The Lunar New Year holiday often brings families together and with that comes a renewed focus on health. Cancer, a leading cause of death, is a frequent topic of concern. Early detection and prevention are key, and understanding the risks associated with specific cancers is crucial. This article focuses on stomach cancer, a particularly prevalent concern in Korea, with insights from Dr. Yu Moon-won, a professor of gastrointestinal surgery at Asan Medical Center in Seoul.
The case of Mr. Oh, a 47-year-old who enjoyed spicy foods and initially dismissed mild discomfort as a result of his diet, highlights the importance of proactive health screenings. He was eventually diagnosed with ‘early stomach cancer’ after a gastroscopy, a diagnosis that could have been far more serious had it been delayed. The cancer had invaded the submucosa, but hadn’t yet reached the stomach muscle layer, which would have classified it as ‘advanced stomach cancer.’
Stomach cancer is a significant health issue in Korea, with statistics showing 28,943 new cases – the fifth highest cancer incidence overall. Notably, Korea’s annual gastric cancer incidence rate ranks third globally, following Mongolia and Japan.
Several factors contribute to the development of stomach cancer. Dietary habits and Helicobacter pylori infection are primary causes. A diet high in salt, carbohydrates relative to proteins and fats, blackened foods, and salt-pickled foods increases risk. Nitrates in processed meats and meats grilled over charcoal are also implicated. Recent research also suggests a link between obesity and increased risk.
Chronic gastritis caused by Helicobacter pylori infection can progress to atrophic gastritis, and to stomach cancer if left untreated. Individuals with chronic atrophic gastritis and intestinal metaplasia – a change in the stomach lining – are considered high-risk.
However, there is encouraging news. The incidence of stomach cancer in Korea is gradually decreasing, potentially due to shifts in dietary habits – a move towards increased protein and fat intake and a reduction in salted or burnt foods. Increased eradication treatment for Helicobacter pylori is also playing a role.
Early-stage stomach cancer often presents with no specific or mild symptoms, making detection challenging. Even as the cancer progresses, symptoms may be subtle. This is why regular checkups are so important.
As the tumor grows, symptoms like indigestion, abdominal pain, heartburn, vomiting, black stools, and weight loss may appear. However, these symptoms are also common in benign conditions like gastritis and stomach ulcers, leading to potential misdiagnosis or delayed treatment.
Gastroscopy remains the most accurate method for diagnosing stomach cancer, allowing for direct visualization of the stomach lining and biopsy of suspicious lesions. While gastrointestinal angiography is an option, gastroscopy is essential when cancer is suspected.
Remarkably, 70-80% of patients identified through stomach cancer screening are diagnosed with early-stage cancer. 90% of stage 1 stomach cancer cases are detected through screening, demonstrating the effectiveness of early detection and the potential for complete cure through endoscopic treatment and surgery.
The national cancer screening program recommends gastroscopy every two years for individuals between the ages of 40 and 74. However, high-risk groups – those with atrophic gastritis and intestinal metaplasia, a family history of stomach cancer, or Helicobacter pylori infection – should consider annual screenings.
How to prevent and treat
Prevention is paramount. A balanced diet rich in nutrients, with a preference for bland foods, is recommended. Limiting consumption of blackened or salt-pickled meats and incorporating fresh fruits and vegetables are also beneficial. Individuals over 40 should undergo gastroscopy even in the absence of symptoms, given the increased incidence of stomach cancer with age.
Treatment options vary depending on the stage of cancer and may include endoscopic treatment, surgery, chemotherapy, and radiation therapy. Early gastric cancer is often treated with ‘endoscopic submucosal dissection,’ a minimally invasive procedure that removes only the tumor area through an endoscope. This approach offers advantages such as reduced pain, faster recovery, and preservation of stomach function, but is limited to early-stage cancers with a low risk of metastasis.
For advanced gastric cancer, a combination of surgery and chemotherapy is typically employed. If complete resection is possible during surgery, chemotherapy may be administered post-operatively, depending on the stage. In cases where surgery is not feasible or distant metastasis has occurred, chemotherapy is the primary treatment modality.
Stomach cancer surgery involves removing part or all of the stomach, along with surrounding lymph nodes. Minimally invasive techniques, such as laparoscopic and robotic surgery, are increasingly used to reduce pain, shorten recovery times, and improve patients’ quality of life. However, given the high risk of recurrence associated with advanced stomach cancer, early detection and treatment remain the most effective strategies.
