Stomach cancer, also known as gastric cancer, is a cancer which develops from the lining of the stomach. Early symptoms may include heartburn, upper abdominal pain, nausea and loss of appetite. Later signs and symptoms may include weight loss, yellowing of the skin and whites of the eyes, vomiting, difficulty swallowing and blood in the stool among others. The cancer may spread from the stomach to other parts of the body, particularly the liver, lungs, bones, lining of the abdomen and lymph nodes.
The most common cause is infection by the bacterium Helicobacter pylori, which accounts for more than 60% of cases. Certain types of H. pylori have greater risks than others. Smoking, dietary factors such as pickled vegetables and obesity are other risk factors. About 10% of cases run in families, and between 1% and 3% of cases are due to genetic syndromes inherited from a person's parents such as hereditary diffuse gastric cancer. Most cases of stomach cancers are gastric carcinomas. This type can be divided into a number of subtypes. Lymphomas and mesenchymal tumors may also develop in the stomach. Most of the time, stomach cancer develops in stages over years. Diagnosis is usually by biopsy done during endoscopy. This is followed by medical imaging to determine if the disease has spread to other parts of the body. Japan and South Korea, two countries that have high rates of the disease, screen for stomach cancer.
A Mediterranean diet lowers the risk of cancer as does the stopping of smoking. There is tentative evidence that treating H. pylori decreases the future risk. If cancer is treated early, many cases can be cured. Treatments may include some combination of surgery, chemotherapy, radiation therapy and targeted therapy. If treated late, palliative care may be advised. Outcomes are often poor with a less than 10% five-year survival rate globally. This is largely because most people with the condition present with advanced disease. In the United States, five-year survival is 28%, while in South Korea it is over 65%, partly due to screening efforts.
Globally, stomach cancer is the fifth leading cause of cancer and the third leading cause of death from cancer, making up 7% of cases and 9% of deaths. In 2012, it newly occurred in 950,000 people and caused 723,000 deaths. Before the 1930s, in much of the world, including most Western developed countries, it was the most common cause of death from cancer. Rates of death have been decreasing in many areas of the world since then. This is believed to be due to the eating of less salted and pickled foods as a result of the development of refrigeration as a method of keeping food fresh. Stomach cancer occurs most commonly in East Asia and Eastern Europe. It occurs twice as often in males as in females.
|A stomach ulcer that was diagnosed as cancer on biopsy and surgically removed|
|Symptoms||Early: Heartburn, upper abdominal pain, nausea, loss of appetite.|
Later: Weight loss, yellowing of the skin and whites of the eyes, vomiting, difficulty swallowing, blood in the stool
|Usual onset||Over years|
|Types||Gastric carcinomas, lymphoma, mesenchymal tumor|
|Causes||Helicobacter pylori, genetics|
|Risk factors||Smoking, dietary factors such as pickled vegetables, obesity|
|Diagnostic method||Biopsy done during endoscopy|
|Prevention||Mediterranean diet, stopping smoking|
|Treatment||Surgery, chemotherapy, radiation therapy, targeted therapy|
|Prognosis||Five-year survival rate < 10% (globally),|
28% (US), 65% (S. Korea)
|Frequency||3.5 million (2015)|
Stomach cancer is often either asymptomatic (producing no noticeable symptoms) or it may cause only nonspecific symptoms (symptoms that may also be present in other related or unrelated disorders) in its early stages. By the time symptoms occur, the cancer has often reached an advanced stage (see below) and may have metastasized (spread to other, perhaps distant, parts of the body), which is one of the main reasons for its relatively poor prognosis. Stomach cancer can cause the following signs and symptoms:
Early cancers may be associated with indigestion or a burning sensation (heartburn). However, less than 1 in every 50 people referred for endoscopy due to indigestion has cancer. Abdominal discomfort and loss of appetite, especially for meat, can occur.
Gastric cancers that have enlarged and invaded normal tissue can cause weakness, fatigue, bloating of the stomach after meals, abdominal pain in the upper abdomen, nausea and occasional vomiting, diarrhea or constipation. Further enlargement may cause weight loss or bleeding with vomiting blood or having blood in the stool, the latter apparent as black discolouration (melena) and sometimes leading to anemia. Dysphagia suggests a tumour in the cardia or extension of the gastric tumour into the esophagus.
Helicobacter pylori infection is an essential risk factor in 65–80% of gastric cancers, but only 2% of people with Helicobacter infections develop stomach cancer. The mechanism by which H. pylori induces stomach cancer potentially involves chronic inflammation, or the action of H. pylori virulence factors such as CagA. It was estimated that Epstein–Barr virus is responsible for 84,000 cases per year. AIDS is also associated with elevated risk.
Smoking increases the risk of developing gastric cancer significantly, from 40% increased risk for current smokers to 82% increase for heavy smokers. Gastric cancers due to smoking mostly occur in the upper part of the stomach near the esophagus. Some studies show increased risk with alcohol consumption as well.
Dietary factors are not proven causes and the association between stomach cancer and various foods and beverages is weak. Some foods including smoked foods, salt and salt-rich foods, red meat, processed meat, pickled vegetables, and bracken are associated with a higher risk of stomach cancer. Nitrates and nitrites in cured meats can be converted by certain bacteria, including H. pylori, into compounds that have been found to cause stomach cancer in animals.
Fresh fruit and vegetable intake, citrus fruit intake, and antioxidant intake are associated with a lower risk of stomach cancer. A Mediterranean diet is associated with lower rates of stomach cancer, as is regular aspirin use.
Obesity is a physical risk factor that has been found to increase the risk of gastric adenocarcinoma by contributing to the development of gastroesophageal reflux disease (GERD). The exact mechanism by which obesity causes GERD is not completely known. Studies hypothesize that increased dietary fat leading to increased pressure on the stomach and the lower esophageal sphincter, due to excess adipose tissue, could play a role, yet no statistically significant data has been collected. However, the risk of gastric cardia adenocarcinoma, with GERD present, has been found to increase more than 2 times for an obese person. There is a correlation between iodine deficiency and gastric cancer.
A genetic risk factor for gastric cancer is a genetic defect of the CDH1 gene known as hereditary diffuse gastric cancer (HDGC). The CDH1 gene, which codes for E-cadherin, lies on the 16th chromosome. When the gene experiences a particular mutation, gastric cancer develops through a mechanism that is not fully understood. This mutation is considered autosomal dominant meaning that half of a carrier’s children will likely experience the same mutation. Diagnosis of hereditary diffuse gastric cancer usually takes place when at least two cases involving a family member, such as a parent or grandparent, are diagnosed, with at least one diagnosed before the age of 50. The diagnosis can also be made if there are at least three cases in the family, in which case age is not considered.
The International Cancer Genome Consortium is leading efforts to identify genomic changes involved in stomach cancer. A very small percentage of diffuse-type gastric cancers (see Histopathology below) arise from an inherited abnormal CDH1 gene. Genetic testing and treatment options are available for families at risk.
To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:
In 2013, Chinese and Israeli scientists reported a successful pilot study of a breathalyzer-style breath test intended to diagnose stomach cancer by analyzing exhaled chemicals without the need for an intrusive endoscopy. A larger-scale clinical trial of this technology was completed in 2014.
Abnormal tissue seen in a gastroscope examination will be biopsied by the surgeon or gastroenterologist. This tissue is then sent to a pathologist for histological examination under a microscope to check for the presence of cancerous cells. A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells.
Various gastroscopic modalities have been developed to increase yield of detected mucosa with a dye that accentuates the cell structure and can identify areas of dysplasia. Endocytoscopy involves ultra-high magnification to visualise cellular structure to better determine areas of dysplasia. Other gastroscopic modalities such as optical coherence tomography are being tested investigationally for similar applications.
A number of cutaneous conditions are associated with gastric cancer. A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as acanthosis nigricans, is associated with intra-abdominal cancers such as gastric cancer. Other cutaneous manifestations of gastric cancer include tripe palms (a similar darkening hyperplasia of the skin of the palms) and the Leser-Trelat sign, which is the rapid development of skin lesions known as seborrheic keratoses.
If cancer cells are found in the tissue sample, the next step is to stage, or find out the extent of the disease. Various tests determine whether the cancer has spread and, if so, what parts of the body are affected. Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a CT scan, a PET scan, an endoscopic ultrasound exam, or other tests to check these areas. Blood tests for tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) may be ordered, as their levels correlate to extent of metastasis, especially to the liver, and the cure rate.
Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for examination by a pathologist.
In a study of open-access endoscopy in Scotland, patients were diagnosed 7% in Stage I 17% in Stage II, and 28% in Stage III. A Minnesota population was diagnosed 10% in Stage I, 13% in Stage II, and 18% in Stage III. However, in a high-risk population in the Valdivia Province of southern Chile, only 5% of patients were diagnosed in the first two stages and 10% in stage III.
Getting rid of H. pylori in those who are infected decreases the risk of stomach cancer, at least in those who are Asian. A 2014 meta-analysis of observational studies found that a diet high in fruits, mushrooms, garlic, soybeans, and green onions was associated with a lower risk of stomach cancer in the Korean population. Low doses of vitamins, especially from a healthy diet, decrease the risk of stomach cancer. A previous review of antioxidant supplementation did not find supporting evidence and possibly worse outcomes.
Cancer of the stomach is difficult to cure unless it is found at an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made.
Treatment for stomach cancer may include surgery, chemotherapy, and/or radiation therapy. New treatment approaches such as immunotherapy or gene therapy and improved ways of using current methods are being studied in clinical trials.
Surgery remains the only curative therapy for stomach cancer. Of the different surgical techniques, endoscopic mucosal resection (EMR) is a treatment for early gastric cancer (tumor only involves the mucosa) that was pioneered in Japan and is available in the United States at some centers. In this procedure, the tumor, together with the inner lining of stomach (mucosa), is removed from the wall of the stomach using an electrical wire loop through the endoscope. The advantage is that it is a much smaller operation than removing the stomach. Endoscopic submucosal dissection (ESD) is a similar technique pioneered in Japan, used to resect a large area of mucosa in one piece. If the pathologic examination of the resected specimen shows incomplete resection or deep invasion by tumor, the patient would need a formal stomach resection. A 2016 Cochrane review found low quality evidence of no difference in short-term mortality between laparoscopic and open gastrectomy (removal of stomach), and that benefits or harms of laparoscopic gastrectomy cannot be ruled out. Post-operatively, up to 70% of people undergoing total gastrectomy develop complications such as dumping syndrome and reflux esophagitis. Construction of a "pouch", which serves as a "stomach substitute", reduced the incidence of dumping syndrome and reflux esophagitis by 73% and 63% respectively, and led to improvements in quality-of-life, nutritional outcomes, and body mass index.
Those with metastatic disease at the time of presentation may receive palliative surgery and while it remains controversial, due to the possibility of complications from the surgery itself and the fact that it may delay chemotherapy the data so far is mostly positive, with improved survival rates being seen in those treated with this approach.
The use of chemotherapy to treat stomach cancer has no firmly established standard of care. Unfortunately, stomach cancer has not been particularly sensitive to these drugs, and chemotherapy, if used, has usually served to palliatively reduce the size of the tumor, relieve symptoms of the disease and increase survival time. Some drugs used in stomach cancer treatment have included: 5-FU (fluorouracil) or its analog capecitabine, BCNU (carmustine), methyl-CCNU (semustine) and doxorubicin (Adriamycin), as well as mitomycin C, and more recently cisplatin and taxotere, often using drugs in various combinations. The relative benefits of these different drugs, alone and in combination, are unclear. Clinical researchers are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells.
Recently, treatment with human epidermal growth factor receptor 2 (HER2) inhibitor, trastuzumab, has been demonstrated to increase overall survival in inoperable locally advanced or metastatic gastric carcinoma over-expressing the HER2/neu gene. In particular, HER2 is overexpressed in 13–22% of patients with gastric cancer. Of note, HER2 overexpression in gastric neoplasia is heterogeneous and comprises a minority of tumor cells (less than 10% of gastric cancers overexpress HER2 in more than 5% of tumor cells). Hence, this heterogeneous expression should be taken into account for HER2 testing, particularly in small samples such as biopsies, requiring the evaluation of more than one bioptic sample.
The prognosis of stomach cancer is generally poor, due to the fact the tumour has often metastasised by the time of discovery and the fact that most people with the condition are elderly (median age is between 70 and 75 years) at presentation. The five-year survival rate for stomach cancer is reported to be less than 10 percent.
Almost 300 genes are related to outcomes in stomach cancer with both unfavorable genes where high expression related to poor survival and favorable genes where high expression associated with longer survival times. Examples of poor prognosis genes include ITGAV and DUSP1.
Worldwide, stomach cancer is the fifth most-common cancer with 952,000 cases diagnosed in 2012. It is more common both in men and in developing countries. In 2012, it represented 8.5% of cancer cases in men, making it the fourth most-common cancer in men. Also in 2012, the number of deaths was 700,000 having decreased slightly from 774,000 in 1990, making it the third-leading cause of cancer-related death (after lung cancer and liver cancer).
Less than 5% of stomach cancers occur in people under 40 years of age with 81.1% of that 5% in the age-group of 30 to 39 and 18.9% in the age-group of 20 to 29.
In 2014, stomach cancer resulted in 0.61% of deaths (13,303 cases) in the U.S. In China, stomach cancer accounted for 3.56% of all deaths (324,439 cases). The highest rate of stomach cancer was in Mongolia, at 28 cases per 100,000 people.
In the United Kingdom, stomach cancer is the fifteenth most-common cancer (around 7,100 people were diagnosed with stomach cancer in 2011), and it is the tenth most-common cause of cancer-related deaths (around 4,800 people died in 2012).
Incidence and mortality rates of gastric cancer vary greatly in Africa. The GLOBOCAN system is currently the most widely-used method to compare these rates between countries, but African incidence and mortality rates are seen to differ among countries, possibly due to the lack of universal access to a registry system for all countries. Variation as drastic as estimated rates from 0.3/100000 in Botswana to 20.3/100000 in Mali have been observed. In Uganda, the incidence of gastric cancer has increased from the 1960s measurement of 0.8/100000 to 5.6/100000. Gastric cancer, though present, is relatively low when compared to countries with high incidence like Japan and China. One suspected cause of the variation within Africa and between other countries is due to different strains of the Helicobacter pylori bacteria. The trend commonly-seen is that H. pylori infection increases the risk for gastric cancer. However, this is not the case in Africa, giving this phenomenon the name the “African enigma.” Although this bacteria is found in Africa, evidence has supported that different strains with mutations in the bacterial genotype may contribute to the difference in cancer development between African countries and others outside the continent. However, increasing access to health care and treatment measures have been commonly-associated with the rising incidence, particularly in Uganda.
The stomach is a muscular organ of the gastrointestinal tract that holds food and begins the digestive process by secreting gastric juice. The most common cancers of the stomach are adenocarcinomas but other histological types have been reported. Signs vary but may include vomiting (especially if blood is present), weight loss, anemia, and lack of appetite. Bowel movements may be dark and tarry in nature. In order to determine whether cancer is present in the stomach, special X-rays and/or abdominal ultrasound may be performed. Gastroscopy, a test using an instrument called endoscope to examine the stomach, is a useful diagnostic tool that can also take samples of the suspected mass for histopathological analysis to confirm or rule out cancer. The most definitive method of cancer diagnosis is through open surgical biopsy. Most stomach tumors are malignant with evidence of spread to lymph nodes or liver, making treatment difficult. Except for lymphoma, surgery is the most frequent treatment option for stomach cancers but it is associated with significant risks.
Epidemiology of Helicobacter pylori and gastric cancer…
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Alonzo Arza Hinckley (April 23, 1870 – December 22, 1936) was a member of the Quorum of the Twelve Apostles of The Church of Jesus Christ of Latter-day Saints (LDS Church) from 1934 until his death.
Hinckley was born in Cove Fort, Utah Territory, to Ira Hinckley and Angeline Wilcox Noble. He married his wife Rose May Robison in 1892 in the Manti Temple. Hinckley served as an LDS Church missionary in the Netherlands.On August 11, 1912, during a conference in Millard County, Utah, Hinckley was selected to be president of the newly formed Deseret Stake, which was located in the western half of Millard County, Utah.Hinckley was ordained an apostle on October 11, 1934, to fill a vacancy in the Quorum of the Twelve Apostles created by elevation of David O. McKay to the First Presidency following the death of Anthony W. Ivins.
Hinckley died of stomach cancer on December 22, 1936 in Salt Lake City. He was buried at Salt Lake City Cemetery. He was succeeded in the Quorum of the Twelve by Albert E. Bowen.
Hinckley was the uncle of LDS Church president Gordon B. Hinckley.Charles Brode
Charles Brode was a merchant and property owner in 19th Century Los Angeles, California.
He was a member of that city's governing body, the Los Angeles Common Council, from December 5, 1878, to March 13, 1879, when he resigned.
Brode was born in Boreck, Posen, Prussia, on February 6, 1836, and at the age of nineteen he emigrated to Australia, where he was a miner for seven years. He then came to the United States, where he engaged in "various kinds of business" in the territories of Montana, Idaho and Utah.He moved to Los Angeles in 1868 and opened a grocery store on South Spring Street, where the Parisian Suit and Cloak Company was later situated. next to the Hollenbeck Hotel. The building he constructed there was known as the Brode Block.Brode was a director of the German-American Savings Bank and of the Los Angeles Soap Company. He was a member of the Odd Fellows, Turnverein Germania (charter member) and Pioneers' Society of California.He died of stomach cancer on August 13, 1901, and was survived by his wife and six children, Mrs. Emma Friese, Mrs. Louise Bruning, A.C. Brode, W.C. Brode, Mrs. Oscar Lawler and Leopold Brode.Christopher Skase
Christopher Charles Skase (18 September 1948 – 5 August 2001) was an Australian businessman who later became one of his country's most wanted fugitives, after his business empire crashed spectacularly and he fled to Majorca, Spain.Denniz Pop
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Fernando Andrés Cornejo Jiménez (January 28, 1969 – January 24, 2009) was a Chilean football midfielder.
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Mary Charlene Noble (October 15, 1940 – April 27, 2006), known from childhood by her nickname Kay Noble, was an American professional wrestler. Her career spanned from the 1950s to the 1980s, during which time she was known for her toughness in the ring. She worked along well-known female professional wrestlers such as Penny Banner, The Fabulous Moolah, and Gladys Gillem. She also wrestled in mixed tag team matches with partners such as her husband Doug Gilbert and Terry Funk. During her almost thirty years wrestling, she held the Texas Women's Championship, Central States Women's Championship, and AWA World Women's Championship. She was also honored by the Cauliflower Alley Club in 2001, before dying of stomach cancer in April 2006.Linitis plastica
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Linitis plastica is a type of adenocarcinoma and accounts for 3-19% of gastric adenocarcinomas. Causes of cancerous linitis plastica could be metastatic infiltration of the stomach, particularly breast and lung carcinoma. It is not associated with H. pylori infection or chronic gastritis. The risk factors are undefined, except for rare inherited mutations in E-cadherin, which are found in about 50% of diffuse-type gastric carcinomas.Max Nettlau
Max Heinrich Hermann Reinhardt Nettlau (German: [ˈnɛtlaʊ]; 30 April 1865 – 23 July 1944) was a German anarchist and historian. Although born in Neuwaldegg (today part of Vienna) and raised in Vienna, he lived there until the annexation to Nazi Germany in 1938. Max Nettlau retained his Prussian (later German) nationality throughout his life. A student of the Welsh language he spent time in London where he joined the Socialist League and met William Morris. While in London he met anarchists such as Errico Malatesta and Peter Kropotkin whom he remained in contact with for the rest of his life. He also helped to found Freedom Press for whom he wrote for many years.
In the 1890s realising that a generation of socialist and anarchist militants from the mid-19th century was passing away and their archives of writings and correspondence being destroyed, he concentrated his effort and a recent modest inheritance from his father on acquiring and rescuing such collections from destruction. He also made many interviews of veteran militants for posterity. He wrote biographies of many famous anarchists, including Mikhail Bakunin, Élisée Reclus, and Errico Malatesta. He also wrote a seven volume history of anarchism.
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Sergey Nikolayevich Volkov (Russian: Сергей Николаевич Волков; 19 April 1949 – 31 August 1990) was a Soviet figure skater. He won the 1975 World titles and placed second in 1974.Stomach disease
Stomach diseases include gastritis, gastroparesis, diarrhea, Crohn's disease and various cancers.The stomach is an important organ in the body. It plays a vital role in digestion of foods, releases various enzymes and also protects the lower intestine from harmful organisms. The stomach connects to the esophagus above and to the small intestine below. It is intricately related to the pancreas, spleen and liver. The stomach does vary in size but its J shape is constant. The stomach lies in the upper part of the abdomen just below the left rib cage.
Examples including the name gastropathy include portal hypertensive gastropathy and Ménétrier's disease, also known as "hyperplastic hypersecretory gastropathy". However, there are many other stomach diseases that don't include the word "gastropathy" such as gastric or peptic ulcer disease, gastroparesis, and dyspepsia.
Many stomach diseases are associated with infection. Historically, it was widely believed that the highly acidic environment of the stomach would keep the stomach immune from infection. However, a large number of studies have indicated that most cases of stomach ulcers, gastritis, and stomach cancer are caused by Helicobacter pylori infection. One of the ways it is able to survive in the stomach involves its urease enzymes which metabolize urea (which is normally secreted into the stomach) to ammonia and carbon dioxide which neutralises gastric acid and thus prevents its digestion. In recent years, it has been discovered that other Helicobacter bacteria are also capable of colonising the stomach and have been associated with gastritis.
Having too little or no gastric acid is known as hypochlorhydria or achlorhydria respectively and are conditions which can have negative health impacts. Having high levels of gastric acid is called hyperchlorhydria. Many people believe that hyperchlorhydria can cause stomach ulcers. However, recent research indicates that the gastric mucosa which secretes gastric acid is acid-resistant.
Gastritis and stomach cancer can be caused by Helicobacter pylori infection.
There are many types of chronic disorders which affect the stomach. However, since the symptoms are localized to this organ, the typical symptoms of stomach problems include nausea, vomiting, bloating, cramps, diarrhea and pain.Tiki Fulwood
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In the late 1960s, Fulwood was the house drummer for the Uptown Theater in Philadelphia when he met guitarist Eddie Hazel. Hazel and bassist Billy Bass Nelson were on tour as musical support for the doo wop vocal group The Parliaments. Hazel and Nelson convinced group leader George Clinton to add Fulwood to the group, where he replaced drummer Harvey McGee. Fulwood, Hazel, and Nelson formed the core of The Parliaments musical backing group, which later became known as Funkadelic. Fulwood also played drums in the Tyrone Davis band and the Chairmen of the Board between stints with P-Funk, and later was briefly employed by Miles Davis. Fulwood was officially dismissed from Parliament-Funkadelic in 1973. While living in Washington, D.C., Fulwood formed his own band (Tiki) with the help of a young friend, Wilbur Harris, who knew a lot of young musicians. They finished an album that was never released.
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