The Surprising History, Causes, and Importance of Stomach Cancer

Stomach cancer is a type of cancer that can develop in any part of the stomach, an organ of the digestive system. The first description of stomach cancer was found in Avicenna's Medical Encyclopedia, but stomach cancer was not well understood until the middle of the 19th century. The historical mystery behind the death of the famous French emperor Napoleon Bonapartein 1821 would not be solved until J. Cruveilhier described benign and malignant stomach ulcers in 1835.

Napoleon Bonaparte suffered abdominal pain of unknown origin… After his defeat at Waterloo, the French emperor was exiled to St. Helena, a small island in the Atlantic Ocean. Recurrent attacks of fever, abdominal pain, persistent hiccups, and vomiting began 2 years before his death. Attempts were made to treat him with large amounts of emetic tartar (potassium antimony tartrate) and calomel, a purgative mercury mineral also known as sweet sublimate. His complaints progressively worsened: he vomited almost every day, experienced intermittent constipation, diarrhea, and fever attacks, and his abdominal pain became more severe and prolonged, while his fatigue increased steadily. On 27 April 1821, he vomited material resembling coffee grounds, after which his condition rapidly deteriorated. Before his death, he made the following request to his doctor: “…I ask you to open my body to examine my stomach and prepare a detailed report to be given to my son.” Bonaparte knew that his father and some relatives had died from stomach diseases and was worried for his son. Today, only about %10 of stomach cancers are known to be associated with familial predisposition. On 2 May, when vomiting resumed, he was given the purgative calomel; 5 hours later, severe bowel movements and tar-colored stool were followed by circulatory collapse (a sudden reduction in blood circulation), profuse sweating, and a rapid pulse. He died 2 days later.

Stomach cancer accounts for approximately %10 of cancers worldwide. It ranks 2nd after lung cancer in cancer-related deaths, with approximately 700.000 thousand people dying from it each year. Its incidence varies according to dietary habits. In America, 5 new stomach cancers occur annually per hundred thousand people, while in Japan the figure exceeds 60 per hundred thousand. Japan and South Korea are the 2 countries with the highest stomach cancer incidence. Incidence has decreased over the last 20 years. The reasons include increased consumption of fresh fruit and vegetables, safer food storage (refrigeration instead of salting and smoking), and reduced Helicobacter pylori infection. According to 2010 data from our country, its incidence among cancer types is %16,2 in men and %8.1 in women. Worldwide, as in our country, it is 2 times more common in men than women. Stomach cancer incidence also increases with age.

Stomach cancer may cause no symptoms early on. However, burning and pain in the upper abdomen, nausea, and loss of appetite are possible early signs and symptoms. As the disease progresses, weight loss, difficulty swallowing, vomiting, and iron deficiency anemia are expected to develop. The disease may spread from the stomach to other parts of the body, particularly the liver, lungs, bones, and abdominal lymph nodes, through metastasis .

Tumors arising from the stomach originate from glandular epithelium in %95 of cases and are called adenocarcinomas . Other rare malignant stomach tumors include gastric lymphoma and gastrointestinal stromal tumors. In this article, stomach cancer and gastric adenocarcinoma are used synonymously.

What causes stomach cancer?

The 3 most common causes of stomach cancer are Helicobacter pilori (H. pilori) infection, smoking, and consumption of preserved foods (pickled, salted, smoked). The Mediterranean diet, like quitting smoking , reduces stomach cancer risk.

The graph above shows the relationship between salt intake and stomach cancer. As salt intake increases, stomach cancer mortality rates rise (right). The most important cause of stomach cancer is infection with a bacterium called Helicobacter pilori. High salt intake is known to facilitate its colonization of the stomach and may worsen the infection.

H. pilori, is the main cause of stomach ulcers and cancer. Stomach ulcers and related conditions cost approximately 6 billion dollars annually in America alone. H. pilori is a bacterium that colonizes various areas of the stomach and duodenum. By causing chronic infection where it settles, it can lead to ulcers and cancer. It is very common in society: more than % 50 of people worldwide carry H. pilori in the upper gastrointestinal tract. However, more than % 80 of infected people show no symptoms of disease. Identifying who will develop symptoms is a major research topic. A range of host factors and factors related to the bacterium's ability to cause disease act together to identify individuals at the highest risk of disease. These include changes in host genes responsible for regulating the immune response and bacterial products. H. pilori infection is declining in developed countries.

Helicobacter pilori was discovered relatively late compared with other microorganisms, in 1982. The discovery by Barry Marshall and Robin Warren is considered one of the most important of the century and earned them the Nobel Prize in Medicine in 2005. Before then, smoking, alcohol, caffeine, acidic drinks, spicy foods, and stress were believed to cause ulcers. Earlier treatments reduced symptoms but offered no permanent solution because they did not eliminate the infection. Today, H. pilori can be treated with a combination of appropriate antibiotics and drugs that suppress stomach acid.

Causes of H. pilori infection include unclean water sources, low socioeconomic conditions, crowded family environments, and parents infected with this bacterium. H. pilori infection is declining in developed countries. Recent studies have focused on its transmission through unclean water by forming biofilms. A biofilm is a cluster of microorganisms whose cells adhere to one another or to their surface.

More recently, in addition to H. pilori, a virus called Ebstein-Barr (EBV) has also been associated with stomach cancer. EBV is thought to account for approximately %10 of all stomach cancers.

Related Topic:

- Stomach Cancer Symptoms, Stages, and Treatment