Stomach Cancer: Are You at Risk?

By Robynne K. Chutkan, MD, FASGE Assistant Professor of Medicine, Georgetown University Hospital Founder and Medical Director, Digestive Center for Women

Stomach Cancer: Are You at Risk?

In order to find a cure for cancer, we need to find out what causes it. It would be nice if that cause were something simple, like a chemical in the environment we're inadvertently exposed to, a vitamin deficiency, a bacterial infection, a lifestyle factor like smoking, or a gene we inherit from our parents. The reality is most cancers are probably caused by a combination of all of the above: genetic predisposition, toxic exposure, suboptimal nutrition, and infectious agents. And that's just the stuff we know about.

Identifying the Causes

Stomach cancer is the second leading cause of cancer deaths worldwide and a prime example of a cancer with many causes. Infection with the bacteria Helicobacter pylori (H pylori) is the main risk factor for developing stomach cancer. The interesting thing about H pylori is that although more than half the world's population is infected with it, only a small percentage will develop symptoms, which include stomach ulcers, abdominal pain and stomach cancer.

Nitrates and nitrites in smoked and preserved meats can form compounds called nitrosamines. Animal studies show that consuming large amounts of these substances over time can lead to cancer. In addition to avoiding large amounts of processed meats, maximizing your intake of fruits and vegetables that contain cancer-preventing phytonutrients is also a critical part of decreasing your risk for stomach cancer. Lifestyle factors such as smoking and heavy alcohol consumption are risk factors for most forms of cancer and stomach cancer is no exception.

Most cases of stomach cancer are sporadic, meaning that they don't occur as a result of inherited genes. However, in a small percentage, stomach cancer is associated with a genetic abnormality on chromosome 16; for family members unlucky enough to inherit that particular gene (the CDH1 gene), the lifetime risk for developing stomach cancer is 70%. For people with a strong family history of stomach cancer who test positive for the gene, preventative removal of the stomach is a drastic but reasonable option. 

Practicing Prevention 

What can we do to minimize our risk for developing this deadly cancer?

  • If you have multiple family members with stomach cancer, consider getting genetic testing.
  • Eat a mostly plant-based diet consisting of deeply pigmented fruits and vegetables. Avoid excessive consumption of smoked or preserved meats.
  • Limit alcohol and avoid tobacco.
  • If you have symptoms such as abdominal pain, blood in the stool, anemia, feeling full faster, nausea, vomiting or unexplained weight loss, seek medical attention from a gastroenterologist who will examine the inside of your stomach with an instrument called an endoscope – the best way to diagnose stomach cancer. 

Your Parent Has Dementia: What to Talk to Their Doctor About

Make sure all their doctors are aware of all the medications she is taking.

Q: My mom is 94 and has dementia. She is taking a whole medicine cabinet-full of medications and I think they actually make her fuzzier. How should I talk to her various doctors about what she is taking and if she can get off some of the meds? — Gary R., Denver, Colorado

A: Many dementia patients are taking what docs call a "polypharmacy" — three or more medications that affect their central nervous system. And we really don't know how that mixture truly affects each individual person.

A new study in JAMA Network that looked at more than 1 million Medicare patients found almost 14% of them were taking a potentially harmful mix of antidepressants, antipsychotics, antiepileptics, benzodiazepines such as Valium and Ativan, nonbenzodiazepine benzodiazepine receptor agonist hypnotics such as Ambien or Sonata, and opioids. And almost a third of those folks were taking five or more such medications. The most common medication combination included an antidepressant, an antiepileptic, and an antipsychotic. Gabapentin was the most common medication — often for off-label uses, such as to ease chronic pain or treat psychiatric disorders, according to the researchers from the University of Michigan.

Keep Reading Show less