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eating foods that are dried, smoked, heavily salted, or pickled is a risk factor for stomach cancer. Having peptic ulcers (see page 755) of the stomach does not seem to increase the risk of stomach cancer. However, the presence of the bacterium Helicobacter pylori in the stomach (which has been linked to gastric ulcers) may be linked to stomach cancer. Stomach cancer is much less common in the United States than it was in 1940. It is twice as common in men as in women, and the risk increases with age. Smoking also increases the risk of stomach cancer.

Symptoms

The initial symptoms of stomach cancer are easy to ignore and include indigestion (especially right after eating) and loss of appetite. Later symptoms include severe pain in the upper abdomen, weight loss, frequent vomiting (the vomit is usually tinged with blood), and red or dark blood in the stool. A rare condition called pyloric stenosis can result if a tumor blocks the pylorus (the outlet from the stomach to the small intestine), preventing the stomach from emptying normally, and sometimes causing projectile vomiting (forceful vomiting immediately after eating).

Diagnosis

If you have symptoms of stomach cancer (especially if the symptoms are different from your usual indigestion), your doctor will perform a procedure called endoscopy (see page 766) to examine your esophagus and stomach and, possibly, take samples of cells from the stomach for examination under a microscope for cancer (biopsy). He or she may also recommend a barium X-ray (see page 767) of your stomach.

Treatment

The treatment of stomach cancer depends on the stage of the disease. Removing only the part of the stomach affected by cancer (called a partial gastrectomy) is the most common treatment. However, it may be necessary to remove all of the stomach (total gastrectomy). Cases that are diagnosed and treated at the earliest stage have the best chances for a cure. Your doctor will order radiation therapy (see page 23) in combination with chemotherapy (see page 23) to keep the cancer from spreading or returning.

Gastrectomy

Gastrectomy

A gastrectomy is the surgical removal of a portion of the stomach (partial gastrectomy; above center) or the entire stomach (total gastrectomy; above right). In a partial gastrectomy, the remaining part of the stomach is joined to the jejunum (the middle part of the small intestine), and the duodenum (the first part of the small intestine) is closed off where it used to join the stomach. In a total gastrectomy, the whole stomach is removed and the esophagus is joined directly to the jejunum.

General Abdominal Disorders

The other sections of this chapter cover disorders specific to a particular part of the digestive system (such as the small intestine). However, sometimes a disorder can affect more than one digestive organ in the abdomen (such as the stomach and the intestines). This section discusses the disorders that affect multiple organs, including the stomach, the small intestine, the large intestine, and the peritoneum (the membrane that lines the entire abdominal cavity and encloses many organs). These disorders often involve signs and symptoms such as inflammation, blockage, and paralysis.

The stomach, small intestine, and large intestine

Sometimes a disorder of the digestive system can affect more than one organ, such as the stomach, small intestine, and large intestine.

Peritonitis

Peritonitis is inflammation of the peritoneum, the two-layered membrane that lines the abdominal cavity and covers the stomach, intestines, and other abdominal organs. Peritonitis almost always results from an underlying untreated inflammatory disorder. For example, it may occur as a complication of a disorder of the digestive tract such as a peptic ulcer (see page 755), diverticulitis (see page 772), appendicitis (see page 771), or Crohn’s disease (see page 764). In women, peritonitis can be a complication of some disorders of the fallopian tubes such as a ruptured ectopic pregnancy (see page 523). Peritonitis also can be caused by an infection