Stomach cancer is not uncommon, with around 15,000 new cases per year on the list of carcinomas. 9,300 men and 5,600 women are affected. The cause of the gender difference is currently unknown.

Stomach cancer is not one of the most common cancers, but the chances of survival are not good. Two thirds ultimately die of the tumor disease. “We have to assume that three out of four patients will only be diagnosed in a locally extended or even metastatic situation,” reports Michael Stahl, head of the Clinic for Internal Oncology at the Evangelical Clinics Essen-Mitte (KEM).

This late diagnosis means that three quarters of the patients have a poor prognosis and cannot be cured with an operation alone, summarizes the oncologist, who is among other things the author responsible for the German guideline for the diagnosis and treatment of esophageal cancer and a member of the lead group of the working group for internal oncology for carcinomas of the stomach and esophagus.

Cause of stomach cancer unknown but there are risk factors

“The only good relative risk factor for stomach cancer is the stomach germ Helicobacter pylori”, the expert clarifies. That would be risk factor number 1.

However, around a quarter of Germans are infected with this bacterium, but only a fraction of them develop gastric cancer. Why they get sick is not yet fully understood, just as much is still unknown about the causes of stomach cancer.

There is also evidence that smoking increases the risk. And what about alcohol? “However, there is no meaningful evidence that alcohol also increases the risk of stomach cancer,” adds the oncologist. However, it can lead to gastric mucosal inflammation, i.e. gastritis, up to and including gastric ulcer (ulcer).

Chronic gastric mucosal inflammation and reflux disease could in turn increase the risk of stomach cancer at the junction with the esophagus.

Stomach cancer can also develop from previous operations on the stomach.

The reflux of bile is also considered a risk factor. This danger arises from being very overweight.

And on the subject of obesity and nutrition: Scientists assume that a one-sided diet with a lot of processed meat products, heavily salted, but also smoked and grilled foods promote stomach cancer – keyword nitrosamines, which are known to be carcinogenic. Rotten and moldy foods pose a general health risk, also with regard to stomach cancer.

Stomach cancer with certain genetic changes

In addition, there are genetic components in the development of gastric cancer: first-degree relatives (children, siblings) of patients with gastric cancer have an increased risk – i.e. if the father, mother or sibling are ill. In addition, stomach cancer can occur if a certain form of colon cancer is already present (hereditary colorectal cancer) or breast cancer.

These are patients with changes in their genetic makeup, for example what is known as microsatellite instability (MSI). You are at an increased risk of various types of cancer, including cancer of the stomach and intestines. “Doctors should keep this in mind if a patient has a colon cancer with microsatellite instability , or if there are multiple carcinomas in the family,” emphasizes the Essen-based oncologist.

However, all of these are only possible risk factors. “Of most patients who fall ill, we don’t know why, because none of these risk factors apply to them,” summarizes Michael Stahl.

Look out for these warning signs

Besides this, there is the second difficulty in gastric cancer – late diagnosis. This is because the symptoms are rather unspecific, affecting the stomach, but are often dismissed as harmless everyday complaints. Early signs can be:

• Feeling of fullness, pressure in the stomach
• general upper abdominal discomfort
• Eructation
• nausea
• Vomit
• Flatulence
• Loss of appetite

“Anyone who has one or more of these complaints for more than three weeks should have them checked out by a doctor,” advises Michael Stahl.

Do not treat persistent stomach problems with acid blockers on your own initiative

However, many sufferers do not take these symptoms seriously and try to relieve them first with self-medication – wasting valuable time on early cancer therapy and thus a high chance of recovery.

They resort to gastric acid blockers that are available over the counter or prescribed by doctors. The pain will actually go away. “Cancer itself does not cause the pain at the beginning of the disease, rather the mucous membrane defect it causes is irritated by stomach acid – and that triggers the pain,” explains the expert.

This pain disappears when the stomach acid is blocked because it no longer irritates the mucous membrane. The cancer growth is not influenced by this, the tumor can spread undisturbed.

The most important diagnostic tool – gastroscopy

The oncologist therefore urgently recommends that the complaints be clarified by a quality-assured endoscopy, i.e. in a gastroenterological practice that carries out these examinations on a daily basis or in an appropriate center.

The gastroscopy only takes a few minutes; the doctor can not only check the condition of the esophagus and stomach up to the duodenum, but can also test whether Helicobacter is present and possibly take additional tissue samples.

Usually no tumor is discovered, but rather the stomach germ or an enlargement or relocation of the area between the stomach and esophagus (hernia), which can cause reflux. A change in diet can help here or medication may be necessary. Sometimes, however, the doctor finds stomach cancer, “and more and more often in the transition area to the esophagus,” reports the expert from the practice.

The reason for this is that there are more and more people who are very overweight. “Being overweight puts pressure on the abdominal cavity, which is why bile acids and stomach acids flow back into the transition area to the esophagus, which is not designed for frequent contact with these acids and is therefore damaged,” says Michael Stahl, summarizing the chain of reactions.

How stomach cancer spreads

The treatment depends on the severity of the disease (grading):

• Whether the carcinoma is limited to the mucous membrane,
• already affects the underlying muscle
• in addition, the outer connective tissue of the stomach
• surrounding organs
• Lymph nodes
• Has metastasized.

In Asian countries, where the risk of stomach cancer is very high and gastric cancer screening is therefore carried out regularly, the cancer can often be detected early. If the diagnosis “stomach cancer” is made in the early stages, i.e. only the mucous membrane is affected, there is a high chance of recovery.

Unfortunately, this is extremely rare in Germany, explains the oncologist. In this country, stomach cancer is usually only discovered when it has worked its way deeper into the tissue or has already broken through the stomach. This is also the reason why the prognosis for stomach cancer in Germany is so unfavorable – the cancer is recognized very late.

Stomach cancer does not depend on age

How long the time span between gastric cancer in its initial stage and the appearance of metastases cannot be answered. However, Michael Stahl points out in this context that it is a cancer myth that the tumor only grows slowly in the elderly. “We also have elderly patients with rapidly growing stomach cancer, and young ones,” he warns. Young people should also take stomach problems seriously and not dismiss them: “I’m only 35, it can’t be something bad, like cancer.”

Treatments for stomach cancer – chemotherapy plus surgery

Only in the early stages, i.e. when stomach cancer is limited to the mucous membrane, surgery alone is the method of choice. Then it is the only way to cure the patient.

Most patients, however, need more than the operation, the scientist reports. For locally advanced tumors (without metastasis), treatment consists of chemotherapy, surgery and renewed chemotherapy. Chemotherapy before the operation is intended to shrink the tumor and combat (invisible) metastases at an early stage.

Antibody therapy for HER2-positive gastric cancer

In addition, chemotherapy plus antibody therapy with so-called HER2 antibodies is used for certain forms of metastatic gastric cancer. In around 20 percent of gastric cancer patients, HER2 receptors (HER2-positive gastric cancer) are found in particularly large numbers on the cancer cells. They are docking points for growth factors. Occupied by the special antibodies, tumor growth can slow down significantly.

By the way, HER2 receptors are also found on breast cancer cells, keyword HER2-positive breast cancer. This is where this antibody therapy, which incidentally does not count among the immunotherapies, was first used.

In addition, attempts are being made in Germany, the scientist reports, to treat HER2-positive gastric cancer with HER2 antibodies plus immunotherapy. Scientists hope that this will enable them to offer equivalent treatment without chemotherapy in the future. However, the effect of this combination of therapies has not yet been proven.

Immunotherapies for gastric cancer do not (yet) meet expectations

In some forms of cancer such as melanoma or lung cancer, immunotherapies, for example with checkpoint inhibitors, are considered particularly successful today. These drugs are also currently being tested in studies for gastric cancer .

“Unfortunately, the first results are sobering,” reports the scientist. He and his colleagues had hoped that immunotherapy could improve the effect of chemo, but this was not confirmed. “If, however, all therapy options have already been exhausted in a patient, more can be achieved with immunotherapy than without further tumor-specific treatment,” reports Michael Stahl about the studies.

The problem with this is that it is currently difficult to predict in which patients the immunotherapy will work and which will not. Only in the few patients (less than ten percent of all patients with gastric cancer) whose tumors show what is known as high microsatellite instability (MSI-H) can one predict that immunotherapy has a high chance of effectiveness. Overall, the risk of severe side effects under immunotherapy is significantly lower than under chemotherapy, namely 20 percent instead of 60 percent.

The prognosis for gastric cancer is poor because the patients are late

How successful are the therapies at a glance? “The chances of a cure for stomach cancer are on average 25 to 30 percent; if stomach cancer is metastatic, the average life expectancy is one year,” reports Michael Stahl. The prognosis is only very good at a very early stage. However, patients with gastric cancer in this easily curable stage would be the exception in practice because many go to the doctor too late.

Prevention of stomach cancer – three measures

This makes provision and prevention all the more important. This includes, on the one hand, having longer stomach complaints clarified by a gastroscopy – and it does not matter how old the person affected is.

On the other hand, everyone should pay attention to the following three factors. Because little is known about the development of stomach cancer, so few are:

1. Pay attention to food hygiene, do not eat spoiled food, nothing that is moldy
2. Do not smoke
3. Avoid being overweight

This can not only protect the stomach, but is known to promote general health – not smoking and maintaining a normal weight are among the most important preventive measures against cardiovascular diseases such as high blood pressure, heart attack and stroke, but also against cancer.

I don’t know about you, but do you always feel so drained and overfed, especially in the first few months of the new year? Yes? My condolences. I do not anymore. I’m out of the number. But I’ll also be happy to tell you how I did it. Or as my friend Inke said the other day: “You are always so slim – despite feasting. How does that work?”

“Diets are not about the ‘what’, but the ‘how'”

My answer to that, when her eyes got bigger and bigger: “Very simple: In principle you can eat anything, it’s not about the ‘what’, it’s just about the ‘how’. Carbohydrates are okay, even chocolate is perfectly fine. ”And the best thing is: I actually only found that out on the side while I was trying to eat my family and myself as healthy as possible.

For a year I cooked my way through all the usual diet trends: from paleo and superfoods to apple cider vinegar and algae sweets to bog water, I tried a wide variety of methods.

Carbohydrates make us happy and relaxed

Since then, I’ve always shook my head a little when I hear again that Jennifer Lopez and others are calling out “No Carbs Week” on Instagram again. Carbohydrates only bark, but they don’t bite. They are not angry – on the contrary: They make us happy, let us relax and increase our ability to perceive. The brain needs carbohydrates, otherwise it will cook on the back burner.

“But they should make you fat?” My friend Inke explains to me again. Whereupon I have to laugh: “Yes, we all think so. Because we combine them incorrectly. If we only ate one type of carbohydrate per meal and took enough breaks, we would not gain weight at all. ”

Incidentally, a theory that I stumbled across during my research from Hamburg to Hollywood. Even Hollywood stars are taught that – only not the fat average German.

The body needs carbohydrates – but not too much at once

Need an example? Let’s take our breakfast. Hands up, who eats a jam roll in the morning? Mistake number one! Because there are three types of carbohydrates in jam rolls per se. The first is the cereal in the bun, the second is the fructose from the jam and the third is perhaps a refined sugar for preservation.

Our body then thinks: “Great, I know the grain, I’ll use it, but I’ll put the other two carbohydrates on my hip right away. And then I get tired and lie down first. “Hello afternoon low!

So my trick – if it has to be a roll – would be to top it with a neutral hard cheese. This meal doesn’t make you fat or tired. But please don’t use a soft camembert, because it contains lactose.

Now you also know why I never offer my children a few cornflakes with milk and sugar before school. In terms of metabolism, the dwarfs would prefer to go straight back to bed – with such a combination of milk and industrial sugar and cereals, no wonder.

Select carbohydrates specifically

“But that’s terribly complicated – I have to know all the carbohydrates!” Interjects Inke.

Actually, it’s not difficult. Meat and fish as well as vegetables, hard cheese and eggs are neutral. And you wouldn’t actually eat rice, potatoes and pasta together with that. Actually, I just make sure that I only eat one sugar or only one type of cereal or only one starch together. When I fry something, I don’t mix the fats, I stick with one. In the restaurant, I don’t eat the bread basket empty if I’ve ordered potatoes with the fish anyway. And if it should be a glass of wine (also contains carbohydrates), then I enjoy it best after dinner.

Give your digestion breaks

We come to factor two: The ‘how’ does not only refer to the composition of our meals, but also to the ‘when’. In general, I noticed that we are actually digesting continuously.

In the morning we eat our fattening breakfast, which nobody really needs because it takes away all energy, then we drink a carbohydrate bomb in the form of a café latte with lots of milk and sugar afterwards, push ourselves into the canteen, then need it caffeine again because we’re so tired from eating before we go back in the evening.

Our body actually just wants a break. And maybe a green tea, a smoothie, or just nothing so he can send the cleaning crew through. We eat and eat and don’t even know why.

What can you still eat? It is confusing

I admit, everything has gotten very confusing too: gluten is bad, milk full of hormones, meat the devil, everyone is confused. I often hear that you can continue to eat as normal. It is worthwhile to feed in more precisely. If we buy it cheaply in the bakery for twenty cents, the dough can contain additives such as corn, potatoes, glucose syrup, i.e. sugar, and there are also flavor enhancers.

Do you notice what? Again several carbohydrates and chemistry. And immediately we get fat and tired, have a stomachache like we did in the ninth month and in the end even stomach ache, migraines and sleep disorders. With organic you are on the safe side. And with breaks and some kind of carbohydrate too, I think.

Sinning is allowed – but then there is a long pause

And whoever has sinned, simply waits five instead of two hours. Who is perfect and always obeys all the rules? If I am invited to a friend’s house, I sometimes skip five, but I always return to the one-carbohydrate principle. This also applies to snacking: at the moment I like to treat myself to a bar of chocolate in the evening – from Monday to Friday.

Yes you’ve read correctly. Chocolate is my insider tip, because the cocoa practically covers the sugar, which is why chocolate is just one type of carbohydrate. Or as my nutritionist Dörten Wolff once put it: “If you know how to eat chocolate correctly, it doesn’t necessarily work!”

In my case, eating right means: If I notice that I have to put in another chocolate unit in the evening, then I eat meat and vegetables instead of high-carbohydrates for dinner. My dessert, the chocolate, is my carbohydrate component. Without question, it should be high quality chocolate and not cheap, adulterated one.