| ICD-9-CM: |
| 151 - | Malignant Neoplasm of Stomach |
| 151.0 - | Neoplasm, Cardia, Malignant; Cardiac Orifice; Cardio-esophageal Junction |
| 151.1 - | Neoplasm, Pylorus, Malignant; Prepylorus; Pyloric Canal |
| 151.2 - | Neoplasm, Pyloric Antrum, Malignant ; Antrum of Stomach NOS |
| 151.3 - | Neoplasm, Fundus of Stomach, Malignant |
| 151.4 - | Neoplasm, Body of Stomach, Malignant |
| 151.5 - | Neoplasm, Lesser Curvature, Unspecified, Malignant |
| 151.6 - | Neoplasm, Greater Curvature, Unspecified, Malignant |
| 151.8 - | Neoplasm, Other Specified Sites of Stomach, Malignant |
| 151.9 - | Cancer, Stomach, Unspecified Site; Carcinoma Ventriculi, Gastric Cancer |
| 197.8 - | Secondary Malignant Neoplasm of Respiratory and Digestive Systems; Other Digestive Organs and Spleen |
| 230.2 - | Carcinoma in Situ of Stomach |
| 235.2 - | Neoplasm of Uncertain Behavior of Stomach, Intestines and Rectum |
| 235.5 - | Neoplasm of Uncertain Behavior of Other and Unspecified Digestive Organs; Anal, Canal, Sphincter; Anus NOS; Esophagus; Pancreas; Spleen |
| Stomach cancer, also called gastric cancer, occurs when cancerous cells develop in any part of the stomach. The stomach is made up of five layers, most cancers originate in the inner, or mucosal, layer of the stomach (adenocarcinomas). Other, much less common cancers of the stomach are lymphomas, leiomyosarcomas, gastric stromal tumor, carcinoid and adenoacanthomas. Stomach cancer can rarely be the result of cancerous cells spreading (metastasizing) from cancer in another part of the body.
Stomach cancer appears to be linked to the presence of Helicobacter pylori infection. Prolonged infection by this bacterium can lead to inflammation of the lining of the stomach. The bacterium is thought to cause damage and precancerous changes to the mucosal cells. Many people who have H. pylori in their stomach do not develop stomach cancer.
Both cure and survival rates are heavily dependent on the stage at which stomach cancer is discovered. Since early symptoms are few or absent, many stomach cancers are not discovered until they reach an advanced stage.
Conditions that increase the risk of getting stomach cancer include prior stomach surgery; stomach inflammation; ulcers; or any condition that lowers the acidity of the stomach, such as pernicious anemia, achlorhydria, and atrophic gastritis.Risk: Some individuals are at higher risk for developing stomach cancer than others. The risk of contracting stomach cancer increases sharply after age 50. Most stomach cancers are diagnosed in individuals in their 60s and 70s. The disease is almost twice as common in men as in women, and there are substantial rate differences in racial and ethnic populations. In the US, the rate is highest among individuals of Asian or Pacific Islander descent, followed by Hispanics and blacks. Non-Hispanic whites have the lowest rate of stomach cancer ("Overview").
Lifestyle choices also appear to affect the rate of stomach cancer. Researchers believe that diets high in foods that are pickled or preserved by drying, salting, or smoking (all of which cause an increase in nitrates), may play a role in the development of stomach cancer. Exposure to certain dusts and fumes in the workplace and smoking have also been linked to a higher-than-average risk of stomach cancer. Patients with gastritis, family history and blood type A are also at risk for developing stomach cancer. Smoking tobacco doubles the risk of an individual developing stomach cancer ("Overview"). Incidence and Prevalence: In the US, the American Cancer Society estimates that about 21,860 individuals will be diagnosed with stomach cancer in 2005, and about 11,500 people will die from the disease ("Detailed Guide"). In the 1930s, stomach cancer was the leading cause of cancer deaths in the US. Today, the rate of stomach cancer has decreased by about 75%, possibly due to changes in the way food is preserved and the increased use of antibiotics that destroy H. pylori ("Detailed Guide"). Stomach cancer is more common in other parts of the world than in the US. Japan leads the world in stomach cancers diagnosed. In Japan, the disease is so common that the health system has instituted early screening procedures to catch the cancer in its early stages. |
Source: Medical Disability Advisor
| History: Stomach cancer is hard to detect in its early stages, because often signs and symptoms are nonexistent, nonspecific, or mimic other digestive conditions, such as an ulcer. The most common early symptoms are indigestion or heartburn; abdominal pain or discomfort; nausea, vomiting, constipation, or diarrhea; occasional belching; a feeling of fullness even after a small meal; loss of appetite; weakness; and fatigue. Less common symptoms are anemia and weight loss. Symptoms of advanced cancer include acute upper abdominal pain, blood in the stool or the vomitus, extreme weight loss, a palpable abdominal mass, accumulation of fluid in the abdomen (ascites), yellowish appearance of the skin (jaundice), and extreme malnutrition (cachexia). Physical exam: Initially, the physician will palpate the body to feel for enlarged masses in the abdominal cavity, an enlarged liver and for enlarged lymph nodes. Enlarged lymph nodes, especially in the area of the left collarbone and left armpit, may represent a sign of spreading cancer (metastasis). A rectal exam to test for masses or other abnormal formations in the lower colon may be done to check for spread into the pelvis. Tests: An endoscopy is the main procedure used to diagnose stomach cancer. Tissue biopsies are taken during the endoscopy for microscopic examination. X-rays may be taken of the upper gastrointestinal (GI) tract after the individual has swallowed a barium solution (upper GI series). The barium solution outlines the stomach on the x-rays, making it easier for the doctor to detect tumors or other abnormal areas. CT scans produce pictures of the stomach that can pinpoint the cancer to guide needle biopsy. CT and MRI scans are used to look for metastases especially to the liver. An endoscopic ultrasound helps to determine how far the cancer has spread into the wall of the stomach or surrounding organs. A fecal occult blood test is performed. Other tests may be ordered based on the findings of the endoscopy and imaging scans. Other tests such as chest x-ray (CXR) to look for lung metastasis, laparoscopy, complete blood count (CBC), liver function tests (LFTs) may also be indicated. |
Source: Medical Disability Advisor
| Treatment for stomach cancer depends on the stage and location of the cancer. Since stomach cancer is normally a disease of older individuals, the person's general health is also a consideration in developing a treatment plan. There are several ways of staging stomach cancer, but in general, the stages of stomach cancer are as follows: stage 0, in which cancer is confined to the inner lining of the stomach (mucosa), and no lymph node involvement and no metastasis have occurred; stage I, in which cancer has spread to, but not through, the membrane that lines the abdominal cavity; stage II, in which cancer has penetrated the membrane that lines the abdominal cavity but has not spread to adjacent organs; stage III, in which cancer involves nearby organs and possibly has spread to lymph nodes; and stage IV, in which cancer has metastasized to distant organs, tissues, or lymph nodes.
Treatment with surgery is most often used in stages 0 to III of the disease. The most common surgical procedure is removal of part or all of the stomach (subtotal, partial, or total gastrectomy). During a subtotal or partial gastrectomy, a surgeon removes part of the stomach and then connects the remaining stomach portion to the esophagus or small intestine. A total gastrectomy removes the entire stomach, along with some of the tissue around the stomach and the lymph nodes near the tumor. After a total gastrectomy, the surgeon connects the esophagus directly to the small intestine. The extent of the gastrectomy is contingent on the stage of the disease.
Anticancer drugs (chemotherapy) are referred to as systemic therapy, because the drugs taken orally, by injection, or intravenously (via IV) enter the bloodstream and travel throughout the body. In cases of advanced stomach cancer, chemotherapy is used in combination with surgery and radiation to provide temporary relief by slowing tumor growth.
Radiation therapy uses high-energy x-rays to damage cancer cells and slow their growth. Local radiation therapy affects only the cancer cells in the area treated and, when used after surgery, helps destroy any remaining cancer cells. Radiation therapy may also be used to relieve pain or blockage and to treat cancers that cause chronic bleeding. |
Source: Medical Disability Advisor
| The most significant predictors of outcome are the stage of the cancer at the time of diagnosis, the location of the tumor, and the type of surgery that can be performed. The American Cancer Society estimates 5-year survival rates in the US as follows: stage 0: 89%; stage I: 58% to 78%; stage II: 34%; stage III: 8% to 20%; stage IV: 7%. The overall 5-year survival rate is estimated to be 22% ("Detailed Guide"). Many individuals with stage 0 or I cancer can be successfully treated surgically, but they will need to make lifestyle adjustments, including altering the size, content, and frequency of meals. |
Source: Medical Disability Advisor
| The frequency and duration of the rehabilitation program will vary among individuals with stomach cancer. Individuals recovering from stomach cancer may benefit from four types of rehabilitation. Supportive rehabilitation allows the individual to gain some control over the ordinary activities of life and to cope emotionally. Vocational rehabilitation eases the transition back into the workplace. Palliative rehabilitation allows individuals in advanced stages of the disease to achieve some level of physical comfort. Physical rehabilitation allows individuals to regain strength and stamina lost due to the disease process and during treatment of the disease. |
Source: Medical Disability Advisor
| Complications arise when the tumor spreads (metastasizes) to other tissue or adjoining organs. In stomach cancer, a common route of spread is through the lymphatic system. The cancer extends to regional nodes around the stomach and/or to distant ones, such as those near the base of the neck. The tumor may also penetrate the stomach wall and invade the membrane that lines the abdominal cavity, spreading to adjoining organs of the digestive tract. Organs frequently affected are the pancreas, spleen, esophagus, intestines, and liver. Cancer cells may also spread to more distant sites via the bloodstream. After surgery, the individual may experience abdominal pain especially after eating. Vitamin supplements are required for those vitamins which the stomach helps absorb. Radiation therapy can lead to the following side effects: minor skin problems, upset stomach, emesis, diarrhea, and low energy. Chemotherapy can lead to the following side effects: upset stomach, emesis, poor appetite, hair loss, diarrhea, mouth sores, decreased blood cell counts, infections, hemorrhage or bruising after mild scrapes or injuries and difficulty breathing. |
Source: Medical Disability Advisor
| The treatment and the disease itself may weaken the individual and severely limit his or her ability to return to previous work activities. The individual may be able to work a limited number of hours per day or days per week, and duties may need to be largely sedentary. Because of the rigors of the disease and treatment, the individual may need a place at work where he or she may periodically rest. Some individuals undergoing chemotherapy and/or radiation may require additional leave from work. Because of diminished stomach capacity, provisions will have to be made for the individual to eat several small meals during work hours. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual had previous stomach surgery?
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Did individual have previous stomach irritation or ulcers caused by Helicobacter pylori infections? Any conditions that reduce stomach acidity?
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Does individual take vitamin C?
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Is cancer present elsewhere in the body?
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Does individual have heartburn? Nausea? Vomiting? Belching? Constipation or diarrhea? Blood in the stool?
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Does individual have abdominal pain or discomfort? Loss of appetite? A feeling of fullness even after a small meal?
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Was there an unexplained weight loss?
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Did physical exam reveal a palpable abdominal mass? Ascites? Jaundice?
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Does individual appear malnourished?
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Were x-rays, fecal occult blood test, endoscopy, and an upper GI series done? Biopsy with the endoscopy? CT or ultrasound?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Was individual's cancer operable?
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Was a subtotal, partial, or total gastrectomy done? A palliative total gastrectomy?
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Is individual on chemotherapy? Radiation therapy?
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Secondary to the stress, shock, and uncertainty of the disease, is individual seeing a mental health specialist?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that could affect recovery?
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What stage was the cancer in when diagnosed?
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Does individual have metastatic disease?
|
Source: Medical Disability Advisor
| "Detailed Guide: Stomach Cancer." American Cancer Society. 1 Feb. 2005 <http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=40>. "Overview: Stomach Cancer." American Cancer Society. 15 Sep. 2004 <http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_stomach_cancer_40.asp?rnav=cri>. |
Source: Medical Disability Advisor
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