Cancer of the stomach - Causes, symptoms and treatment. MF.

Gastric cancer is a malignant tumor that develops from the cells of the gastric mucosa.

The causes of stomach cancer can be divided into several types:

1. Alimentary - associated with eating habits: the abuse of fatty, fried, canned and spicy food. The damaging effect of chemically active substances on the gastric mucosa is the destruction of the protective layer of mucus on the surface of the epithelium and the penetration of carcinogenic( cancer-causing) substances into cells, followed by their destruction or degeneration. At the same time, eating a large number of vegetables and fruits, microelements and vitamins significantly reduces the incidence of cancer.

2. Smoking and alcohol affect the development of stomach cancer.

3. Preceding chronic diseases of the stomach: peptic ulcer, erosive and atrophic gastritis. Often the cause of most chronic diseases of the stomach is Helicobacter - a bacterium that can live and multiply in the stomach, and sometimes in the human intestine. The microorganism secretes the products of its vital activity, destroying with their help a protective shell from the gastric mucus and parasitizing the surface or penetrating the cells of the epithelium, absorbing nutrients, causing cell death. Destruction of the protective shell from mucus causes damage to the gastric epithelium with hydrochloric acid, normally released by goblet cells, with the formation of erosions and ulcers. In turn, ulcers, long-existing, poorly treatable, having a deep bottom, "undercut" edges, gray deposits of fibrin on the bottom, are extremely suspicious of cancer. All of the above reasons can cause a cancer to degenerate. Atrophic gastritis is considered a background disease for the development of stomach cancer, typical for the elderly, this is due to the fact that during aging, atrophy( dying) of the mucous membrane and a decrease in the secretory activity of the gastric glands occurs.

4. Genetic factors: hereditary predisposition - the presence in the family of close relatives, patients with cancer of the gastrointestinal tract or other organs.

5. Constitutional features and hormonal activity. Large weight and obesity are background diseases for the organs of the genital and gastrointestinal tract, including stomach cancer.

Up to 80% of patients with initial forms of stomach cancer do not make complaints. Often, referral to a doctor is due to concomitant diseases. Expressed symptoms usually indicate a far-gone process.

Symptoms of stomach cancer

There are no typical symptoms of stomach cancer, but there are a number of symptoms that help to suspect the disease, they can be divided into two groups:

1) Nonspecific for the stomach: weakness, body temperature rises, decreased or no appetite,weight.

2) Specific for stomach diseases:
- abdominal pain: characterized by aching, pulling, dull epigastric pain( under the left edge of the ribs).It can be periodic, often occurs after eating. Pain becomes permanent as a result of the addition of a concomitant inflammatory process or the growth of a tumor by neighboring organs.
- nausea and vomiting: a symptom of various diseases of the stomach: acute gastritis, peptic ulcer, with cancer characterizes a large tumor overlapping the exit from the stomach.
- vomiting stagnant contents( eaten the day before for 1-2 days with food): with tumors of the output( antral) part of the stomach, on the border with the duodenum, causing stenosis and leading to stagnant contents in the lumen of the stomach to several hours or days, painful sensations andexhaustion of the patient.
- vomiting "black, coffee grounds", black liquid stools - characterizes bleeding from an ulcer or a stomach tumor, requires urgent medical measures( stop bleeding).
- difficulty in the passage of food, up to the impossibility of passing through the fluids symptom of esophageal cancer and the initial part of the stomach.
- sensation of stomach overflow after eating, heaviness, discomfort, rapid saturation.
- increased heartburn, belching - the patient himself can notice the change in the intensity of complaints.

3) symptoms of a far-gone process:
- a palpable tumor in the abdomen.
- an increase in the abdomen in size due to the presence of fluid( ascites) or enlarged liver.
- jaundice, pale skin as a result of anemia( reduction of red blood).
- enlargement of supraclavicular lymph nodes on the left, left axillary lymph nodes and near the navel( metastatic lesion).

If the patient has such complaints, as well as the intensity and nature of the usual complaints, the doctor should be consulted immediately.

If you vomit "coffee grounds" you should immediately call an ambulance.

A number of examinations to detect stomach cancer:

The leading study in this case is video-esophagogastroduodenoscopy( FGDS).
This method of investigation allows you to examine in detail the mucous membrane of the esophagus, stomach and duodenum and detect the tumor, determine its boundaries and take a piece for examination under a microscope.
The method is safe and well tolerated by patients. When small tumors are detected in the initial stage, it is possible to remove them through the same apparatus using short-acting intravenous anesthesia.

Two mirror tumors in the antral part of the stomach, view through the

gastroscope Type of gastric tumor in NDI mode through the

gastroscope All patients after 50 years old, as well as suffering from chronic gastritis and having a history of gastric ulcer, need to perform gastroscopy( from the Latin "Gaster"- a stomach," scopia "- to inspect) in order to identify a tumor pathology at an early stage.

X-ray of the stomach is one of the oldest methods of research. To a greater extent it allows to evaluate the functional capabilities of the organ. Allows you to suspect a relapse of the tumor after surgery on the stomach. Effective in infiltrative forms of cancer, when the results of a biopsy can be negative, safe for the patient and does not carry a large radiation load.

The ultrasound examination of the abdominal cavity allows revealing the indirect signs of a stomach tumor( a symptom of volume formation in the upper half of the abdomen), the growth of a tumor into the underlying organs( pancreas), metastatic damage to the liver, nearby lymph nodes, the presence of fluid in the stomach( ascites), metastaticdefeat of the serous membrane of internal organs( peritoneum).

Computed tomography of the abdominal cavity of allows more detailed interpretation of the changes detected by ultrasound - exclude or confirm metastases in internal organs.

Endoscopic ultrasound is used when suspected of submucosal gastric tumors growing in the thickness of its wall, when early cancers are detected to assess the depth of germination in the tumor in the wall of the organ.

Diagnostic laparoscopy is an operation performed under intravenous anesthesia through punctures in the abdominal wall, where a camera is inserted to examine the organs of the abdominal cavity. The study is used in unclear cases, as well as to identify tumor germination in surrounding tissues, metastases to the liver and peritoneum and biopsy.

Blood test for the oncomarkers are proteins produced only by the tumor and absent in a healthy body. To detect gastric cancer, Ca 19.9, REA, Ca 72.4 are used. But they all have low diagnostic value and are usually used in treated patients to detect metastases at the earliest possible time.

Types of tumor lesions of the stomach depending on the location of the tumor in the organ:

- cancer of the cardiac region - the area of ​​the esophageal-gastric junction;
- cancer of the lower third of the esophagus;
- cancer of the body of the stomach;
- cancer of the antrum of the stomach( output department);
- cancer of the angle of the stomach( angle between the stomach and duodenum);
- total stomach damage in infiltrative cancers.

Schematic representation of the stomach

Schematic representation of the inner lining of the stomach( mucosa)

Forms of stomach cancer:

- exophytic cancer: the tumor grows into the lumen of the stomach, having the appearance of a polyp, cauliflower, or ulcer, can be in the form of a saucer and so on.
- infiltrative cancer: as if "stelitsya" along the wall of the stomach.

Stages of stomach cancer differ depending on the depth of germination of the organ wall:
0 stage - cancer "in place" - the initial form of cancer, limited to the mucous membrane, the wall of the stomach does not germinate;
Stage 1 - the tumor sprouts into the submucous layer of the stomach wall without metastases in the nearby lymph nodes;
2 stage - grows in the muscular membrane of the stomach, there are metastases in the nearby lymph nodes;
3 stage - the tumor sprouts the entire thickness of the stomach wall, there are metastases in the nearby lymph nodes;
Stage 4 - the tumor grows into adjacent organs: pancreas, large vessels of the abdominal cavity. Or there are metastases in the organs of the abdominal cavity( liver, peritoneum, ovaries in women).

Prognosis for stomach cancer

The prognosis is most favorable for initial cancer and stage 1 of the tumor process, the survival rate reaches 80-90%.At 2-3 stages the prognosis depends on the number of metastases in regional lymph nodes, directly proportional to their number. At stage 4, the prognosis is extremely unfavorable and hope for recovery can only be in case of complete removal of the tumor as a result of extended operations.

Stomach cancer, unlike other malignant tumors, is dangerous by local recurrence of the disease( relapse) both in the walls of the removed organ and in the abdominal cavity itself. Metastasizes gastric cancer more often in the liver and peritoneum( implantation metastases), into the lymph nodes of the abdominal cavity, less often into other organs( supraclavicular lymph nodes, ovaries, lungs).Metastases are cuttings from the main tumor, having its structure and capable of growing, disrupting the function of those organs where they develop. The appearance of metastases is associated with the regular growth of the tumor: the tissue grows quickly, the nutrition does not suffice for all its elements, some cells lose contact with the rest, it breaks away from the tumor and enters the blood vessels, spreads through the body and enters the organs with a shallow and developed vascular network, lungs, brain, bones), settle in them from the bloodstream and begin to grow, forming colonies-metastases. In some cases, metastases can reach huge sizes( more than 10 cm) and lead to death of patients from poisoning with the products of the tumor's vital activity and disruption of the organ's functioning.

Relapses of the disease are very difficult to treat, in some cases, repeated operations are possible.

Treatment of stomach cancer

In the treatment of stomach cancer, like any other cancer, the leading and only method that gives hope for recovery is surgery.

There are several options for stomach surgery:

- Removal of part of the organ - resection of the stomach( distal - removal of the outlet, proximal - removal of the esophagus closest to the esophagus), is performed with exophytic tumors of the antral or cardiac parts of the stomach, respectively.
- gastrectomy( from Latin gastric gastric emptying, ectomy - removal) - removal of the entire stomach with the subsequent formation of a "reservoir" from the loops of the small intestine, is performed with tumors of the body of the stomach( middle part).
- Combined advanced operations - with the removal of a portion of nearby, involved in the tumor of the organs-pancreas, liver and others.
- excretion of the gastrostomy - the formation of a hole in the stomach on the stomach, is performed with undetectable tumors that violate the passage of food, for feeding patients, in order to ease the patient's condition and prolong life.
- the formation of a bypass anastomosis between the stomach and the intestinal loops - creating a detour for the passage of food, is used with undetectable tumors to prolong the life of patients.

Often, the operation is supplemented with some special antitumour treatment:

- in the presence of confirmed metastases in nearby( regional) lymph nodes, the use of preventive chemotherapy is mandatory. Chemotherapy is the intravenous administration of toxic chemicals to destroy microscopic metastases that could not be detected during surgery.
- in detecting metastases in other organs( liver, lungs, peritoneum and so on), it is mandatory to use chemotherapy, designed to reduce the size of metastases or completely destroy them.

Radiation treatment for stomach cancer is not used because the stomach is mobile in the abdominal cavity and the tumor of this organ is not sensitive to radiation. Radiation therapy can be used in the postoperative period, if the tumor is not completely removed, tumor cells are determined in the area of ​​resection when examined under a microscope - irradiation of the anastomosis( formed anastomosis) between the esophagus and the intestine.

Self-medication for stomach tumors is unacceptable and dangerous, since it can lead to a complete disruption of the passage of food from the stomach to the intestine-the stenosis of the gatekeeper, which in turn leads the patients to die of hunger. Use the so-called "folk remedies", too, is not necessary, especially toxic, since many of them( hemlock, celandine, chaga) can cause poisoning of the body and worsen the condition of patients.

Only timely and qualified medical care with as early treatment as possible allows to ensure recovery of the patient.

Complications of stomach cancer:

- bleeding from a tumor is a dangerous complication that can lead a patient to death very quickly. If symptoms such as vomiting "coffee grounds" - black clotted blood or black liquid stools, you should immediately call a doctor or call an ambulance, especially if these symptoms are accompanied by pain in the abdomen, palpitations and paleness of the skin, fainting.
- pyloric stenosis( obstruction) - the formation of an obstruction from the tumor in the outlet stomach, completely blocking the normal passage of food through the gastrointestinal tract. Symptoms of stenosis of the pylorus are: vomiting stagnant contents( on the eve of 1-2 days, eaten by food).Requires emergency surgical interventions.

Prophylaxis of

Prevention of gastric cancer includes proper and adequate nutrition, smoking cessation, timely annual examination of the stomach, especially for patients who have a history of peptic ulcer and chronic gastritis.

Consultation of a doctor oncologist on stomach cancer:

1. Question: Is it possible to identify stomach cancer at an early stage?
Answer: Yes, it is possible, for example, in Japan the share of early gastric cancer is 40%, while in Russia there are no more than 10%.Most often, early cancers are detected during examination for another, concomitant pathology. The leading in detecting early cancers is the annual endoscopic examination of the stomach - FGD in an experienced specialist, in a clinic with good equipment.

2. Question: What are the results of treatment of early gastric cancer?
Answer: The cure for early cancers is almost 100%.The operations are performed endoscopically - through a fibroadastroscope with the use of special equipment. Only the mucous membrane of the stomach with the tumor is removed. Such operations can be performed only with early cancers, with all other forms of cancer shown by a canal operation.

3. Question: What are the results of treatment of stomach cancer in advanced stages?
Answer: The survival prognosis is more or less favorable only if the entire tumor and metastasis is removed as a result of the extended operations, but even in this case a relapse of the disease is possible.

Doctor oncologist Barinova Natalya Yurevna