Stomach cancer
Last reviewed: 23.04.2024
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Gastric cancer has many causes, but Helicobacter pylori plays a significant role. Symptoms of stomach cancer include a feeling of overflow, obturation and bleeding, but tend to manifest in later stages of the disease. The diagnosis is established with endoscopy followed by CT and endoscopic ultrasound to determine the stage. Treatment of stomach cancer is mainly surgical; chemotherapy can provide only a temporary effect. Long-term survival of patients is small, except for cases of local injury.
Annually in the USA there are approximately 21 000 cases of stomach cancer and 12 000 deaths. Adenocarcinoma of the stomach is 95% of gastric cancer; Limited there are limited gastric lymphomas and leiomyosarcomas. Gastric cancer is the 2nd most common cancer in the world, but the incidence is highly variable; the incidence is extremely high in Japan, Chile and Iceland. In the US in recent decades, the incidence has decreased and ranks 7th among the common causes of death from cancer. In the US, the disease is typical for black people, immigrants from Spain and India. The incidence of cancer increases with age - more than 75% of patients older than 50 years.
See also: Stomach cancer in the elderly
[What causes stomach cancer?
Infection with H. Pylori is the underlying cause of most stomach cancer. Autoimmune atrophic gastritis and various genetic disorders are risk factors.
Gastric polyps can be precursors of stomach cancer. Inflammation of polyps can develop in patients taking NSAIDs, and the pit-like polyp in the bottom of the stomach is characteristic of patients taking proton pump inhibitors. Adenomatous polyps, especially multiple, although rare, but definitely malignant. Malignancy is particularly likely if the adenomatous polyp is more than 2 cm in diameter or has a villous structure. Since malignant degeneration can not be detected during examination, all polyps found during endoscopy should be removed. The incidence of gastric cancer as a whole is reduced in patients with duodenal ulcer.
Gastric adenocarcinomas can be classified according to a macroscopic pattern.
- Bulging - a tumor that is polypoid or mushroom-like (polypoid cancer).
- Invasive - a tumor in the form of an ulcer (saucer-shaped cancer).
- Surface spread - the tumor spreads on the mucous membrane or superficially infiltrates the wall of the stomach (ulcerative infiltrative cancer).
- Linitis plasties - a tumor infiltrates the gastric wall with an associated fibrotic reaction that causes rigidity of the stomach as a "skin vessel".
- Mixed - a tumor is a manifestation of two or more other types; this classification is the largest.
Polypovidnye tumors have a better prognosis in contrast to common types of tumors, since the symptoms of stomach cancer earlier manifest themselves.
Symptoms of stomach cancer
The initial symptoms of stomach cancer are usually undefined, often consisting of dyspeptic disorders, suggestive of peptic ulcers. Patients and doctors often do not pay attention to symptoms and prescribe treatment for the patient, respectively, peptic ulcer disease. Later, symptoms of rapid satiety (a feeling of overflow after taking a small amount of food) may develop if the tumor affects the pyloric area or if the stomach becomes again rigid due to linitis plastica. Dysphagia can develop if the cancer of the cardiac part of the stomach breaks the passage through the esophagus. Characteristic are weight loss and weakness, which are usually a consequence of food restriction. Hematomesis or melena are uncharacteristic, but secondary anemia is a consequence of hidden bleeding. Sometimes the first signs of stomach cancer are manifested by metastases (eg, jaundice, ascites, fractures).
The physical examination data may be small or limited only by the gempositive stool. In advanced cases, changes include the detection of volumetric education in the epigastric region; lymph nodes of the umbilical, left supraclavicular and left axillary regions; hepatomegaly and bulk formations of the ovary or rectum. There may be lesions of the lungs, central nervous system and bones.
What's bothering you?
Diagnosis of stomach cancer
Differential diagnosis of stomach cancer usually involves peptic ulcer and its complications.
Patients with suspected gastric cancer should undergo endoscopy with multiple biopsies and cytology of mucosal scraping. Sometimes a biopsy, limited only by the mucous membrane, misses the tumor tissue in the submucosal layer. X-ray, especially with double contrast, can visualize the lesion, but does not exclude the need for subsequent endoscopy.
Patients with identified cancer need CT of the chest and CT of the abdominal cavity to verify the degree of spread of the tumor. If CT is not metastasized, endoscopic ultrasound should be performed to determine the extent of tumor invasion and regional metastasis to the lymph nodes. The findings determine treatment and prognosis.
It is necessary to perform basic blood tests, including a general blood test, electrolytes and functional liver tests to assess anemia, hydration, homeostasis and possible metastasis to the liver. Carcinoembryonic antigen (CEAg) should be determined before and after surgical treatment.
Screening endoscopy is used in populations at high risk (eg, Japan), but not recommended in the US. Subsequent screening studies in patients after treatment consist of endoscopy and CT of the chest, abdomen and pelvis. If the levels of CEAg fall after surgical treatment, follow-up should include monitoring the levels of CEAg; increase indicates relapse.
What do need to examine?
What tests are needed?
Who to contact?
Treatment of stomach cancer
The choice of the amount of treatment depends on the stage of the tumor and the wishes of the patient (some refrain from aggressive treatment).
Surgical treatment of gastric cancer involves the removal of most or all of the stomach and regional lymph nodes and is indicated for patients with a disease limited by the stomach and, possibly, regional lymph nodes (less than 50% of patients). Additional chemotherapy or combined chemo- and radiotherapy after surgery is of questionable efficacy.
Local resection with an advanced regional lesion leads, on average, to survival within 10 months (versus 3-4 months without resection).
Metastasis or extensive lesion of nodes excludes surgical treatment, and, at most, palliative manipulations should be prescribed.
However, the true extent of the spread of the tumor is often not established until surgical intervention. If the patient's quality of life can be improved, a palliative surgery should be performed, usually involving gastroenterostomy in pyloric obstruction. Patients who are not subject to surgical treatment may have a temporary effect of combined chemotherapy regimens (5-fluorouracil, doxorubicin, mitomycin, cisplatin or leucovorin in various combinations), with a slight increase in survival time - up to 5 years. Radiation therapy has limited effectiveness.
More information of the treatment
What prognosis does stomach cancer have?
The cancer of the stomach has a different prognosis. It depends on the stage, but everywhere it is not quite favorable (5 years of survival: less than 5-15%), since most patients are treated with an advanced form of the disease. If the tumor is confined to the mucosa or submucosa, 5 years of survival can reach 80%. In tumors with regional lymph node involvement, survival is 20-40%. With a wider spread of the disease, the prognosis is almost always fatal within 1 year. With gastric lymphomas, the prognosis is better.