Cancer of the stomach is the 11th most common and 8th most fatal cancer for Kiwis. In New Zealand, your chances of living five years after a stomach cancer diagnosis sit below 25%. In Australia, that rate is around 32%. The slightly better outcomes in Australia seem associated with faster access to comprehensive diagnostics and public funding of more effective drugs.
Stomach cancer (also known as gastric cancer) tends to affect people over 50. Māori and Pasifika are three times more likely than New Zealand Europeans to develop the disease, and it’s more common in men than in women.
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Cancer in the stomach begins when cells grow and divide abnormally. Early diagnosis and treatment are vital; however, early signs of the disease are often missed. Symptoms may resemble other issues, and there may be relatively few - or even none at all. Screening is a valuable diagnostic tool for those with no symptoms and a genetic predisposition towards stomach cancer.
Types of stomach cancer
The stomach is a muscular sac that digests and liquefies food for further processing in the bowel. Cancer can grow anywhere in the stomach, and there are several forms. The most common is known as adenocarcinoma, which accounts for around 95% of all stomach cancers in New Zealand.
Adenocarcinoma presents as two types:
Intestinal-type stomach cancer
Begins in the inner tissue of the stomach and makes up the majority of cases. Intestinal-type stomach cancer tends to be slightly easier to treat and has a better survival rate.
Hereditary diffuse stomach cancer
Also known as Hereditary Diffuse Gastric Cancer - (HDGC), this type is rare globally. It’s mostly triggered by a genetic mutation that runs through families.
This type tends to be more pervasive, aggressive, difficult to treat, and likely to return.
Maori are more at risk
Māori have a 62% risk of developing stomach cancer of any type (three times that of European New Zealanders). This higher risk is largely due to two factors:
- Helicobacter pylori (H. pylori) bacteria is known to increase the risk of stomach cancer. This bacteria is around five times more prevalent in Māori and Pasifika communities than in the New Zealand European population.
- Several Māori families carry a genetic mutation (CDH1), which can result in as many as 70% of people with this gene developing diffuse stomach cancer before 40. Females who carry this gene also have a 40% chance of developing breast cancer.
Stomach cancer symptoms
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The disease often shows no warning signs in its initial stages. Sometimes, stomach cancer symptoms appear but are ignored or mistaken for other issues.
So then, what are the symptoms of stomach cancer to look out for?
- Feeling full, even after a small meal
- Poor appetite and unexplained weight loss
- Unusual tiredness or weakness
- Pain or burning sensation in the abdomen
- Heartburn or indigestion
- Vomiting (blood in the vomit) or nausea
- Abdominal swelling
- Black-coloured faeces.
These stomach cancer signs do not always mean you have the disease, but still, have them checked by a doctor. Early diagnosis is key because the earlier you get treatment, the greater your chance of survival.
Stomach cancer diagnosis
Your doctor will perform a physical examination and take stool samples and blood tests. To confirm a stomach cancer diagnosis, an endoscopy (gastroscopy) will also be performed. This involves sending a tiny camera into the stomach to view any cellular changes. At the same time, the doctor may collect tissue samples for examination under a microscope (biopsy).
Further blood tests and scans, such as MRI, PET, or x-ray, will give your medical team a clearer idea of the cancer’s size and spread. In addition, you might need to undergo a laparoscopy - a procedure that closely examines tumours not visible on CT or PET scans. These tests are integral to developing your cancer treatment plan.
Unfortunately, New Zealand’s public health system is struggling with funding and staffing shortfalls. That means you could be waiting a long time for your diagnostic tests. Here are some maximum wait times for an MRI or CT scan (2021):
- 246 days for an MRI – Hutt Valley DHB
- 203 days for an MRI – Wairarapa DHB
- 93 days for a CT Scan – Whakatane Hospital
Stomach cancer staging
Your medical team will assign a stage classification to your tumour which indicates its size and spread. Staging is useful for mapping out a treatment plan.
- Stage I - Cancer cells have not spread beyond the stomach lining.
- Stage II - Cancer has moved deeper into the stomach.
- Stage III - Cancer is identified in neighbouring lymph nodes.
- Stage IV - Cancer is identified in distant parts of the body, such as the lungs, liver, or lymph nodes.
Stomach cancer treatment
The stage of your cancer, your age, general health, and personal preferences will guide doctors in formulating a treatment plan. Generally, treatment will include some or all of the following:
Surgery
Surgery is the most common stomach cancer treatment. Surgeons may only need to remove part of the stomach (partial gastrectomy), or if cancer has spread further, they may remove the entire stomach (total gastrectomy) and some lymph nodes. A gastrectomy is appropriate if cancer hasn’t spread to other organs in the body.
If the tumour is small enough, keyhole-type surgeries such as laparoscopy are possible. This involves inserting a fine tube with a video camera into the abdomen. The surgeon can then manipulate special instruments through the tube and perform microsurgeries.
A total gastrectomy is the standard treatment for hereditary diffuse stomach cancers.
Side effects:
- Tiredness
- Pain or discomfort
- Diarrhoea
- Loss of appetite and weight loss
Radiation therapy
High-energy, precision x-rays kill cancer cells on their own or in combination with surgery or chemotherapy. Radiation therapy helps reduce the size of tumours before surgery and also relieves pain and other symptoms.
Side effects:
- Tiredness
- Pain or burning sensation
- Weight loss
Chemotherapy
Chemotherapy uses powerful drugs to kill fast-growing cancer cells. Chemotherapy is widely used to treat stomach cancer. It may be used before surgery to reduce the tumour size, or after surgery to prevent the tumour returning. It’s also the first-choice treatment for those cancers that are too advanced to be surgically removed.
Side effects:
- Nausea, vomiting and weight loss
- Tiredness and unclear thinking
- Sore mouth or throat
- Taste changes and loss of appetite
What causes stomach cancer?
Although we don’t know for sure why someone might develop stomach cancer, certain factors might increase your risk:
- Smoking
- Alcohol consumption
- Obesity and poor diet
- Aged over 60
- Helicobacter pylori bacterial infection
- Family history of stomach cancer or a specific genetic mutation
- Pernicious anaemia or gastric-related medical conditions.
Stomach cancer survival rate
Five-year survival rates for this disease are low in New Zealand: around the 25% mark. The most critical factors affecting your survival rate are prompt diagnosis and early treatment.
If there is a history of stomach cancer or other gut problems in your family, get yourself checked out (even before symptoms appear). DNA testing for issues that contribute to the risk factors listed for stomach cancer is also an important step.
Are you prepared for life’s uncertainties?
ou might not have stomach cancer today, and it may not run in your family, but that’s no guarantee it won’t happen to you or someone you love.
Think about how health insurance can help you prepare for the possibility.
But not all health insurance plans are the same. Some plans will only pay for a tiny fraction of your cancer treatment cost.
Don’t let this happen to you. When buying health insurance, talk to a Policywise adviser about maximum benefit amounts for cancer treatments, non-Pharmac cover, inclusions, and any exclusions.
We provide clear, easy-to-understand plan comparisons from different insurers so you can choose the policy with the best cover. Our service is free - and it might just change your life for the better.