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The stomach is between the esophagus and the duodenum. More than 20,000 people produce gastric cancer per year in the USA. The stomach acid, which is a factor in the development of ulcers. Acid does not cause cancer, but acid reflux into the esophagus can cause cells in the esophagus to change into stomach cells, which in turn can lead to cancer. Cancer in the lower portion of the esophagus is being found more frequently then ever, especially in young, white males.
Cancer of the stomach has recently been discovered to be related to a bacterial infection that also is related to the development of ulcers, a finding that may impact treatment in the future. Currently, the most effective treatment for stomach cancer is to surgically remove the cancer with the smallest operation possible. However, once these tumors have broken through the wall of the stomach or spread to lymph nodes, surgery alone may not be very effective. Chemotherapy after surgery has not been very effective, and must be delayed until the patient recovers. According to recent studies, pre-operative chemotherapy with or without radiotherapy seems to offer better results. Therefore, determining whether the tumor has spread out of the stomach has become very important to planning treatment. Determining which patients would most likely benefit from pre-operative treatment is best done with EUS and CT scan.
The duodenum is the first part of the small intestine, which is below the stomach. Cancer in this area is very rare. The bile duct and pancreatic duct open into the duodenum, and cancers do develop at this site (the ampulla of Vater). Although such tumors can cause symptoms similar to those of pancreatic cancer, duodenal cancer responds better when surgery is performed first (unlike pancreatic cancer). EUS can determine the exact type and location of tumors in the duodenum and provide the surgeon with the best possible map to plan treatment.