Introduction

Stomach cancer (gastric cancer) is the growth of abnormal cells within the stomach that grow and divide rapidly. The top of the stomach is connected to your food pipe (oesophagus), and the bottom is connected to the bowel.¹ Stomach cancer mainly develops in the stomach body, and this is a factor that health care providers consider when treating people for stomach cancer. Other factors include the cancer stage and the type of cells affected.²

Being diagnosed with stomach cancer can negatively impact one’s mental health, causing issues such as anxiety, stress or depression. Addressing the impacts of a cancer diagnosis and subsequent treatment is a pressing issue for modern medicine. This article explores the emotional, psychological and physical effects of stomach cancer.

Understanding stomach cancer

Types of stomach cancer

90-95% of diagnoses of stomach cancers are adenocarcinomas which form in the inner linings of the stomach and can be categorised into two variants: intestinal adenocarcinomas, which are usually more treatable as they grow at a slower rate, and diffuse adenocarcinomas, which is a rarer but more aggressive form of stomach cancer that grows at a faster rate, affecting predominantly young people. Due to its rapid growth, it tends to metastasise and spread to other body parts faster. 

Another rare form of adenocarcinoma is linitis plastica. This type of cancer spreads throughout the stomach and causes tissues to stiffen, and has likely spread to the lymph nodes by the time a diagnosis has been made. Linitis plastica accounts for 7-14% of stomach cancer cases and is usually difficult to treat. Other rare forms of stomach cancer include lymphomas, gastrointestinal stromal tumours, carcinoid tumours and hereditary (familial) diffuse gastric cancer.³

Common causes and risk factors

It is not fully known what causes stomach cancer, however, experts indicate that stomach cancer begins when the inside lining of the stomach is damaged. Examples of this may be having long-term acid reflux and eating large amounts of salty foods. Note that not everyone develops stomach cancer with these risk factors, and as a result, more research needs to be carried out to discern the biological causes of stomach cancer.¹ 

Many factors can increase the risk of stomach cancer, namely:

• Stomach acid comes up into the oesophagus over a long period of time. This is known as gastroesophageal reflux disease
• Eating salty foods
• A diet lacking in fruit and vegetables
• Helicobacter pylori bacterial infections
• Smoking
• Polyps – noncancerous growths in the stomach
• A hereditary history of stomach cancer 
• A history of genetic syndromes predisposing one to developing stomach cancer²

Symptoms and stage of the cancer

Symptoms of stomach cancer can include:

• Difficulty swallowing
• Abdominal pain
• Feeling bloated after eating
• Feeling full easily
• Lack of appetite despite not eating
• Heartburn
• Indigestion
• Nausea
• Vomiting
• Unexpected weight loss
• Fatigue
• Black stools

Treatment options

The type of treatment required for stomach cancer is contingent on where the cancer is in the stomach and which stage the cancer is at. When developing a treatment plan, your health care provider will consider important factors such as your overall health and preferences. The types of treatments one may undergo include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy and palliative care.^1,4

• Surgery: Various surgeries can be carried out, such as removing cells from the stomach lining, removing part of the stomach, removing the entire stomach and removing lymph nodes
• Chemotherapy: This drug treatment involves using chemicals to kill cancer cells. Types of chemotherapy include chemotherapy that travels through the whole body targeting cancer cells, which is taken intravenously or in the form of a pill, or chemotherapy that goes directly into the belly after surgery. The medicines are heated to increase their efficacy and then left for a set time before being drained
• Radiation therapy: This involves using high-powered energy beams to kill cancer cells. Radiotherapy can be combined with chemotherapy or used before surgery to shrink the cancer, making it easier to remove 
• Targeted therapy: This uses therapeutics specifically targeting chemicals present within the cancer cells. When these chemicals are blocked, the cancer cells die 
• Immunotherapy: This treatment utilises the immune system to kill cancer cells. The role of your body’s immune system is to kill germs and cells that have invaded the body. To survive, cancer cells hide from the immune system. Immunotherapeutic medicines are then used to help the immune system locate and kill the cancer cells

The psychological impact of stomach cancer

When receiving a cancer diagnosis, you may feel shock, anxiety, denial and fear. Your mental health will be negatively impacted, and therefore, it is essential not to neglect your mental health throughout your cancer journey, including during treatment. 

Studies have shown that ignoring your mental health while dealing with cancer can have extreme consequences, affecting the extent to which someone adheres to their treatment plan, their quality of life and their overall health outcomes.⁵ Ensuring that mental health resources are integrated into cancer care and treatment enables early recognition and intervention for people experiencing psychological distress.⁶ 

When mental support is offered to people who have received a cancer diagnosis, this provides a safe and supportive environment where people can freely discuss and explore their emotions. As a result, this can relieve feelings of isolation and depression.⁷ Some psychological effects individuals may experience when receiving a cancer diagnosis include:

• Anxiety: Individuals may experience anxiety due to anticipating going through treatment, which is often associated with worrying about any pain or side effects they may encounter during treatment. Additionally, individuals may be anxious about the prognosis of cancer due to how varied outcomes can be depending on the stage of cancer and the type of treatment they will be receiving⁸
• Depression and mood disorders: Individuals may experience feelings of hopelessness, lose interest in hobbies, changes in appetite and weight, disrupted sleep patterns, fatigue, difficulty concentrating and feeling suicidal.⁹ Additionally, the physical effects cancer can have on the body, such as pain and fatigue, can further emphasise the feelings of depression
• PTSD and cancer-related trauma: People diagnosed with cancer can develop PTSD from the trauma that stems from the diagnosis, invasive treatments, lengthy hospital stays or the fear of cancer recurrence. Additionally, the fear of death and uncertainty of the future can also cause PTSD in individuals with cancer¹¹

Coping strategies and mental health support

Protecting mental well-being is crucial in supporting individuals through their cancer journey. Practising coping mechanisms aimed at improving one’s mental health post-cancer diagnosis is an essential aspect of treatment:¹⁰

• Seeking emotional support: Ensuring you have a support system throughout cancer treatment and recovery is key to protecting your mental well-being. Your support system can consist of family, friends, and healthcare professionals such as counsellors
• Communication: Having honest conversations with your medical team allows them to have a better understanding of how to approach your cancer care, as they can address any mental health concerns and tailor your treatment plan accordingly
• Practising a positive mindset: Maintaining a positive outlook throughout treatment and recovery requires effort and practice. However, practising a positive outlook can positively impact your emotional and mental health. Activities include listing three things you are grateful for daily, journaling, and practising mindfulness
• Nutrition: Consulting a nutritionist to help maintain a balanced diet can positively impact your energy levels, mood and overall mental wellbeing
• Good sleeping patterns: Cancer treatment may disrupt one’s sleeping patterns, so prioritising your sleep is important. Limiting screen time, creating a calm environment, and meditation can all promote healthy sleeping habits¹²

Summary

Stomach (gastric) cancer alters the course of an individual's life once diagnosed, and following diagnosis, the focus is primarily centred on what stage the cancer is and the treatment you will undergo, such as surgery, chemotherapy, radiotherapy, immunotherapy and targeted therapy. Nevertheless, it is still important to emphasise the psychological impacts that receiving a diagnosis and enduring treatment and recovery have on people, too. People diagnosed with stomach cancer may experience psychological symptoms such as anxiety, depression and PTSD, all of which can be debilitating. 

Therefore, an individual's cancer treatment must integrate various coping mechanisms to preserve their mental well-being. Coping mechanisms such as support networks (family, friends, medical professionals), encouraging healthy communication of your emotions, practising a positive mindset and outlook and maintaining good nutrition and sleeping patterns are vital in protecting mental wellbeing throughout the treatment and recovery of stomach cancer. 

To conclude, when treating stomach cancer, we must also treat the minds of the afflicted individuals, providing patients with stomach cancer with the means to persevere throughout their treatment and recovery.