Stomach cancer

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Stomach cancer

Approximately 90-95% of gastric tumors are malignant, and of all malignant tumors, 95% are carcinomas. Stomach cancer ranks second in terms of morbidity and mortality. Frequency. Previously, gastric carcinoma was considered the most common form of malignant diseases of the stomach; currently, the incidence has decreased in the United States. However, the incidence remains high in Eastern Europe, where there is an inverse relationship with the incidence of intestinal carcinoma. In men, gastric carcinoma is detected 2 times more often, traditionally in WHO Etiology. The cause of the disease is unknown. An increase in the incidence of carcinoma among members of the same family (by 20%) is noted, as well as among individuals with blood type A, which suggests the presence of a genetic component. Chronic diseases of the gastric mucosa, vitamin C deficiency, preservatives,

Precancerous conditions

    • pernicious anemia
    • Atrophic gastritis
    • Condition after resection of the stomach (especially after 10-20 years after resection according to Bimrot-11)
    • Adenomatous polyps of the stomach (the frequency of malignancy is 40% for polyps > 2 cm in diameter). Most gastric polyps are hyperplastic, they are not classified as precancerous conditions.
    • Immunodeficiency states, especially variable unclassified immunodeficiency (risk of carcinoma – 33%)
    • Helicobacter pylori infection. Classifications
    • According to macroscopic features
    • Polyposis cancer (exophytic). This type of tumor in the stomach is not often found, the prognosis for it is relatively favorable.
    • Saucer-shaped cancer is most characteristic of the stomach
    • Ulcerative infiltrative cancer
    • Diffuse-infiltrative cancer (linitis plastica, plastic linitis): widespread tumor infiltration of the mucosa and submucosa is observed
    • According to histological features. The most common form of stomach cancer is adenocarcinoma (of varying differentiation)
    • Papillary adenocarcinoma is represented by narrow or wide epithelial outgrowths on a connective tissue basis.
    • Tubular adenocarcinoma – branched tubular structures enclosed in stroma
    • Mucinous adenocarcinoma. The tumor contains a significant amount of mucus
    • Ring cell carcinoma. Tumor cells contain a lot of mucus
    • TNM classification (see also Tumor, stages)
    • T, – the tumor, regardless of its size, captures the mucous membrane or the mucous and submucosal membranes
    • T2 – tumor with deep invasion, occupies no more than half of one anatomical region
    • T3 – tumor with deep invasion, occupies more than half, but not more than one anatomical region
    • T4 – the tumor occupies more than one anatomical region or spreads to neighboring organs.

Clinical picture

    • Symptoms of stomach cancer usually appear in the later stages of the disease.
    • Epigastric pain is noted in 70% of patients
    • Anorexia (lack of appetite) and weight loss are typical for 70-80% of patients
    • Nausea and vomiting with lesions of the distal parts of the stomach. Vomiting is the result of obstruction of the pylorus by a tumor, but may be a consequence of impaired gastric motility
    • Dysphagia in cardiac lesions
    • Feeling of early satiety. Diffuse gastric cancer often occurs with a feeling of rapid satiety, because. the wall of the stomach cannot stretch normally
    • Gastrointestinal bleeding in gastric carcinomas occurs infrequently (less than 10% of cases) Palpable lymph node (Virchow node) in the left supraclavicular region indicates metastasis
    • Weakness and fatigue.

Diagnostics

    • X-ray contrast study. Serial x-rays of the upper GI tract reveal a neoplasm, ulcer, or thickened, non-distensible, skin-like stomach (diffuse gastric cancer). Simultaneous contrasting with air increases the information content of X-ray examination
    • Endoscopy with biopsy and cytology provides diagnosis of gastric cancer in 95-99% of cases
    • Ultrasound and CT of the abdomen are needed to detect metastases
    • In the blood, carcinoembryonic hypertension is not often determined, as well as an increase in the activity of p-glucuronidase in the secret of the stomach. Achlorhydria in response to maximal stimulation in gastric ulcers indicates malignant ulceration.

Treatment:

Diet number 0. Then, depending on the surgical intervention

    • Those who underwent partial resection of the stomach: a hyposodium, physiologically complete diet with a high content of proteins, a normal content of complex and a sharp restriction of easily digestible carbohydrates, a normal content of fats. It should limit the content of mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract (salts, marinades, smoking, canned food, hot, cold and carbonated drinks, alcohol, chocolate, spices, etc.), the content of nitrogenous extractive substances should be minimized (especially purines), refractory fats, aldehydes, acroleins. Exclude strong stimulants of bile secretion and secretion of the pancreas, as well as foods and dishes that can cause dumping syndrome (sweet liquid milk porridge, sweet milk, sweet tea, hot fatty soup, etc.). All dishes are cooked boiled or steamed, mashed. Energy value – 2 800-3 000 kcal / day
    • Those who underwent total resection of the stomach (1.5-3 months after the operation): a hyposodium, physiologically complete diet with a high content of proteins, restriction of fats and complex carbohydrates to the lower limit of the norm and a sharp restriction of easily digestible carbohydrates, with a moderate restriction of mechanical and chemical mucosal irritants membranes and receptor apparatus of the gastrointestinal tract. Stimulants of bile secretion and pancreatic secretion are excluded. All dishes are prepared boiled or steamed, not pureed. Energy value – 2 500-2 900 kcal / day. Surgical treatment of gastric cancer depends on the extent of the tumor in the stomach, the degree of damage to regional lymph nodes, and the presence of distant metastases.
    • Operation is a selection method; 5-year survival – in 12% of cases. With superficial localization of the tumor, the 5-year survival rate can reach 70%. For gastric ulcer cancer, the prognosis is slightly better (5-year survival rate is 30-50%)
    • Subtotal distal resection of the stomach with greater and lesser omentums in case of tumor localization in the distal parts of the stomach
    • Subtotal proximal resection of the stomach with greater and lesser omentums in case of damage to the cardia of the stomach
    • Gastrectomy with damage to the body of the stomach or with infiltrative tumors located in any of its departments
    • Combined gastrectomy with contact germination of the tumor in adjacent organs (for example, in the pancreas). They are removed as a single block.
    • Removal of regional lymph nodes during operations for gastric cancer leads to an increase in the life expectancy of patients, so lymphadenectomy is indicated for all patients.
    • Palliative resections of the stomach are indicated in the development of stenosis

stomach or bleeding from a decaying tumor. Chemotherapy suppresses malignant growth in 25-40% of cases, but has little effect on life expectancy. The question of the advisability of adjuvant therapy after surgical treatment of potentially curable tumors is quite controversial; however, some benefit has been achieved with fluorouracil, doxorubicin, and mitomycin. In inoperable tumors, some temporary benefit can be achieved with combined chemotherapy and radiation therapy.

  • Contraindications
  • Fluorouracil nbsp; – cachexia, leuko- and thrombocytopenia, severe infections, gastric and duodenal ulcers, ulcerative colitis, severe liver dysfunction; the product is not recommended for use within 1 month after a complex surgical intervention
  • Doxorubicin – severe disorders of the liver and kidneys, leukocytopenia and thrombocytopenia, severe concomitant heart disease, bleeding, tuberculosis, peptic ulcer of the stomach and duodenum
  • Mitomycin nbsp; – number of platelets