HIV Foundation Health Stomach cancer emerges years beforehand – these symptoms must be taken seriously

Stomach cancer emerges years beforehand – these symptoms must be taken seriously

Stomach cancer is not as common as colon or breast cancer, but its prognosis is less favorable. FOCUS Online explains the reasons why early detection is therefore particularly important, the current therapies and what belongs to prevention.

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.

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Workplace health ѕhоuld bе оnе оf уоur tор priorities. Aftеr аll, healthy employees mеаn lеѕѕ sick days аnd mоrе productivity. Evеn whеn a sick employee іѕ аt work, thеу аrе nоt аt thе tор оf thеіr game аnd they’re nоt near аѕ productive аѕ thеу (or you) wоuld like tо bе. Whеn thіѕ happens, іt costs уоu bоth tіmе аnd money аnd produces vеrу unhappy employees.

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Vitamin A deficiency is blind: which foods protect them – and which are no-gosVitamin A deficiency is blind: which foods protect them – and which are no-gos

Vitamin A is a generic term for several vital substances, including beta-carotene. A deficiency is rare, but there are risk groups, for example with liver or intestinal diseases. The signs of A-deficiency, how to avoid it and how dangerous an overdose can be.

Carrots are high in vitamin A and beta carotene, hence their name, and are important for the eyes and the immune system. Most of them do not know more about these vital substances – and this statement is sometimes even incorrect.

Vitamin A, provitamin A and beta carotene – what are they?

Because vitamin A is a complex of vitamins that includes retinol and retinyl esters . These forms are mainly found in animal foods.

There is also provitamin A as a precursor, which is found in plant-based foods. “There are also various representatives of provitamin A, the best known is beta carotene,” explains Andrea Henze, nutritionist at the University of Potsdam. The body has to convert provitamin A such as beta carotene into vitamin A so that it can be used. This processing takes place mainly in the intestines and liver.

Beta carotene – like all provitamins A – in turn belongs to the large group of carotenoids, of which there are more than 600 different ones. All of them have the property, as a natural coloring agent, of coloring plants yellow, orange, red and are therefore found in many orange-red vegetables. “But green vegetables such as spinach can also contain a lot of carotenoids,” adds the scientist, who is also researching the subject of vitamin A. In green vegetables, however, the orange-red color of the carotenoids is masked by the green plant substance chlorophyll.

The function of vitamin A.

Vitamin A is vital. “We need vitamin A for almost all body functions because it enables cells to differentiate,” explains Andrea Henze. This means that under the influence of this vital substance, the cell can become a skin cell, a mucous membrane or nerve cell. The other functions of vitamin A:

  • Immune system: Vitamin A primarily promotes the development of lymphocytes and thus a strong immune response to foreign substances and pathogens.
  • Skin and mucous membranes: It ensures healthy cell growth and cell integrity, thus preventing cracks and other damage, improving wound healing, i.e. regenerating. In this sense, vitamin A also acts on the lung epithelium and supports the constant renewal of the fine cilia that line the lung surface. It is similar in the intestine with the intestinal epithelium. Vitamin A is responsible for this constant renewal.
  • Blood formation: Vitamin A promotes the formation of red blood cells (erythrocytes) and thus improves the transport of oxygen into every cell.
  • Bones: It influences the storage of calcium phosphate in the bones.
  • Reproduction and fertility: Vitamin A is extremely important for the formation of healthy egg cells and sperm as well as for embryonic development. “We know from studies that vitamin A deficiency in animals often causes infertility or, if fertilization does take place, the offspring can have deformities of the limbs,” adds the scientist.
  • Seeing: Vitamin A is important in the eye as a pigment that enables the process of vision. It plays a key role in the nerve impulse that is triggered by the incidence of light and sent to the brain. Vitamin A, so to speak, mediates this signal cascade during the visual process.

Vitamin A does not have an antioxidant effect

From a purely chemical point of view, vitamin A is an antioxidant, but it does not play a role in the body in this context, for example because of its binding to transport proteins and its intracellular localization. As is often assumed, it is not a radical catcher and does not protect against “cell rust”, i.e. oxidation. “Vitamin A has no direct effect in this context, only an indirect one,” explains Andrea Henze more precisely: Vitamin A increases the absorption of vitamin E and selenium in the intestine, which have an antioxidant effect.

Pro-vitamins A such as beta carotene, on the other hand, can develop an antioxidant effect in the body before they are converted into vitamin A.

Why is this distinction important? Andrea Henze explains why it is best to use both animal and vegetable sources of vitamin A: Only then can the full spectrum of activity of these vital substances be used to the full.

Foods that are high in vitamin A and beta carotene

Among the foods of animal origin, the following are particularly rich in vitamin A:

  • Beef liver
  • Pork liver
  • poultry
  • butter
  • cheese
  • Eggs

When it comes to plant-based fruits and vegetables, these are good provitamin A suppliers:

  • Carrots
  • Cabbage
  • spinach
  • Apricots
  • paprika

Store and prepare foods rich in vitamin A correctly

Vitamin A is sensitive to light, so food should be stored in the dark. In addition, the vital substance is relatively heat-stable and fat-soluble. This means that it is bound to fat and can therefore best be absorbed by the body.

In the case of animal sources, this is usually given or due to the preparation, for example the extremely low-fat liver is fried in oil. For the preliminary stage vitamin A, however, the corresponding vegetables should be prepared together with fat. “Studies have shown that it is particularly well absorbed by the body when it is crushed and steamed with a little fat,” reports Andrea Henze. Grinding is important so that the provitamin is released from the cellular structures.

An example: carrot vegetables, chopped up and steamed with a little safflower oil, provide the body with the vitamin better than nibbling raw carrots.

This is how much vitamin A you need every day

According to the reference value of the German Nutrition Society, the daily requirement for vitamin A is around one milligram per day. However, this is a bit simplified. Other units are used in nutritional science, the requirement is given as so-called retinol equivalents (RE) or retinol activity equivalents (RAE), explains the scientist and explains in more detail. 1 milligram of retinol corresponds to 1 milligram of RE or RAE. For provitamin A carotenoids, the calculation is more complex because additional factors have to be taken into account:

  • Efficiency of absorption in the intestine (this is generally lower for carotenoids than for retinol or retinyl ester and depends on the food matrix)
  • Conversion efficiency of provitamin A into vitamin A (this differs greatly between the provitamin A carotenoids, it is highest for beta carotene)

When using RAE, a conversion factor of 12: 1 is assumed for beta carotene and 24: 1 for all other provitamin A carotenoids. This means that 12 milligrams of beta carotene or 24 milligrams of other provitamin A carotenoids must be ingested with food to meet the requirement of 1 milligram of RAE. If, on the other hand, the intake takes place in the form of retinol or retinyl esters (i.e. from animal foods), the required intake is correspondingly lower.

According to this calculation, the daily requirement for vitamin A is covered with 150 grams of carrots, for example, or with a mixed diet: 1 egg, 100 grams of Gouda cheese and 75 grams of carrots.

Vitamin A deficiency affects certain risk groups

Because these foods are so rich in vitamin A, there is virtually no deficiency in this vital substance in Germany and other industrialized nations. However, that’s only true at first glance. Because experts differentiate between primary deficiency and secondary causes when it comes to undersupply.

Primary means that too few foods rich in vitamin A are eaten. This is almost never the case in this country. Even those who only eat fast food are adequately supplied with vitamin A. Vegans and vegetarians also get enough vitamin A from the preliminary stage.

It is different, however, with a secondary deficiency. In this context, secondary is used when the deficiency arises as a result of illnesses. Digestive diseases that affect absorption, such as:

  • inflammatory bowel disease such as Crohn’s disease
  • Celiac disease
  • chronic liver disease, because vitamin A can then no longer be stored
  • Diseases of the pancreas, because the digestive enzymes that are important for the absorption of the vitamin are not sufficiently produced.

In addition, there is a risk of undersupply if the vitamin A requirement is increased, this is the case with:

  • pronounced inflammatory processes
  • massive injuries such as burns when much of the skin surface is destroyed
  • Kidney disease, which causes vitamin A to be excreted in the urine without being used
  • Alcohol abuse because liver function is impaired
  • pregnancy

Vitamin A Deficiency: Symptoms can be dramatic

As a rule, these risk groups are well looked after by a doctor, so that symptoms of deficiency rarely occur. Exception: alcoholics and very overweight people with massive fatty liver who do not seek medical advice. Apart from these patients, little is known about vitamin A deficiency in Germany. “Vitamin A deficiency occurs mainly in developing countries, where it is the main cause of blindness,” adds the scientist. Because one of the signs of vitamin A deficiency is night blindness, which can increase to complete blindness and is then no longer treatable.

There are also many other causes of night blindness, which are primarily age-related. The adaptive ability of the eye declines, for example as a result of cataracts, macular degeneration or retinopathia pigmentosa (hereditary disease). In any case, a doctor should always clarify if twilight vision deteriorates.

The other signs are a bit unspecific

  • Susceptibility to infection
  • dry skin and eyes
  • brittle hair
  • Loss of appetite
  • Muscle weakness
  • Fertility disorders

Vitamin A deficiency is best compensated for naturally

Anyone who thinks they are undersupplied with vitamin A should simply use more of the corresponding fruits and vegetables. Overdosing is not possible because the body only converts as much provitamin as it needs and it still makes sense to store it.

Over-the-counter supplements are the next step. It is best to get advice from a doctor and trust products from Germany. “Over-the-counter products only contain provitamin A, so overdosing is difficult, and absorption in the intestine is reduced if there is sufficient quantity,” explains Andrea Henze in more detail.

Beware of vitamin A supplements

Vitamin A supplements, on the other hand, can be more problematic, and poisoning is possible if overdosed. In Germany such products are therefore not freely available, but in other countries they are. “Vitamin A supplements should only be used under medical supervision and not for self-medication,” warns Andrea Henze.

Vitamin A poisoning – the first signs

The excess supply of vitamin A does not slow down the body, as is usually the case with provitamin A. The excess vitamin A is mainly stored in the liver; if it becomes too much, the detoxification organ can no longer work. “It leads to intoxication,” says the scientist. In pregnant women, this can also have negative consequences for the embryo.

The signs of vitamin A hypervitaminosis:

  • Nausea and headache ,
  • the bone tissue becomes porous.

If the oversupply lasts longer, it can even lead to death.

Incidentally, high doses of vitamin A supplements also led to the increase in lung cancer among smokers, previous studies warn.

There is no risk of intoxication from vitamin A through food – with one exception

What is certain is that over-the-counter supplements, which mainly contain beta-carotene, are usually harmless even if taken regularly. It is different with products that contain vitamin A, such as retinol. With them, intoxication is quite possible and can occur with a daily intake of 3 milligrams or more. By the way, retinol can also be found in many care products to keep the skin young and firm. “In this context, there is no need to fear overdosing, the substance does not pass from the skin into the bloodstream,” reassures the expert.

And hypervitaminosis A is hardly to be feared with food either. “Unless you eat liver several times a week,” warns Andrea Henze. Liver can contain over 30 milligrams per 100 grams of goods and thus exceeds the daily requirement by more than 30 times!

A historical anecdote shows how tragic this can end: More than 100 years ago, three researchers set out on an Antarctic expedition, Douglas Mawson, Belgrave Ninnis and Xavier Mertz. The expedition was not a lucky star, the men had to gradually eat the sled dogs in their distress in order not to starve to death. Mertz is said to have eaten the livers as well, subsequently complained of stomach pain, and his skin was partially peeling. After he fell into delirium, he passed away. Experts suspect that it was vitamin A poisoning from the dogs’ liver .

Therefore do not demonize the liver

Nobody knows for sure whether the story is really true. However, it is scientifically proven that hypervitaminosis A from natural foods is not to be feared, unless one eats a liver daily. Apart from that, the liver is an extremely valuable food from a nutritional point of view, contains vitamin A, iron, zinc , copper, vitamin B12 and folic acid, the supply of which is sometimes critical.

The most sensible recommendation: A lack of vitamin A can best be prevented with a balanced mixed diet, i.e. eat a lot of fruit and vegetables, whole grain and low-fat dairy products, sometimes a little fish or poultry.

Every second German affected! How to prevent osteoarthritis in everyday lifeEvery second German affected! How to prevent osteoarthritis in everyday life

Around 35 million people in Germany suffer from osteoarthritis. Is sport good for the joints? Whether for prevention or for those affected: exercise is the best medicine. FOCUS Online explains which sports are suitable and what you should pay attention to.

  • If you want to do something about osteoarthritis, you should exercise.
  • With these sports you can prevent.
  • At the same time, those affected can still practice many sports.

Anyone who hurts movements in their knees, shoulders or ankles usually suffers from osteoarthritis. It is the most common joint disease. At least five million Germans suffer from it. Experts even speak of 35 million people affected in Germany for early forms of osteoarthritis.

From the age of 30, the risk increases linearly. Among those over the age of 60, 50 percent of women and a third of men suffer from osteoarthritis.

Strictly speaking, however, everyone would get osteoarthritis, says Karl-Dieter Heller, chief physician at the Orthopedic Clinic Duchess Elisabeth Hospital. From the age of 40 at the latest, arthritic changes appear in the X-ray. Osteoarthritis occurs when bones, ligaments, tendons and joint capsules wear out.

Many movements are therefore painful. That tempts you to keep calm. However, this is exactly the wrong way to go. Anyone who wants to prevent joint wear and tear should definitely be active in sports.

With these sports you can prevent osteoarthritis

On the one hand, the aim of sport is to move the joint and maintain flexibility. The movement supplies the cartilage with nutrients. Because this itself is not supplied with blood.

On the other hand, the movement strengthens the joint-stabilizing muscles, which relieves the joint.

Sport improves the metabolism in the joint and the control function of the joints is maintained. Bones and cartilage are relieved.

Cycling, Nordic walking, swimming and cross-country skiing are sports that do not put stress on the joints, but move them gently.

At the same time, a change in diet also plays an important role in prevention, as being overweight puts extreme stress on the joints.

This is how many hours of exercise a week should be

Heller recommends: Three quarters to an hour three times a week is a good workload.

Limit: If you experience swelling and pain in your knees, shoulders or feet, you should adjust the intensity of your training.

Stop-and-go sports can put too much strain on the joints. These include tennis, badminton and squash.