Stomach cancer spread means that the tumor has “seeded” to other parts of your body.
These “secondary’s” can go absolutely anywhere and it depends on where they are as to the sort of symptoms you may experience.
I would like to concentrate on four areas of spread which are the liver, bone, abdomen, lung and brain.
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If the tumor deposits in the liver, initially you are unlikely to have symptoms at all or may just feel tired.
As the deposit grows and further ones occur, you may experience discomfort usually in the right upper portion of your abdomen and possibly between your shoulder blades.
You may start to become jaundiced or turn yellow in color as the liver becomes unable to handle bilirubin, the break down product of blood cells.
Stomach cancer spread to the lymph glands may compress on the tube that drains bile from the liver (known as the common bile duct) resulting in further jaundice.
Complications from becoming jaundiced include itching, bleeding and confusion.
If you develop any of these symptoms, there are things that can be done. These may include:
Itching occurs because of excessive bile salts. These can be treated with antihistamine drugs which block the release of histamine, an inflammatory mediator.
Cholestyramine is a drug that binds bile salts and can help with the itching in some cases. It comes as a powder that is mixed in water.
Ultimately the best way of relieving itching is to relieve the jaundice itself.
The main way of doing this is through placing a stent in the common bile duct using a technique known as ERCP or endoscopic retrograde cholangiopancreatography.
ERCP is performed under sedation by an experienced endoscopist with the guidance of x-ray.
This technique is only possible if there is a narrowing or stricture of the common bile duct.
If this is not possible, jaundice can also be relieved by interventional radiologists who, with the guidance of x-ray or ultrasound can place a tube through the skin and in to the ductal system.
This is known as PTC or percutaneous transcutaneous cholangiography.
Bleeding can occur for three main reasons.
Firstly, the cancer can cause the liver to fail.
One very important job of the liver is the manufacturing of your clotting factors required for you blood to clot. If the liver fails these factors aren't produced and bleeding can occur.
If the liver fails, toxins that normally are broken down in the liver can have an affect on the bone marrow, the part of your body that produces blood cells including platelets.
Platelets are an important part of the blood clotting process. Lack of them or dysfunctional cells will cause bleeding to occur.
Secondly, if the cancer spreads to the bones the manufacture of platelets can be affected directly.
Finally, vitamin K is an important vitamin in the production of the clotting factors D,E,A and K. If you malabsorb the vitamin these factors aren't produced and bleeding will ensue.
Replacement of vitamin K by injection may help. If bone metastases are present, sometimes radiotherapy can help.
Supportive replacement of platelets is occasionally given if bleeding is occurring due to stomach cancer spread.
Bone metastases occur when stomach cancer spread to the bone has occurred.
When these occur they can cause problems including:
Pain is a common symptom of bone metastases. It is normally dealt with by painkillers including NSAID's or Non-Steroidal Anti-Inflammatory drugs such as Ibuprofen and morphine derivatives.
Radiotherapy is an option too as it can shrink the tumors present and relieve pain.
Because the bone becomes fragile, fractures or broken bones can occur.
The common areas of breakage include the spine, hips and ribs although any bone can be affected.
If this happens, there are various options and your doctor will be able to advise should this happen.
Raised calcium levels can occur in stomach cancer spread and may be asymptomatic, but they can also cause symptoms in you.
It is caused either because of bone metastases or through a PTH like hormone produced by the tumor.
PTH or Parathormone is normally produced by the parathyroid glands in your neck. They normally regulate the bodies calcium levels.
A PTH like hormone mimics the normal PTH, raising the calcium levels in your blood.
If this happens, hypercalcaemia ensues and can cause symptoms of increased urination, thirst and need to drink more fluids.
Dehydration can result if fluid isn't replaced.
This can make you feel dizzy, your blood pressure can lower and make you more at risk of falls or collapses.
The main treatment for this condition is rehydration either through drinking more if possible or through the use of drips or infusion in a health care setting.
Drugs known as bisphosphonates are used once hydrated to keep your calcium levels down. The common ones are Pamidronate and Risedronate.
Stomach cancer spread to the abdominal cavity may create problems in one of two ways:
The main complication from abdominal metastases is compression and pain in some cases.
Compression on to your bowel can result in a blockage and constipation is common.
If the blockage is complete, you will need specialist care for this although it is relatively unusual.
Ascites or fluid in the abdomen cavity is common in the later stages of the disease.
It normally occurs when there is stomach cancer spread to the liver and you will notice that you are becoming more bloated or distended in the abdomen or tummy.
The abdomen can hold many litres of fluid and it usually isn't evident until a large volume has accumulated.
The treatment for this may be in 2 forms:
Lung metastases occur with a wide variety of tumors including those from the stomach.
When this occurs, the most common symptom is increasing breathlessness and there are 2 main reasons for this:
It is inevitable that as the number of tumor deposits increase in numbers and in volume, you will become more breathless. This tends to occur in the later stages of your disease, although may not be an issue.
There are various options for this including the use of chemotherapy, steroids and oxygen.
Drugs that reduce the sense of breathlessness may be given to you including morphine derivatives and benzodiazepine drugs similar to Valium.
Sometimes fluid builds up in between the two membranes of the lung surface known as the pleura.
If this occurs, as a result of stomach cancer spread, many litres of fluid can build up. Your doctor will be able to help you with this by arranging for you to have either:
Pleural aspiration involves the insertion of a needle through your chest wall under local anesthesia usually.
A syringe is attached and your doctor will aspirate or remove fluid through this.
This method is an easy way of removing fluid, but it can take some time if there is a lot of fluid present.
As an alternative, you may be offered pleural drainage through the insertion of a chest drain tube.
This is a more complex procedure and can be either a temporary way of dealing with your effusion or a longer term solution.
Some drains are left in place as effusions can recur quite quickly in some people.
An alternative approach is to perform a pleurodesis. This is a procedure that involves passing a chemical irritant through the chest drain tube.
This results in localised inflammation and the 2 pleural membranes stick together, preventing fluid to build up in the space.
Commonly used irritants are talc and tetracycline (an antibiotic).
This can be initially uncomfortable and if this is the case you will be offered pain relief from your doctor.
If it does occur, you may notice no symptoms at all or might develop symptoms including headaches, neurological problems similar to a stroke and confusion.
Ultimately this condition is incurable, but you will likely be offered either radiotherapy and steroids for this.
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