gastric fluids to start breaking down food
Submucosa (supports the mucosa)
  • glands in the submucosa produce fluid (mucus)
  • this fluid helps to move food through the oesophagus
  • provides blood and nutrients to the stomach
Muscle layer
  • known as the muscularis propria
  • produces contractions to help push food down the oesophagus and into the stomach
  • known as the muscularis externa
  • produces muscle contractions to help break down food and push it into the small bowel in a controlled way
Outer layer
  • known as the adventitia
  • connective tissue supporting the oesophagus
  • known as the serosa
  • a smooth membrane that surrounds the stomach

What is stomach cancer?

Stomach cancer begins from abnormal cells in the lining (mucosa) of the stomach. Tumours can begin anywhere in the stomach, although most start in the glandular tissue found on the stomach's inner surface. This type of cancer is called adenocarcinoma of the stomach (also known as gastric cancer).

If not found and treated early, stomach cancer can spread through the lymphatic system to nearby lymph nodes or through the bloodstream to other parts of the body, such as the liver and lungs. It may also spread to the walls of the abdomen (peritoneum). Rarely, it can grow through the stomach wall into nearby organs such as the pancreas and bowel.

How common is stomach cancer?

About 2100 people are diagnosed with stomach cancer in Australia each year. Men are two times more likely than women to be diagnosed with stomach cancer. It is more common in people over 60, but it can occur at any age. About one in 121 men and one in 290 women are likely to develop stomach cancer before the age of 75. 3

What is oesophageal cancer?

Oesophageal cancer begins from abnormal cells in the innermost layer (mucosa) of the oesophagus. A tumour can start at any point along the length of the oesophagus. The two main subtypes are:

Oesophageal squamous cell carcinoma

Starts in the thin, flat cells in the lining of the oesophagus, which are called squamous cells. It often begins in the middle and upper part of the oesophagus. In Australia, squamous cell carcinomas are less common than adenocarcinomas.

Oesophageal adenocarcinoma

Barrett's oesophagus occurs when the squamous cells lining the lower section of the oesophagus change into glandular cells. A tumour that starts in glandular cells is called an adenocarcinoma. Adenocarcinomas are now the most common form of oesophageal cancer in Australia.

If it is not found and treated early, oesophageal cancer can spread through the lymphatic system to nearby lymph nodes or through the bloodstream to other parts of the body, most commonly the liver. It can also grow through the oesophageal wall and invade the windpipe and lungs.

Less common types of cancer

Other less common types of cancer can affect the stomach and oesophagus. These include small cell carcinomas, lymphomas, neuroendocrine tumours, and gastrointestinal stromal tumours.

These types of cancer aren't discussed in this section and treatment may be different. Call Cancer Council 13 11 20 for information about these types of cancer, or speak to someone in your medical team.

Is oesophageal cancer common?

This is an uncommon cancer. In Australia, about 1400 people are diagnosed with oesophageal cancer each year. Men are nearly three times more likely than women to be diagnosed with this cancer. It is more common in people over 60, but can occur at any age. About one in 158 men and one in 575 women are likely to develop oesophageal cancer before the age of 75. 4

What are the risk factors?

The exact causes of stomach and oesophageal cancers are unknown, but the factors listed below may increase your risk. However, having one or more of these risk factors does not mean you will develop cancer.

GORD and Barrett's oesophagus

Gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus are risk factors for oesophageal adenocarcinoma. Reflux is when stomach acid backs up into the oesophagus. People who have repeated episodes of reflux may be diagnosed with GORD.

Over time, stomach acid can damage the walls of the oesophagus, causing inflammation or ulceration (oesophagitis). In some people, this may cause the squamous cells lining the oesophagus to be replaced by glandular cells. This condition, called Barrett's oesophagus, can lead to oesophageal adenocarcinoma. Most people with Barrett's oesophagus will not develop oesophageal cancer.

Known risk factors

Stomach cancer

  • older age (being over 60)
  • infection with Helicobacter pylori (H. pylori), a type of bacteria found in the stomach
  • having had a subtotal gastrectomy (see page 26) to treat non-cancerous conditions
  • smoking
  • low red blood cell levels
  • (pernicious anaemia)
  • a family history of stomach cancer
  • inheriting a genetic change that causes a bowel disorder such as familial adenomatous polyposis or Lynch syndrome
  • chronic inflammation of the stomach (chronic gastritis)
  • alcohol consumption
  • dietary factors – eating foods preserved by salting and processed meats (e.g. bacon, salami or ham)
  • being overweight or obese

Oesophageal cancer

Squamous cell carcinoma
  • alcohol consumption
  • smoking
  • older age (being over 60)
  • infection with human papilloma virus (HPV)
Adenocarcinoma
  • being overweight or obese
  • medical conditions, including gastrooesophageal reflux disease (GORD) and Barrett's oesophagus (see above)
  • smoking
  • older age (being over 60)
  • a personal or family history of gastro-oesophageal disorders, such as hernia, polyps, ulceration or oesophagitis

What are the symptoms?

Stomach and oesophageal cancers may not cause symptoms in their early stages. This means that they are usually diagnosed when the cancer is more advanced.

Common symptoms are listed below. These symptoms can also occur in many other conditions and do not necessarily mean that you have cancer. Speak with your general practitioner (GP) if you are concerned.

Stomach cancer

  • unexplained weight loss or loss of appetite
  • difficulty swallowing
  • indigestion – e.g. pain or burning sensation in the abdomen (heartburn), frequent burping, reflux
  • persistent nausea and/or vomiting with no apparent cause
  • a sense of fullness, even after a small meal
  • swelling of the abdomen or feeling bloated
  • unexplained tiredness, which may be due to anaemia
  • vomit containing blood
  • black-coloured or bloody stools

Oesophageal cancer

  • difficulty swallowing
  • vomiting blood
  • black-coloured or bloody stools
  • food or fluids "catching" in the throat or episodes of choking when swallowing
  • pain when swallowing
  • unexplained weight loss or loss of appetite
  • new or worsening heartburn or reflux
  • cough, hoarseness
  • development of upper abdominal discomfort especially when eating
  • persistent unexplained tiredness

Reviewed by: Prof David Watson, Head, Flinders University Department of Surgery, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Staff Specialist, Cancer Services, Princess Alexandra Hospital, QLD; Dr Fiona Day, Medical Oncologist, Calvary Mater Hospital, Newcastle, and Conjoint Senior Lecturer, University of Newcastle, NSW; Mark Diggle, Consumer; Merran Findlay, Executive Research Lead – Cancer Nutrition and Oncology Specialist Dietitian, Royal Prince Alfred Hospital, NSW; Rosie Newth, 13 11 20 Consultant, Cancer Council NSW; Dr David Ransom, Medical Oncologist, Fiona Stanley Hospital, WA; Megan Rogers, Specialist Nurse, Upper Gastrointestinal Cancer Service, Peter MacCallum Cancer Centre, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.

3. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Stomach cancer, AIHW, Canberra, 2017.
4. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Oesophageal cancer, AIHW, Canberra, 2017.

Diagnosing stomach or oesophageal cancer

Sunday 1 November 2015
Your GP will examine you and refer you for further tests. The diagnostic blood tests, procedures or scans you have will vary depending on your symptoms.

Treatment for stomach & oesophageal cancer

Sunday 1 November 2015
Surgery is a common type of treatment for oesophageal and stomach cancer. Some people have chemotherapy or radiotherapy either on their own or in combination.

Treatment for oesophageal cancer

Friday 1 September 2017
Surgery is a common type of treatment for oesophageal cancer. Some people have chemotherapy or radiotherapy either on their own or in combination.

Managing side effects of stomach & oesophageal cancer

Sunday 1 November 2015
Oesophageal and stomach cancers and their treatment can cause many side effects.

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