STOMACH CANCER

Best Cancer Treatment in Bangalore | Stomach Cancer

Cancer of the stomach is a disease, in which normal cells lining the stomach mutate and become cancerous. They grow and divide rapidly to form a tumour/ growth. The stomach has four layers/ linings, and most of the cancer start in the innermost lining called the mucosa. This layer is where the digestive enzymes and stomach acids are produced. As the cancer spreads from the mucosa to the outer layers, the disease advances to more critical stages.There are other cancers of stomach that arise from the deeper layers of the stomach wall, and can behave as cancer.

Cancers can originate in any part of the stomach and may manifest different symptoms and the response to treatments can vary accordingly. Pre-cancerous physiological changes often occur before the onset of the full-fledged disease. However, they rarely cause symptoms and go undetected. That is why regular health check-ups are universally recommended.

The stomach cancer spread in the following manners:

  • Lymphatic: the most comoon type of spread is into the surrounding lympatics/ lymph nodes.
  • Blood: can spread to distant organs like liver, lungs etc
  • Local invasion: the cancer can invade through the layers of the stomach into surrounding organs like liver, pancreas, spleen

Causes and Symptoms of Stomach Cancer

There are many risk factors associated with stomach cancer, and certainly taking steps to minimise this risks can also minimise the risk of developing this cancer.  Smoking and alcohol probably have the strongest assosciation with development of cancer. Increasingly, Helicobacter Pylori, a bacteria found in the lining of the stoamch wall, can also lead to precancerous conditions and eventual develoment of cancer if left untreated. Diet rich in nitrate and high salt, and processed food are also known to be risk factors for developing cancer. Genetic/ Familial inheritance can be seen in patients with CDH-1 gene, and with HNPCC. It is advisable to discuss with your doctor if there is a strong family history of stomach cancer, and undergo regular screening to pick any early cancers.

The symptoms are very much manifestation as to the site of the cancer within the stomach. Broadly, the stomach can be divided into four regions, proximal to distal – fundus, body, antrum and pylorus . Distal presenting cancers are more likely to present with symptoms, while the proximal tumors may present sympotms only in advanced diseases.

The following symptoms can be manifestations of stomach cancer:

  • Constant fatigue
  • Feeling full after consuming small quantity of food
  • Poor appetite
  • Persistent and severe heartburn (GERD)
  • Chronic indigestion
  • Abdominal pain and distention
  • Relentless vomiting/ vomiting blood
  • Black stools
  • Unexplained weight loss
  • Low red blood cell count/ anemia ( this is often the first presentation patient’s seek investigation

Your symptoms may or may not indicate the presence of cancer. However, it is always advisable to consult a medical practitioner if you have any of these conditions. The earlier cancer is detected, the easier it is to treat.

Diagnosis of Stomach Cancer

If the doctor suspects cancer, he or she will recommend a series of tests to confirm the occurrence of the disease. These will include a variety of tests and is described below:

  • Endoscopy:  This is the ‘gold standard’ test for diagnosing precancerous and cancerous lesions in the stomach.  In high stomach cancer prevalent countries like Japan and Korea, endoscopy is used as a ‘screening tool’ to pick up early cancer.  Endoscopy is a safe procedure and is usually lasts for 10 – 15 minutes, and most patients go home within a few hours after the procedureA tiny video camera attached to a slender, flexible tube is passed down into the stomach through the throat and the esophagus. The endoscope transmits images of the stomach on to a television screen. If the images reveal the presence of cancer, the doctor will prescribe a biopsy.
  • Biopsy: A biopsy is the most direct and is the only reliable technique to diagnose cancer. The medical specialist extracts a small sample of tissue from the mucosa of the stomach or any other part where cancer has been detected. The sample is examined in a clinical laboratory by the pathologist, and will confirm whether cancer is present in the tissue.

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Staging the Cancer

If the endoscopy and biopsy confirm cancer, further imaging tests are carried out to detemine the spread of cancer as this is crucial in determining the treatment. The stage of the cancer can be determined using imaging tests or other options as discussed below:

  • CT Scan: A number of x-ray images of the stomach are taken from different angles. A CT scan, also called computer tomography, combines these images to make a three-dimensional composite image to determine the extent of the tumour.
  • PET Scan: The positron emission tomography (PET) scan is performed by injecting a radioactive substance into the patient’s vein. Cancer cells consume energy faster than normal cells. This gives the tumour a characteristic that can be easily in an x-ray. The PET scan is usually performed at the same time as the CET scan, sometimes jointly called a PET-CET scan.
  • Endoscopic Ultrasound ( EUS):  This is similar to undergoing endoscopy test, and had has a small ultrasound probe at the end of the endoscope. This is usually adviced to determine the layer from which the cancer is arising, and also to take deeper biopsies when normal endoscopic biopy is not possible.

Investigative Surgery:

If the imaging tests cannot reliably detect the spread of cancer in the stomach, the doctor may decide to conduct an investigative surgery. This is usually conducted with a laparoscope. The surgeon makes 2-3 small incisions on the abdomen. A small video camera called a laparoscope is inserted into the stomach with the help of a slender tube, and the surgeon can visualise if any spread is seen from the stomach into the abdominal cavity.

Treatment for Stomach Cancer

Treatment options for all cancers are influenced by the stage of the disease, the patient’s overall health and patient preferences. Surgery is the only definitve way to be cured of the cancer as it removes the cancer tissue along with the surrounding lymph nodes.  There are various described techniques of stomach cancer surgery and is based on the location of the tumor, extent of spread and type of tumor.

Surgical Techniques:
  • Endoscopic Mucosal Resection: Small tumours limited to the mucosa layer/early stage cancers can be removed via endoscopy procedure, and avoids an uneccessary operation. The surgeon uses special instruments to remove the cancer along with a little bit of surrounding, healthy tissue through the endoscope itself, and most of the patients go home within a day.
  • Subtotal Gastrectomy: In cases, which the cancer has spread put from the innermost layer, the surgeon performs this procedure and removes the portion of the stomach that is affected.
  • Total Gastrectomy: In more advanced stages, the surgeon will have no choice but to remove the whole stomach along with healthy, surrounding tissue. The esophagus is then connected directly to the small intestine so that food can be passed through the digestive system.
TYPE OF SURGERY : OPEN vs MIS: Minimally Invasive ( Laparscopy/ Robotic)

MIS surgery is superior to open surgery as it enables quicker recovery with fewer complications. It also allows patients to return to normal activities at an earlier rate compared to open surgery. If the cancer is very advanced/ bulky, then open approach may be more suitable.

CHEMOTHERAPY and RADIOTHERAPY:

Sometimes surgery may be combined with chemotherapy, radiation therapy and other modes of treatment to prevent the cancer from re-growing. The chemotherapy in some cases is given prior to surgey to reduce the tumor burden and to treat small micrometastasis. This is called neoadjuavant therapy. If the chemotherapy is given after the surgery, it is called adjuvant therapy. The surgeon discusses with the oncologist and radiotherapists, and will prescribe the treatment regimen based on the cancer staging, extent of spread and patient’s general health.

PROGNOSTIC FACTORS / SURVIVAL FACTORS:

There are many variables that affect survival / longevity after diagnosis of stomach cancer”

  • Patient’s overall health:

This is a crucial determinant as poor health and multiple illnesses reduced the chances of the body to fight through surgery and chemotherapy. Efforts should be taken by patient to keep any illnesses ( diabetes, blood pressure, heart and lung issues etc) under strict control, and give up addicitons like smoking and alcohol to mininse the risks of developing complications.

  • Nutrition:

In cancer patients, nutrition generally tends to be poor and the surgeon along with dietician support may introduce artifical feeds to complement normla diet. The artifical feeds are usually liquid shakes containing essential proteins, vitamins and other elements that the body requires.

  • Quality of Surgery:

There are prescribed  techniques of stomach cancer surgery and few specialitsts are trained in this. Surgical prinicples like R0 resection, lymphnode count and lymphadenectomy, minimisng complications and early return to nutriton all have a bearing on the outcome after cancer surgery.

  • Tumor Biology:

Tumor biology is also very important, as aggressive tumors have relatively poorer outcomes compared to the slow growing ones. Advanced cancer centers will have the facility to check specific markers on the cancer tissues, and guide chemotherapy and immunotherapy regimens tailor to the tumor biology.