TUMMY ACHES COULD BE A SYMPTOM OF STOMACH CANCER

By Sakina Mohamed

PETALING JAYA (Malaysia), Nov 16 (Bernama) -- Nora, 47, has been feeling this
acute pain in her stomach for the past six months. She has been dismissing it as
just “angin” (bloatedness) but lately, the medicinal oils she has been depending
for relief seems to have little effect.

Gary, 53, has been complaining of frequent attacks of gastric pain in the past
month. When he goes to the clinic, the doctor tells him he has gastritis, and
prescribes some pills to ease the pain. The doctor also advises him to not skip
meals.

“But I don’t understand it,” says Gary. “I eat regularly and never skip meals.”

It may be hard to believe but the symptoms in Nora and Gary could
potentially be the early indications of stomach cancer.

Dr Ramesh Gurunathan, a General and Upper Gastrointestinal Surgeon at the Sunway
Medical Centre, notes that cases of stomach cancer have actually doubled in
Malaysia from 700 in 1997 contrary to decreasing incidences worldwide.

“There is indeed reason for worry,” he says to Bernama at the recent 3rd Asia
Pacific Gastroesophageal Cancer Congress at the Sunway Medical Centre.

SYMPTOMS

Stomach cancer is the number seven most common cancer among males in Malaysia,
and the tenth for women.

Dr Gurunathan says yet many Malaysians are still unaware of its symptoms. This
is because they often dismiss them as a normal stomach ache caused by irregular
eating hours or poor eating habits.

He says those at Stage 1 or Stage 2 of stomach cancer may experience the
following symptoms, which are not too different from normal stomach pain:

· Indigestion or stomach discomfort

· A bloated sensation, particularly after eating

· Early satiety, where a person feels full after eating only a small amount
of food

· Heartburn

· Mild nausea

However, he says, many experience very few of these symptoms in the early
stages. The symptoms in the later stages of the cancer are more obvious, such as
blackish stool, which indicate bleeding in the stomach, weight loss, appetite
loss, lethargy, frequent vomiting or vomiting blood.

“Sadly, these extreme symptoms are the ones that finally forces patients to go
to the hospital to seek treatment,” says Dr Ragunathan. “By then, it may be too
late.”

H. PYLORI INFECTION

The exact cause of stomach cancer is unknown, but some factors can
increase the risk of getting the cancer.

Studies have found the presence of the bacteria Helicobacter Pylori, or
H.Pylori, in 70-90 per cent of the patients with stomach cancer.

These bacteria can act as a carcinogen that can eventually lead to stomach
cancer, says Dr Ragunathan. However, not everyone infected will end up with
cancer.

He notes an interesting finding of a research in Malaysia which shows more
Indians infected with H. Pylori compared with the Chinese, yet more Chinese
suffer from stomach cancer.

Dr Ragunathan says the early symptoms of H. Pylori infection are almost similar
to that of stomach cancer, and sometimes patients are treated using
over-the-counter medication.

“But if you have recurrent attacks of symptoms despite being on medication, you
need to go to a hospital and get yourself checked,” he says.

A routine blood test can determine if one is infected by H. Pylori.
Treatment can be as simple as a week’s dosage of antibiotics, he says.

Will there be recurrent infections? Probably, says the doctor, but chances are
very slim.

GENETICS

Studies show ethnicity and genetics also seem to play quite a significant part
in determining who is more pre-disposed to getting the cancer.

Statistics by the National Cancer Institute in 2006 reveal that the Chinese make
up 61.7 per cent of stomach cancer patients, followed by the Malays (25.9 per
cent) and Indians (12.4 per cent).

“We have tried to find a correlation between the types of diet exclusive to an
ethnic group and other possible factors, but due to the melting pot that is
Malaysia, the results were rather inconclusive,” he says.

LAY OFF RAW FOOD

Interestingly, prolonged ingestion of raw foods can increase the risk of getting
the cancer. This finding disputes the belief of some health advocates, which
advocates raw food as the healthier alternative to cooked foods.

“Raw foods have been cited as one of the reasons why Japan has higher incidences
of stomach cancer,” says Dr Ragunathan.

“I’m not saying you can’t eat sushi at all, but perhaps it can be limited to
once a month.”

Besides that, a diet of salt-cured, smoked, pickled or preserved foods, which
are very common in countries like China, Korea and Japan, have also been
associated with an increased risk of stomach cancer.

Obesity, aging and bad habits such as cigarette smoking and regular
alcohol consumption are also cited as contributing factors for stomach
cancer.

In Japan, where the incidence of stomach cancer is very high, mass screening is
carried out for anyone above 40.

“However, it is not feasible in Malaysia because incidences
aren’t as high as Japan’s and will not be as cost-effective,” says Dr
Ragunathan.

DIAGNOSING AND TREATMENT

He says detecting stomach cancer can be done through an endoscopy. This is where
a tube with a video lense at its tip is inserted into the stomach cavity via the
mouth.

The endoscopist can examine the entire stomach wall visually and take tissue
samples of suspicious areas to determine the presence of cancer cells, if any.

He says in government hospitals, endoscopies can be done at the
heavily-subsidised price of RM20 (about US$7).

However, he says, sometimes doctors are keen to treat with just medication alone.

Therefore, he says, if a patient is over 45, has family history of stomach
cancer and has been suffering of the symptoms for some time, they should relay
this to the doctor and ask: “Should I have an endoscopy done?”

If stomach cancer is detected while it is still at stage 1, surgery may not even
be required to remove the tumour, says Dr Ragunathan.

“It can be removed through endoscopy, and for stage 2, a surgery called
gastractomy may be required,” he says.

The procedure involves removing from half to the entire stomach,
depending on the location of the tumour. This may be followed by chemotherapy or
radiotherapy.

Can a person live without his stomach? Surprisingly, the doctor says yes.

“They can still enjoy a reasonably good life. The only problem is
that they may have to eat six or seven small meals instead of two or three large
meals as there is no place - or for those who have their stomachs partially removed
- limited space to hold the food,” he says.

However, stage 3 and 4 may be more difficult to treat, he says.

“Treatment would be more to palliative care, radiotherapy and chemotherapy. So
do your screening early if you suspect something amiss. It can be treated if
detected early enough.”

Dr Gurunathan is the organising chairman for the two day Congress begining Nov
10 organised by The Malaysian Upper Gastrointestinal Surgical Club and the
College of Surgeons. Well known foreign and local specialists attended and spoke
at the Congress, which discussed topics pertaining to upper gastro intestinal
surgery, a fairly new and rapidly progressing subspeciality in Malaysia.
-- BERNAMA