Gastric cancer is an oncological disease accompanied by the appearance of a malignant tumor formation formed on the basis of the epithelium of the gastric mucosa. Stomach cancer, the symptoms of which most often occur in patients aged 40-45 years (although an earlier age limit of 30-35 years is also allowed), is in second place in terms of morbidity and subsequent mortality, thereby following lung cancer in such comparison criteria.
general description
As we have already indicated, stomach cancer is a fairly common disease, and this pathology can develop in any part of the affected organ with subsequent spread to other organs (this clarification especially applies to the liver, lungs and esophagus). It should also be noted that there is a specific figure corresponding to the mortality rate of stomach cancer, which is about 800,000 people annually, which was determined on the basis of the studied indicators for 2008. In addition, it was found that this disease is more often diagnosed in men.
Approximately 80% of cases of stomach cancer are accompanied by the development of metastases. Let us recall that metastasis (metastasis) is understood as a process in which tumor cells begin to spread to other organs, thereby forming a pathological process in them in the form of a secondary focus. Metastasis in general occurs in tumor diseases through blood vessels (which defines hematogenous metastases), through lymphatic vessels (respectively, these are lymphogenous metastases) or through the space that the body cavities are located (which defines implantation metastases).
Returning to the characteristics of stomach cancer, we can also determine survival, which can be considered as a prognosis for stomach cancer. Thus, if the disease is detected early, 6-month survival is allowed in approximately 65% of cases, while its detection within the framework of progression to more serious ones determines it only in 5-15% of cases. It should also be noted that in approximately half of the cases of patients complaining of dyspepsia (a condition in which the normal functioning of the stomach is disrupted, digestion becomes painful and generally difficult), the subsequent discovery of much more serious pathologies occurs, including, in fact, stomach cancer.
As already noted, the prevailing age group is patients aged 40-45 years, however, the possibility of developing the disease in people from 30 to 35 years old and in younger people is also possible. In about 90% of cases, the tumor is malignant, and approximately 95% of these malignant tumors are carcinomas. Gastric carcinoma in men is diagnosed mainly between the ages of 50 and 75 years.
Stomach cancer is also characterized by the fact that its course can vary significantly depending on the specific country or region where it is diagnosed in a particular patient; accordingly, on the basis of this we can assume how significant a role climatic-geographical, nutritional, household and other types of factors play in development of the pathological process.
Stomach cancer: causes
It is currently not possible to identify a specific cause that provokes the development of stomach cancer. Meanwhile, certain predisposing factors for the development of the pathological process and, in fact, the disease directly related to it, can still be called relevant, among them the following:
- The bacterium Helicobacter pylori (helicobacterpylori). It is quite possible that the reader has an idea of what kind of bacterium this is, but we will briefly highlight the features that are inherent in it, defining what it is and what it provokes. And it provokes nothing more than gastritis and an equally common pathology - gastric ulcer. This bacterium also acts as a predisposing factor to the development of stomach cancer, and this bacterium, if present, increases this risk several times.
- Stomach polyps. They represent a growth of the mucous membrane of an organ of a benign nature; generally, gastric polyps develop against the background of existing chronic diseases that are relevant to the stomach. An example of a predisposing factor in this case is the chronic form of atrophic gastritis, in which the gastric mucosa is subject to depletion, and the production of gastric juice is significantly reduced. As in the previous case of considering a predisposing factor, a gastric polyp increases the risk of developing stomach cancer several times, and precisely in the area where it is located. This risk is supplemented by such conditions for the existing polyp as certain height indicators (if it is 2 or more centimeters), if it contains cells that cause the production of mucus, and if more than one polyp is concentrated on the gastric mucosa.
- The presence of chronic diseases of the gastric mucosa. Here, again, we can highlight the already noted atrophic gastritis, which also acts as a serious predisposing factor to the development of stomach cancer in a patient against this background.
- Heredity. Here, one can traditionally highlight the relevance of stomach diseases, and in particular stomach cancer, among the closest relatives of a particular patient - the risk of developing pathological diseases of this organ and the disease, which is the main one in our consideration, increases.
- Impact of nutritional factors. In particular, in this case, the dietary habits of patients are considered, namely, addiction to fried, spicy, canned and fatty foods. Chemically active substances damage the gastric mucosa by getting on it, which destroys its protective layer of mucus lining the surface of the epithelium, after which carcinogenic substances freely penetrate into the cells (namely, due to them, the development of cancer becomes possible), after which these cells are subject to destruction, or are reborn. In contrast, it can be noted that if the patient’s diet contains a significant amount of fruits and vegetables, vitamins and microelements, the risk of stomach cancer is significantly reduced.
- Smoking, alcohol. These impact factors are almost traditional in identifying factors that contribute to the development of a particular disease or pathological process; stomach cancer is no exception to this.
- Features of the body's hormonal activity, constitutional features. In considering this point, in particular, overweight and obesity in general are considered as background predisposing diseases, not only traditionally for the organs of the reproductive system, but also for the gastrointestinal tract, which, accordingly, determines a significant risk for the development of stomach cancer.
Peptic ulcer and stomach cancer
Peptic ulcer, indicated above as consideration in the context of the impact of Helicobacter on the development of stomach cancer, in its recurrent form, as well as duodenal ulcer - all this is considered as one of the main factors causing the development of stomach cancer. The process of degeneration of an ulcer into stomach cancer sometimes takes many years, but it is the very possibility of such degeneration that is a serious risk.
We will look at the symptoms of stomach cancer below; among them, you can also identify signs indicating that an old ulcer has degenerated into cancer. Stomach cancer develops somewhat less frequently on its own, that is, without a predisposing factor in the form of a previous ulcer. Here, cancer may resemble an ulcer in its manifestations, but the exact difference can only be made by a doctor and only as part of a diagnostic test, which is a biopsy.
Stomach cancer: classification
Based on what cells make up the tumor, the following types of forms of stomach cancer are distinguished:
- Adenocarcinoma (carcinoma). This form, as we initially noted in the general review, acts as the most common form among the types of stomach cancer. This type of stomach cancer involves the formation of a tumor based on cells that produce mucus.
- Solid gastric cancer. This form of pathology is extremely rare; dense tissue acts in this case as the basis of the tumor.
- Signet ring cell cancer of the stomach. This form of cancer is based on cells, examination of which under a microscope reveals their similarity to a ring, which, in turn, was the reason for this definition of cancer. For this gastric cancer, the characteristic features include the rapid growth of tumor formation, as well as early metastasis.
- Leiomyosarcoma. Based on this form of cancer, one can determine its peculiarity, which is the formation of a tumor formation based on the muscle cells of the organ (i.e., the stomach).
- Lymphoma. In this case, the tumor formation in stomach cancer is based on lymphatic cells concentrated within the region of this organ.
The classification of stomach cancer according to its forms does not end there; a separate part of it is based on the specific part in which the tumor developed; the following options are distinguished:
- Cardiac gastric cancer. This form of cancer develops in the upper part of the stomach organ, specifically in the place where it “joins” the esophagus.
- Body cancer of the stomach. In this form, the cancer affects the middle part of the organ.
- Cancer of the lesser curvature of the stomach. Here the cancer covers the area of the right gastric wall.
- Cancer of the pylorus (pylorus). In this variant, cancer develops from the side from which the anatomical transition of the organ to the duodenum occurs.
And finally, depending on the characteristics of the appearance of the tumor formation, a specific number of forms of stomach cancer are also distinguished, in particular, the following options include:
- Endophytic gastric cancer. This type of cancer is characterized by the fact that the tumor grows deep into the gastric wall, which, due to such features, determines its similarity to a stomach ulcer (saucer-shaped stomach cancer, ulcer-cancer).
- Exophytic gastric cancer. This type of cancer is characterized by the fact that the tumor grows into the lumen of the stomach. This type of cancer can manifest itself in a polypoid form (that is, the characteristics of its growth determine its resemblance to a stomach polyp), in a mushroom form (the growth characteristics equate it to a mushroom), and also in a nodular form (the tumor manifests itself in the form of a dense type of node protruding from the side organ walls).
Stomach cancer: stages (degrees)
Based on how intensively the tumor spreads, a number of stages of stomach cancer corresponding to the process are determined.
- Stage 0. This stage is characterized by the fact that, within the framework of its manifestation, tumor cells are limited in damage only to the inner layer of the organ, without concomitant spread into depth. With timely diagnosis of pathology during this stage of its course, very significant positive results can be achieved.
- Stage I. This stage of cancer is characterized by a 5-year survival rate of approximately 80% of cases. It is also divided into the following substages:
- 1A. This substage indicates that the tumor formation has not spread in depth to the inner layer of the organ.
- 1B. This substage determines the spread of the tumor to nearby lymph nodes or indicates its penetration into the muscle layer of the organ.
- Stage II. Similar to the previous stage, this stage is divided into substages, 2A and 2B. As for the survival rate within the considered period of 5 years, here it is approximately 56%.
- 2A. A characteristic feature of the progression of the pathological process within this stage is the lack of spread to the inner layer of the stomach, but at the same time there are already cancer cells in the nearby lymph nodes 3-6 lymph nodes. It is also possible that the tumor has spread to the muscle layer, as well as to 1-2 lymph nodes located nearby. And finally, an option is allowed in which the tumor has grown into all layers of the gastric wall, but with the exception of spread to the lymph nodes.
- 2B. This substage can also manifest itself in several ways. Thus, an option is allowed in which the tumor is limited only to the inner gastric layer while simultaneously spreading to the lymph nodes (7 or more). It is also possible that the tumor grows into the muscle layer while simultaneously spreading to the lymph nodes (1-2). And finally, such an option is allowed within this stage, in which the tumor is outside the outer gastric layer, but with the exception of the pathological process in this scenario of spread to the lymph nodes.
- Stage III. This stage is characterized by the correspondence of the clinical picture to three main variants of substages: 3A, 3B, 3C. At this stage, survival for a period of 5 years is determined in 15-38% of cases.
- 3A. This substage of the disease indicates that the tumor has spread to the muscular gastric layer, as well as to nearby lymph nodes (7 or more). In another variant of the course of the disease, within this substage, tumor growth is allowed to all layers of the stomach with the simultaneous presence of tumor cells in nearby lymph nodes (in the amount of 1-2).
- 3B. This substage indicates that the tumor has grown to the outer gastric wall while simultaneously spreading to nearby lymph nodes (7 or more). It is also possible for a tumor to grow into tissues surrounding the stomach while there are simultaneous presence of cancer cells in nearby lymph nodes (damage to 1-2 lymph nodes).
- 3C. Within this substage, the course of the disease is based on the spread of the tumor beyond the outer gastric wall, as well as its spread to nearby lymph nodes (7 or more). In another variant of the course of the pathological process within this substage, the spread of the tumor process occurs to the tissues surrounding the gastric organ with spread to 3-6 lymph nodes.
- Stage IV. Grade 4 (stage) of stomach cancer is characterized by the fact that the pathological process has spread through the lymphatic pathways to other organs (in other words, metastasis occurs). As for the 5-year survival rate in this case, here it hardly reaches 5%.
Stomach cancer: symptoms
In fact, this disease does not have any symptoms specific to it. Meanwhile, certain manifestations can be considered as signs of stomach cancer. To begin with, we can define two main groups to which such signs (symptoms) can be attributed.- Symptoms not specific to the stomach. These types of manifestations include weakness, fever, weight change (loss), change in appetite (it is either reduced or completely absent). In addition, patients may develop depression, which manifests itself in loss of interest in what is happening around them, alienation and apathy. In this case, special attention is paid to changes in the patient’s typical symptoms (ulcerative or gastric), in particular, to their intensification and addition of other manifestations.
- Symptoms of a specific nature of manifestation. In this case, specific manifestations of symptoms mean such manifestations that are generally inherent in stomach diseases:
- Nausea, vomiting. These manifestations usually indicate a variety of diseases of the stomach, indicating peptic ulcers, acute gastritis, etc. With stomach cancer, these symptoms are caused by the fact that the tumor formation, having reached a significant size, begins to block the space at the exit of the stomach.
- Specific vomiting. In particular, this refers to vomiting with stagnant contents, that is, with such contents that contain food eaten 1-2 days before. This is accompanied by painful sensations for the patient and his general exhaustion.
- Loose black stools, vomit that resembles coffee grounds. These symptoms indicate that bleeding has occurred from an ulcer or a tumor has developed in the stomach. In any case, all this requires immediate medical attention, which, in turn, will be aimed at stopping the bleeding that occurs.
- Abdominal pain. This symptom can manifest itself in different ways, because the pain can be dull, aching or pulling; it is concentrated in the epigastric region (on the left side under the edge of the ribs). As for the nature of the manifestation, the pain is mostly periodic, most often its appearance is noted after eating. If it appears constantly, then this indicates that an inflammatory process has joined the pathological process or that the tumor has begun to grow into neighboring organs.
- Difficulty passing food. This symptom can reach a stage at which even the passage of food is impossible. In this case, this manifestation can be considered either as a symptom of esophageal cancer, or as a symptom of cancer of the initial gastric region.
- Quick satiety with food, feeling of fullness and heaviness in the stomach, general discomfort in its area.
- Increased symptoms of belching, heartburn. Patients notice such manifestations themselves; this, in fact, may be a reason to contact a specialist to clarify the diagnosis.
You should also pay attention to manifestations that indicate an advanced pathological process. These include the following options:
- palpable pain in the abdominal area;
- change in the size of the abdomen (it increases, which occurs against the background of accumulation of fluid in the abdominal cavity (defined as ascites), or this can occur as a result of an enlarged liver);
- pallor of the skin and mucous membranes (against the background of anemia), yellowness of the skin and mucous membranes; as part of later manifestations of the pathology, the skin may acquire an earthy tint; in general, in the early stages, patients do not experience any special external changes;
- an increase in the size of the lymph nodes on the left side in the area above the collarbone, as well as lymph nodes located in the axillary region on the left and lymph nodes concentrated in the navel (these changes indicate metastasis of the pathological process).
Let us repeat that the above-mentioned vomiting, which resembles “coffee grounds” in specificity, requires immediate assistance, so you need to immediately call an ambulance.
Diagnosis
The main methods for diagnosing stomach cancer are the following:- gastroscopy is a method of visualizing the gastric mucosa for current changes, which also allows for a biopsy (removal of tissue in the affected area for subsequent examination);
- fluoroscopy - this method involves the oral administration of a contrast agent, which uses barium sulfate, thereby determining the possibility of identifying the specific location of the lesion and the extent of its extent along the gastric wall;
- Ultrasound is an ultrasound research method aimed at studying the abdominal cavity and the retroperitoneal space (it is used without fail for stomach cancer, it also allows one to determine the relevance of metastasis);
- CT - computed tomography, makes it possible to diagnose stomach cancer, although it is used for a slightly different purpose, which is to assess the extent of the spread of the pathological process and to identify metastases;
- Laparoscopy is a method that allows you to determine the stage of the pathological process in stomach cancer, determine the presence of metastases in the peritoneum and liver that are not detected by CT and ultrasound.
- tumor markers - this method is highly specific, although insensitive; the sensitivity of use increases with actual metastasis.
Treatment
Treatment of stomach cancer today comes down to the only effective method, which is radical removal of the tumor through surgery. Due to gastric resection, in addition, treatment is improved in terms of symptoms associated with the disease. So, in this case, the cause of pain, actual dysphagia and bleeding, is directly eliminated. The number of tumor cells in the body can also be reduced, thereby increasing the patient’s life expectancy and generally improving his condition. In certain cases, during such an operation, part of the stomach must be removed, and sometimes the entire stomach. Chemotherapy and radiation exposure are considered as auxiliary treatment methods - these treatment measures are relevant when the tumor has spread beyond the affected organ.
If symptoms appear that indicate possible stomach cancer, you should contact a gastroenterologist and oncologist.
Stomach cancer is considered by doctors to be a very serious disease, which is very difficult to detect at an early stage. The appearance of abdominal pain in a patient, as well as nausea, may indicate the development of gastritis or a stomach ulcer. Because of this, the patient cannot always understand that he is developing a disease such as cancer. Doctors note that there is no specific list of “causes of stomach cancer” that indicate the development of oncology.
At the initial stages of development, stomach cancer does not reveal itself by any primary symptoms. Because of this, doctors strongly recommend that every patient be well aware of the main signs of cancer development. This will help to identify the disease at an early stage and receive competent treatment from a specialist.
What is stomach cancer and causes
Doctors note that initially the cancer process in the stomach area begins with a violation of its mucous membrane. After this, metastases appear in it, affecting neighboring organs. With the development of a severe stage of cancer, metastases can affect the lungs.
Often patients who have been given this terrible diagnosis turn to their doctor with the question: “What causes stomach cancer?” Doctors note that there are a number of possible factors leading to the appearance of this unpleasant disease:
- Penetration of the bacterium Helicobacter pylori. Doctors note that this virus survives in an acidic environment and can provoke the appearance of diseases such as gastritis and peptic ulcers. The virus destroys the gastric mucosa and causes the appearance of various erosive tumors. They create a favorable environment for the development of the cancer process.
- Frequent consumption of foods with a small amount of useful elements, as well as frequent consumption of fatty, fried, spicy and smoked foods, various pickles and canned food. All this can cause the development of cancer.
- Not following the correct diet. Most often, stomach cancer appears in people who often eat at night, snack on high-calorie foods, as well as in citizens who very often consume large amounts of food.
- Rapid penetration of substances such as nitrates and nitrites into the body. They disrupt the structure of the gastric mucosa and cause the degeneration of cells in it. Doctors note that a person receives these substances by consuming large quantities of vegetables that contain exceeded permissible levels of chemicals.
- Frequent consumption of large quantities of dried foods, beer, cheese. All of them contain salts of nitric and nitrous acids, which also lead to the development of mucous cancer.
- Bad habits and abuse of alcoholic beverages. Doctors have proven that alcohol contains a huge amount of substances such as nitrates and nitrites. In addition, ethyl alcohol itself, which is contained in any alcohol, is the main cause of the development of oncology in the digestive system.
- Frequent use of medications. Experts say that most medications have an extremely negative effect on the digestive system. These usually include antibiotics and corticosteroids. The instructions for use of such drugs often indicate the appearance of a stomach ulcer as a side effect, which usually degenerates into oncology.
- Prolonged exposure of the patient's body to radiation. If a patient's body was exposed to radioactive radiation for a long period of time, then some cells in his body could degenerate into cancer. In addition, oncology can appear in people who have frequent contact with contaminated objects.
Additional causes of cancer in humans:
- the patient is overweight;
- bad heredity.
Also, stomach cancer can appear in those patients who have previously undergone surgery in the digestive system or have previously been diagnosed with tumors of various origins.
Often doctors, when answering the question: “Why does mucous cancer occur,” note that there are a number of diseases that lead to oncology. These include:
- the presence of polyps in the gastrointestinal tract. It is noteworthy that they all degenerate into oncology;
- development of anemia in a person, which is caused by a lack of vitamin B12. It is involved in the formation of epithelial cells of the gastrointestinal tract. Its deficiency causes the development of a cancerous process;
- the presence of chronic gastritis. It is noteworthy that atrophic gastritis often leads to the death of normal stomach cells;
- the patient develops Ménétrier's disease. This disease leads to a sharp increase in the cells of the gastric mucosa;
- stomach ulcer. Doctors note that this disease leads to cancer.
Main signs of gastric cancer
Doctors note that in most cases, stomach cancer is accompanied by the following unpleasant signs:
- the presence of chronic fatigue and rapid fatigue;
- a sharp decrease in appetite and rapid loss of body weight;
- the appearance of discomfort in the stomach;
- frequent bloating and feeling of fullness in the stomach;
- the presence of frequent nausea, vomiting and saliva flow from the mouth;
- the appearance of aching, nagging and dull pain in the digestive tract. Most often they occur in humans after eating;
- The patient is bothered by heartburn and difficulty swallowing. Typically, such signs appear if the tumor has arisen in the upper part of the gastrointestinal tract;
- the appearance of congestive vomiting. Usually a person vomits what he has eaten in a day or two. Also the appearance of vomiting “coffee grounds”, mixed with blood;
- liquid black stool. This usually indicates bleeding in the stomach area. In this case, the patient should immediately call an ambulance.
Thus, no person is immune from developing a cancerous tumor in the stomach area. Doctors recommend a comprehensive examination and diagnostics of the stomach as a preventive measure. Experts also recommend that if unpleasant symptoms appear in the stomach area, immediately consult a specialist.
This will help detect cancer at an early stage and increase the chance of complete relief from the disease, and reduce the likelihood of complications after treatment.
Informative video
Gastric cancer is a malignant tumor that develops from cells in the lining of the stomach.
The causes of stomach cancer can be divided into several types:
1. Nutritional - related to dietary habits: abuse of fatty, fried, canned and spicy foods. 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 the cells, followed by their destruction or degeneration. At the same time, eating a large amount of vegetables and fruits, microelements and vitamins significantly reduces the incidence of cancer.
2. Smoking and alcohol influence the development of stomach cancer.
4. Genetic factors: hereditary predisposition - the presence in the family of close relatives with cancer of the gastrointestinal tract or other organs.
5. Constitutional characteristics and hormonal activity. High weight and obesity are underlying diseases for the reproductive organs and gastrointestinal tract, including stomach cancer.
Up to 80% of patients with initial forms of stomach cancer do not complain. Often, visiting a doctor is due to concomitant diseases. Severe symptoms usually indicate an advanced process.
Symptoms of stomach cancer
There are no characteristic symptoms of stomach cancer, but a number of symptoms can be identified that help to suspect this disease; they can be divided into two groups:
1) Non-specific for the stomach: weakness, rises in body temperature, decreased or lack of appetite, weight loss.
2) Specific for stomach diseases:
- abdominal pain: characterized by aching, pulling, dull pain in the epigastrium (under the left edge of the ribs). May be periodic, most often occurring after eating. The pain becomes constant as a result of the addition of a concomitant inflammatory process or tumor invasion of neighboring organs.
- nausea and vomiting: a symptom of various stomach diseases: acute gastritis, peptic ulcer; in cancer, it is characterized by a large tumor that blocks the exit from the stomach.
- vomiting of stagnant contents (food eaten the day before 1-2 days): with tumors of the outlet (antrum) of the stomach, at the border with the duodenum, causing stenosis and leading to stagnation of contents in the lumen of the stomach for up to several hours or days, painful sensations and exhaustion sick.
- vomiting of “black, coffee grounds”, black loose stools - characterizes bleeding from an ulcer or tumor of the stomach, requires urgent therapeutic measures (stopping the bleeding).
- difficulty passing food, up to the impossibility of passing liquid, a symptom of cancer of the esophagus and the initial part of the stomach.
- feeling of fullness in the stomach after eating, heaviness, discomfort, rapid satiety.
- increased heartburn, belching - a change in the intensity of complaints may be noticed by the patient himself.
3) symptoms of an advanced process:
- palpable tumor in the abdomen.
- an increase in the size of the abdomen due to the presence of fluid (ascites) or an enlarged liver.
- jaundice, pallor of the skin as a result of anemia (decreased red blood).
- enlargement of the supraclavicular lymph nodes on the left, left axillary lymph nodes and near the navel (metastasis).
If the patient experiences such complaints, as well as changes in the intensity and nature of usual complaints, you should immediately consult a doctor.
If you vomit coffee grounds, you should immediately call an ambulance.
A number of examinations to detect stomach cancer:
The leading research in this case is video esophagogastroduodenoscopy (EGD).
This research method allows you to examine in detail the mucous membrane of the esophagus, stomach and duodenum and detect a tumor, determine its boundaries and take a piece for examination under a microscope.
The method is safe and well tolerated by patients. If small tumors are detected in the initial stage, it is possible to remove them through the same device using short-acting intravenous anesthesia.
View of a stomach tumor in NDI mode through a gastroscope
All patients over 50 years of age, as well as those suffering from chronic gastritis and a history of stomach ulcers, must undergo an annual gastroscopy (from the Latin “gaster” - stomach, “scopia” - to examine) in order to identify tumor pathology at an early stage.
X-ray of the stomach- one of the old research methods. To a greater extent, it allows assessing the functional capabilities of the organ. Allows you to suspect tumor recurrence after gastric surgery. It is effective in infiltrative forms of cancer, when biopsy results may be negative, is safe for the patient and does not incur a large radiation dose.
Ultrasound examination of the abdominal organs allows you to identify indirect signs of a stomach tumor (symptom of a mass formation in the upper abdomen), tumor germination into the underlying organs (pancreas), metastatic damage to the liver, nearby lymph nodes, the presence of fluid in the abdomen (ascites), metastatic damage to the serous membrane of internal organs (peritoneum ).
Computed tomography of the abdomen allows you to interpret in more detail the changes detected by ultrasound - to exclude or confirm metastases in the internal organs.
Endoscopic ultrasound examination used when submucosal tumors of the stomach are suspected, growing in the thickness of its wall, when identifying early cancers to assess the depth of tumor growth into the wall of the organ.
Diagnostic laparoscopy- an operation performed under intravenous anesthesia through punctures in the abdominal wall, into which a camera is inserted to examine the abdominal organs. The study is used in unclear cases, as well as to detect tumor growth into surrounding tissues, metastases to the liver and peritoneum, and to take a biopsy.
Blood test for tumor markers- proteins produced only by a tumor and absent in a healthy body. Ca 19.9, CEA, Ca 72.4 are used to detect stomach cancer. But all of them have low diagnostic value and are usually used in treated patients in order to detect metastasis as early as possible.
Types of tumor lesions of the stomach depending on the location of the tumor in the organ:
Cardiac cancer - 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 (outlet section);
- cancer of the gastric angle (the angle between the stomach and duodenum);
- total damage to the stomach with infiltrative cancers.
Forms of stomach cancer:
Exophytic cancer: a tumor grows into the lumen of the stomach, having the appearance of a polyp, “cauliflower” or ulcer, maybe in the shape of a saucer, and so on.
- infiltrative cancer: as if “spreading” along the wall of the stomach.
The stages of stomach cancer vary depending on the depth of invasion of the organ wall:
Stage 0 - cancer “in situ” - the initial form of cancer, limited to the mucous membrane, the stomach wall does not grow;
Stage 1 - the tumor grows into the submucosal layer of the stomach wall without metastases in nearby lymph nodes;
Stage 2 - grows into the muscular lining of the stomach, there are metastases in nearby lymph nodes;
Stage 3 - the tumor grows throughout the thickness of the stomach wall, there are metastases in nearby lymph nodes;
Stage 4 - the tumor grows into neighboring organs: the pancreas, large vessels of the abdominal cavity. Or there are metastases to the abdominal organs (liver, peritoneum, ovaries in women).
Prognosis for stomach cancer
The prognosis is most favorable for early cancer and stage 1 of the tumor process, survival rate reaches 80-90%. At stages 2-3, the prognosis depends on the number of metastases in regional lymph nodes and is directly proportional to their number. At stage 4, the prognosis is extremely unfavorable and there can be hope for recovery only if the tumor is completely removed as a result of extensive surgery.
Stomach cancer, unlike other malignant tumors, is dangerous due to local return of the disease (relapse) both in the walls of the removed organ and in the abdominal cavity itself. Gastric cancer metastasizes most often to the liver and peritoneum (implantation metastases), to the lymph nodes of the abdominal cavity, and less often to other organs (supraclavicular lymph nodes, ovaries, lungs). Metastases are screenings from the main tumor that have its structure and are capable of growing, disrupting the function of the organs where they develop. The appearance of metastases is associated with the natural growth of the tumor: the tissue grows quickly, not all its elements have enough nutrition, some of the cells lose connection with the rest, break away from the tumor and enter the blood vessels, spread throughout the body and enter organs with a small and developed vascular network (liver , lungs, brain, bones), settle in them from the bloodstream and begin to grow, forming colonies-metastases. In some cases, metastases can reach enormous sizes (more than 10 cm) and lead to the death of patients from poisoning with waste products of the tumor and disruption of the organ.
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 gastric surgery:
Removal of part of the organ - resection of the stomach (distal - removal of the outlet section, proximal - removal of the section closest to the esophagus), is performed for exophytic tumors of the antrum or cardiac sections of the stomach, respectively.
- gastrectomy (from the Latin “gastr” - stomach, “ectomy” - removal) - removal of the entire stomach with the subsequent formation of a “reservoir” from the loops of the small intestine, performed for tumors of the body of the stomach (middle part).
- Combined extended operations - with the removal of part of the nearby organs involved in the tumor - pancreas, liver and others.
- removal of a gastrostomy - the formation of an opening in the stomach on the abdomen, is performed for unremovable tumors that interfere with the passage of food, for feeding patients, in order to alleviate the patient’s condition and prolong life.
- formation of a bypass anastomosis between the stomach and intestinal loops - creation of a bypass path for the passage of food, used for intractable tumors in order to prolong the life of patients.
Often the operation is supplemented with some other special antitumor 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 in order to destroy microscopic metastases that could not be detected by the eye during surgery.
- when metastases are detected in other organs (liver, lungs, peritoneum, etc.), 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 tumors of this organ are 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 resection area when examined under a microscope - irradiation of the anastomosis (formed anastomosis) between the esophagus and intestines.
Self-medication for stomach tumors is unacceptable and dangerous, as it can lead to complete disruption of the passage of food from the stomach to the intestines - pyloric stenosis, which in turn leads patients to death from starvation. It is also not worth using so-called “folk remedies”, especially toxic ones, 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 the earliest possible treatment can ensure the patient’s recovery.
Complications of stomach cancer:
Bleeding from a tumor is a dangerous complication that can lead to the patient’s death very quickly. If symptoms such as vomiting “coffee grounds” - black coagulated blood or black liquid stools appear, you should immediately consult a doctor or call an ambulance, especially if these symptoms are accompanied by abdominal pain, increased heart rate, pale skin, and fainting.
- pyloric stenosis (obstruction) - the formation of an obstruction from a tumor in the outlet of the stomach, completely blocking the normal passage of food through the gastrointestinal tract. Symptoms of pyloric stenosis are: vomiting of stagnant contents (1-2 days before, eaten food). Requires emergency surgery.
Prevention
Prevention of stomach cancer includes proper and nutritious nutrition, quitting smoking, and timely annual examination of the stomach, especially for patients with a history of peptic ulcers and chronic gastritis.
Consultation with an oncologist on stomach cancer:
1. Question: Is it possible to detect stomach cancer at an early stage?
Answer: Yes, this is possible, for example, in Japan the proportion of early stomach cancers is 40%, while in Russia there are no more than 10%. Most often, early cancers are detected during examination for another, concomitant pathology. The key to identifying early cancers is an annual endoscopic examination of the stomach - FGDS by an experienced specialist, in a clinic with good equipment.
2. Question: What are the results of treatment for early stomach cancer?
Answer: Cure for early cancers is almost 100%. Operations are performed endoscopically - through a fibrogastroscope using special equipment. Only the gastric mucosa with the tumor is removed. Such operations can be performed only for early cancers; for all other forms of cancer, abdominal surgery is indicated.
3. Question: What are the results of treatment for advanced gastric cancer?
Answer: the survival prognosis is more or less favorable only if the entire tumor and metastases are removed as a result of extended operations, but even in this case, relapse of the disease is possible.
Oncologist Natalya Yurievna Barinova
Today, for every person, the word “oncology” is a terrible expression. Especially when it comes to the presence of a tumor in the stomach. Stomach cancer is very severe and steadily progressing, provided that there is no treatment for a disease that can lead not only to the development of severe complications, but also to the death of the patient.
According to the World Health Organization, stomach cancer is in third place, second only to lung and skin cancer, and in the structure of mortality, stomach cancer is second only to lung cancer. The incidence increases significantly for men over 60 years of age and for women after 50 years of age, while the incidence of stomach cancer for men and women is at the same level.
Causes
Oncological diseases arise due to the influence of a combination of factors on the body. With the onset of DNA mutations, pathologically altered cells are eliminated with the help of special immune cells (NK cells, natural killer cells). If such antitumor immunity is not able to cope with the removal of pathologically altered cells, then the process of uncontrolled division begins.
An initial tumor node begins to form, which destroys the organ from the inside, and then begins to grow into nearby tissues. After this, metastases spread to other more distant organs. A similar situation is present with stomach cancer. Oncological processes at the cellular level can develop over a long period of time, so quite often the asymptomatic stage can last several years.
Provoking environmental factors:
unfavorable environmental conditions - industrial waste, smoke in populated areas with exhaust gases, a large amount of household chemicals (toys made of toxic materials, household appliances, low-quality furniture, cosmetics) - reduces immunity, contributes to the accumulation of carcinogenic substances in organs;
associated diseases are diseases caused by Helicobacter bacteria, which live on the inner wall of the stomach and differ in types that can cause chronic gastritis and stomach ulcers. In chronic gastritis, increased acidity in the stomach can cause the development of ulcers, which can become malignant;
products - refined oil, sugar, white flour, excessive consumption of fatty, fried, spicy foods, fertilizer residues in greenhouse fruits and vegetables, food additives lead to damage to the stomach wall and a decrease in its protective properties;
medications - antibiotics, corticosteroid hormonal drugs, painkillers;
alcohol abuse, smoking - irritation of the mucous membrane;
radiation (ionizing radiation) – causes cell mutation by influencing the nucleus containing DNA.
Internal factors:
metabolic disorders – vitamin metabolism disorders, immune and hormonal disorders;
age – the risk of developing cancer processes in the body increases after 50-60 years;
predisposing diseases - formations in the stomach of a benign nature (adenomas, polyps), which can degenerate into malignant ones, as well as deficiency of folic acid and B12, which are involved in the process of cell reproduction and division without DNA mutation;
genetic predisposition – experts have proven that most diseases are hereditary. Oncological lesions of the body, including stomach cancer, are no exception.
Manifestations and symptoms of stomach cancer
The clinical manifestations of stomach cancer depend on the stage at which the process is present.
Carcinoma “cancer in situ” - clinical manifestations are completely absent, and the detection of pathology in most cases is a completely random finding during a mucosal biopsy for the presence of other pathologies.
First stage of stomach cancer: the tumor is localized mainly in the mucous membrane itself, while there is no germination into the muscular layer of the stomach. Lymph nodes (1-2) are likely to be affected, which are located throughout the entire length of the organ (T1 N1 M0 or T1 N0 M0). Starting from this stage, the first symptoms of the disease are present:
depressive emotional background;
probably a prolonged increase in body temperature (low-grade fever);
aversion to animal proteins in food (fish and meat products or one type of meat);
pronounced decrease in body weight;
anemia (drop in hemoglobin level);
lack of appetite;
increased fatigue;
unmotivated weakness of the body.
Second stage: the tumor may continue to be located within the gastric mucosa, but more than 3-6 lymph nodes are affected, or it grows into the muscle layer with damage to 1-2 lymph nodes (T2 N1 M0 or T1 N2 M0). The first signs begin to appear that indicate a disruption of the gastrointestinal tract:
feeling of discomfort in the abdomen;
defecation disorder;
increased gas formation (flatulence) in the intestines;
progressive loss of body weight;
belching air;
vomiting, which brings only short-term relief;
Such complaints are not of a constant, pronounced nature, so quite often patients do not attach much importance to this and delay their visit to the doctor.
Third stage: the tumor grows not only into the muscle layer, but also through the outer lining of the stomach, causing damage to neighboring tissues and organs, and damage to more than seven lymph nodes. There are no metastases (T2 -4 N1-3 M0).
with cancer of the exiting “pyloric” part of the stomach, food can get stuck in the organ for several days, which is manifested by belching with the smell of rotten eggs, vomiting of stagnant contents, a feeling of fullness in the epigastrium (constant), a feeling of rapid satiety;
in the presence of a tumor in the cardinal (initial) section, dysphagic phenomena appear - regurgitation, frequent choking, so food must be washed down with water or taken only in liquid form;
the patient is practically unable to eat food because it does not pass into the stomach;
pain in the epigastric region intensifies and becomes permanent;
complaints characteristic of the second stage become more pronounced.
Fourth stage: the tumor completely grows in the wall of the stomach, adjacent organs and tissues are destroyed, more than 15 lymph nodes are affected, metastases appear in distant organs and lymph nodes - in the lymph node of the supraclavicular fossa, lymph nodes of the perirectal fatty tissue (around the rectum), ovaries in women:
the body is poisoned from the inside by the products of decay and metabolism in the tumor, a sufficient amount of nutrients is not supplied, the tumor cells absorb nutritional products from the blood, dystrophic changes occur in all systems and organs that lead to death;
constant excruciating pain appears, which is relieved for a short time by taking narcotic analgesics;
the patient is so exhausted that he is able to take food only with the help of a tube;
earlier symptoms become permanent.
It is at stages 3 and 4, which are considered late, that patients consult a doctor (80% of cases). In such cases, the diagnosis of stomach cancer is no longer in doubt and has a worse prognosis.
Diagnosis of stomach cancer
Recently, the issue of early diagnosis of stomach cancer has become particularly acute. For example, research is being conducted in the field of photofluoroscopic screening and electrical impedance spectroscopy, which may increase the percentage of patients with cancer detected in the early stages.
When visiting a doctor, a patient who is suspected of having stomach cancer may be prescribed the following tests:
General analysis of urine and blood. With their help, it is possible to determine impaired renal function (which is determined by the presence of protein and blood in the urine), accelerated blood ESR, and decreased hemoglobin levels;
a biochemical blood test, which can be used to determine dysfunction of the pancreas and liver if metastasis or tumor germination is present;
immunological blood test - study of antibody titers to Helicobacter pylori;
stool analysis for the presence of occult blood - if bleeding from the tumor is suspected;
tumor markers – allow you to evaluate the response of the tumor to therapy after confirmation of the diagnosis;
FEGDS (fibrogastroduodenoscopy) is the most commonly used method for diagnosing malignant tumors in the stomach. Using an optical instrument that is inserted through the esophagus into the duodenum or stomach, you can examine the intestines and stomach for the presence of tumors, evaluate its location, shape and size, and take material for further microscopic examination to determine hormonal, immune, chemical and other properties. For population prevention, such a survey can be carried out annually for people over 40 years of age;
X-ray examination of the chest allows you to determine the presence of metastases in the lymph nodes of the mediastinum, bones of the chest, and lungs;
MRI and CT – by layer-by-layer scanning of the abdominal organs, you can determine the exact location of the tumor, which is very important if surgical treatment is planned;
MRI for more accurate diagnosis of the tumor process;
Ultrasound of the lymph nodes, pelvic organs and abdominal cavity makes it possible to identify the presence of the tumor itself and the extent of damage to the lymph nodes that are adjacent to the pancreas;
X-ray of the limbs and bones of the skull - carried out in case of suspected metastases.
Treatment of stomach cancer
Today, scientists around the world have joined forces in search of an effective cancer treatment. And there are already some achievements in this area. For example, Western clinics are already practicing the use of targeted therapy, in which the patient is treated with drugs that can identify and attack individual pathologically altered cells. Among these drugs:
enzyme inhibitors - are able to penetrate a cancer cell and disrupt its functions, which causes the death of this cell. The following drugs are used: Bortezomib, Penitumumab, Alemtuzmab;
immunoglobulins - act like antibodies, recognize foreign cells and block them, while transmitting information to real immune cells, which destroy pathogenic cells.
In Russia, such methods are still in a state of research and study, and treatment of stomach cancer is carried out using the following methods and their combinations:
Surgery
The operation is a radical method of cancer treatment, since the process involves removing part of the stomach or the entire organ completely (total or subtotal gastrectomy). Lymph nodes and other organs that have undergone a tumor process are also excised.
If a patient is diagnosed with the fourth stage of gastric cancer, in which metastasis occurs to other organs, and it is impossible to perform gastric resection, since there is a pronounced spread of the tumor, then a gastrostomy technique is used - an opening that is located on the anterior abdominal wall and serves to the stomach delivers food.
Chemotherapy
It is a method in which chemotherapy drugs are introduced into the patient’s body, which have a detrimental effect not only on tumor cells, but also on healthy ones (which is why the method has a lot of side effects - hemorrhagic cystitis, weight loss, vomiting, constant nausea, hair loss). These drugs include antitumor antibiotics, cytotoxins and cytostatics (Methotrexal, Epirubicin, Lomustine, Topotecan, 5-fluorouracil). Chemotherapy is carried out in courses that are repeated on the thirtieth day, and after that every eight weeks. Chemotherapy can be given both before and after surgery.
Radiation therapy
It involves irradiating the projection of the organ affected by the tumor using small doses of X-ray radiation. In the presence of stomach cancer, targeted irradiation of the organ is used during surgery.
Symptomatic therapy
Vitamins, painkillers, drugs against flatulence, vomiting, nausea, normalizers of intestinal microflora and immunostimulants are used.
Lifestyle of a patient who has a tumor in the stomach
A patient undergoing tumor therapy should adhere to the following recommendations:
correct organization of the regime - more rest, sufficient sleep, development of an acceptable rest and work regime;
adherence to the diet - the first 3-6 days (the length of time depends on the volume of surgical intervention). It is forbidden to eat food. Only drinking water is allowed. After the expiration of the period, it is necessary to start with liquid food, gradually switch to ground food and expand the diet. Food should be taken in small portions and quite often (6-8 meals). The following products are allowed: bread, dairy products, vegetables, fruits (which do not cause fermentation), fish and lean meat, soups, cereals. It is necessary to limit the consumption of sweets and whole milk. Avoid alcohol, salty, fatty, fried, spicy foods, coffee, smoking and other foods that irritate the mucous membrane of the gastrointestinal tract;
limiting severe physical activity, especially after surgery;
frequent walks in the fresh air;
limit the influence of negative emotions;
undergo periodic spa treatment, but physiotherapeutic procedures should be excluded;
regular examinations with the attending physician with the necessary studies.
Complications of stomach cancer
Bleeding from a tumor:
symptoms – vomiting of blood-stained contents, black tarry stools, loss of consciousness, nausea, severe weakness;
diagnostics: fibrogastroduodenoscopy;
treatment: surgical using a laparoscope, endoscopic (cauterization of the wound using an endoscope).
Cicatricial stenosis of the pyloric pylorus at the junction of the stomach and duodenum. It is characterized by partial or complete obstruction of food from the stomach to the intestines.
symptoms - frequent vomiting of stagnant contents, after which relief comes, belching with a rotten odor, a feeling of fullness in the epigstrum, rapid satiety, constant nausea, weakness;
diagnostics - FEGDS and fluoroscopic examination of the stomach after taking a barium suspension;
treatment is surgery.
Disease prognosis
There is no clear answer to the question of life expectancy with stomach cancer. It all depends on how timely the patient sought medical help. For stomach cancer, the prognosis is determined by five-year survival. Survival varies significantly depending on the stage at which diagnosis is made.
The first stage is the most favorable prognosis: eighty people out of a hundred survive, and 70% of patients achieve complete recovery.
The second stage - the prognosis is not so favorable, since the five-year survival rate is 56%.
The third stage - the prognosis is unfavorable, since only thirty-eight out of a hundred people survive, all the rest die from complications and further spread of cancer.
Stage four – survival rate is only 5%.
It is worth noting that today, due to significant progress in the development of medicine, the diagnosis of “malignant formation” and in particular “stomach cancer” should not be taken as a death sentence. Domestic and foreign oncology today is able to diagnose the disease in the early stages and carry out high-quality, targeted antitumor treatment, which can not only improve the patient’s quality of life, but also significantly prolong it.
Patients should remember that self-medication and self-diagnosis are a threat to health and life, since only a doctor can accurately determine the diagnosis and prescribe adequate treatment in the presence of a tumor process in the stomach.
Cancer- that this is a disease, or something unknown, a terrible word (disease), under which lies a hidden meaning, and, even worse, sad consequences. Cancer, or as it is commonly called a malignant tumor, has the ability to grow faster in some cases and more slowly in other cases. But, perhaps, the only thing that all malignant processes have in common is dysfunction, destruction of the internal organs in which they grow, and spread throughout the body.
The endoscopic diagnostic method is rightfully considered the most reliable method in identifying various pathologies of the upper gastrointestinal tract, including stomach cancer. Using this modern device, the degree of damage to the mucous membrane, the presence of scars, and incorrectly located folds are visualized. If necessary, in doubtful cases, it is also possible to take a piece of tissue from the affected area for microscopic examination. The presence of a cancerous process is confirmed by the presence of atypical malignant cells.
Laboratory research
Laboratory diagnostic methods are not widespread in identifying tumor processes of the stomach and duodenum. Indirect confirmation of the pathological process (the appearance of ulcers on the mucous membrane of the stomach and duodenum) is a positive reaction in the stool test for occult blood (Gregersen reaction).
Treatment of stomach cancer
There is only one radical treatment for stomach cancer. Surgery removes the tumor and prevents it from spreading further throughout the body. Depending on the extent of the pathological process, part of the stomach is cut out (subtotal gastrectomy), or the entire stomach is removed (total gastrectomy). Quite often, surgeons can already determine the degree of damage to the stomach walls during the operation, and be guided by this to decide the required volume of surgical intervention.A mandatory action is to remove nearby lymph nodes, as they may contain tumor cells. The question of removing affected organs located near the stomach is decided by the surgeon at the site of the operation.
The radiological method, as an independent method of treatment, due to the possible risk of irradiation of neighboring healthy organs, is not performed. In some cases, if the necessary equipment is present, the stomach is irradiated during the operation. In this case, X-rays penetrate directly into cancer cells.
Chemotherapy, like the radiation method, has an indirect meaning, which consists in the fact that the patient takes special chemotherapy drugs in courses before and after the operation.
The issue of using auxiliary treatment methods is decided in each individual case individually. It all depends on the availability of the necessary equipment and the qualifications of the personnel. In any case, stomach cancer is a curable disease if detected early. But if the cancer process is quite common and detected at late stages of development, the question of so-called palliative operations is raised, in which it is impossible to remove tumor-affected organs from the body without causing significant harm to health or simply without death. Palliative operations involve reducing the patient's suffering and temporarily prolonging life.
Prevention of stomach cancer
- Prevention of stomach cancer involves actions aimed at preventing the occurrence of chronic diseases of the gastrointestinal tract. Throughout life, it is necessary to follow the general rules of sanitary and hygienic regime, eat right, and, if possible, eliminate the occurrence of stressful situations that can lead to stomach ulcers.
- Prevention of the appearance of precancerous diseases such as pernicious anemia, chronic ulcers of the stomach and duodenum are of exceptional importance in preventive measures aimed at preventing the development of malignant neoplasms of these organs.
- Reducing the influence of harmful environmental factors, such as automobile exhaust gases, industrial waste.
- Nitrates and nitrites, which are found in large quantities in greenhouse plants (tomatoes, cucumbers), and smoked foods, also need to be limited in the diet, since these products are dangerous from the point of view of a carcinogenic effect on the body.
- Maintain moderation in the use of various medications.
- Fresh fruits and vegetables, rich in vitamins, macro and microelements, balance the diet. Also, fresh vegetables and fruits are a good source of antioxidants, which are effective in the fight against the appearance of cancer cells.
Everyday evening walks, physical exercise and hardening procedures, all this will strengthen the immune system, give vigor and additional vitality.
What are the stages of development of stomach cancer?
Regardless of the location, any tumor goes through 4 stages of development. Each stage reflects the size of the tumor ( tumors), the number of affected lymph nodes, and also shows the presence or absence of metastases ( secondary foci of cancer cells), which can penetrate through lymphatic or blood vessels into other tissues and organs. The clinical classification of stomach cancer proposed below, in addition to the four main stages, also includes substages for a more accurate description of each tumor process.
Stages of stomach cancer
| Stage of stomach cancer | Tumor characteristics | Changes in local ( regional) lymph nodes | Presence of distant metastases |
| 0 | Preinvasive cancer ( carcinoma in situ or cancer “in situ”), in which cancer cells do not grow into their own mucous membrane. This form of cancer is characterized by small size and the absence of any clinical manifestations ( absence of symptoms). Preinvasive cancer can be detected only by chance during an endoscopic or x-ray examination of the stomach. | There are no metastases in local lymph nodes. | There are no metastases in distant tissues and organs. |
| I A | A cancerous tumor grows into the stomach's own mucosa or into the muscular plate of the mucous membrane. The size of the tumor is relatively small and does not exceed 2 centimeters. | None. | None. |
| I B | The tumor can grow not only into its own mucous membrane, but also into the muscular layer. The size of the tumor, on average, is 1.5 - 2 centimeters. | In some cases, cancer cells can reach nearby lymph nodes, which are located along the inner or outer curvature of the stomach ( outer and inner edge of the stomach), as well as in the pyloric zone ( the end section of the stomach that separates it from the duodenum). Typically, one or two nearby lymph nodes are affected ( externally they are increased in size). | None. |
| II A | A cancerous tumor can grow into the mucous or muscle layer. Sometimes the tumor process can also affect the subserosal membrane. The size of stomach cancer in this case does not exceed 3.5 - 4 centimeters. | From one to six regional lymph nodes are affected. | There are no distant metastases. |
| II B | The tumor grows into the mucous or muscle layer. It is also possible to grow into the serous layer of the stomach. At this stage, the size of stomach cancer most often reaches from 2 to 5 centimeters. | Three to seven local lymph nodes are affected. | None. |
| III A | At a minimum, the mucous and muscular lining of the stomach wall is affected. In addition, the tumor often penetrates into the subserosal and serous layers. The size of the tumor can exceed 5–6 centimeters. | As a rule, from one to seven or more lymph nodes are affected. | None. |
| III B | The tumor not only grows into all layers of the stomach, but can also penetrate into neighboring tissues. The size of the tumor can reach 7–10 centimeters. | Most often, three to seven or more lymph nodes are affected. | None. |
| III C | The tumor, in most cases, penetrates into neighboring organs. The sizes may vary, but most often the tumor reaches 7 or more centimeters. | Typically, more than seven nearby lymph nodes are affected. | None. |
| IV | Actually stomach cancer. At this stage, the size and location can be any. The main distinguishing feature is the presence of distant metastases that penetrate other tissues and organs and cause secondary malignant neoplasms in them. | Most often, more than seven lymph nodes are affected. | Present. Distant metastases can be found in the peritoneum ( serous membrane that covers the inner walls of the abdominal cavity and the organs that are contained in it), along the right and left gastric arteries, in the lymph nodes of the spleen and omentum ( fold of peritoneum), in the liver, lungs, kidneys, bones, heart, brain and other organs. |
It is worth noting that most often a cancerous tumor occurs in the antrum of the stomach ( lower stomach). One of the reasons is the occurrence of duodenogastric reflux in patients, in which the contents of the duodenum are able to flow back into the stomach ( retrograde promotion of food) and leads to gastritis. At the same time, stomach cancer can occur in almost any functional area of the stomach.
What are the first symptoms of stomach cancer?
The symptoms of stomach cancer can vary greatly depending on the stage of the malignant disease. As a rule, at the very beginning of this cancer, the symptoms are mild and nonspecific ( may occur in various other pathologies). Later, as the malignant tumor grows, so-called “minor signs” of stomach cancer appear, which begin to cause significant discomfort and significantly worsen the quality of life. As this cancer progresses, some characteristic signs of stomach cancer may appear. The first symptoms of stomach cancer
| Symptoms | Characteristic |
| Nonspecific symptoms | |
| Swallowing disorder
(dysphagia) | For cancer of the gastric cardia ( the upper part of the stomach that borders the esophagus) a feeling of discomfort may occur when swallowing food. This is due to the fact that the esophagus in the lower part is compressed by the stomach tumor. As a rule, this is expressed in the appearance of a burning sensation in the lower esophagus. In addition, when a tumor grows into the submucosal layer of the stomach, belching very often occurs, which is permanent. This symptom occurs due to the fact that the tumor disrupts the functioning of the circular muscle of the esophagus ( distal sphincter), which normally prevents food from moving in the opposite direction - from the stomach to the esophagus. |
| Decreased appetite | Quite often, patients with stomach cancer in the initial stages of the disease develop some problems with appetite. Sometimes appetite can sharply deteriorate until a complete loss of appetite, but most often there is pickiness in choosing food or a feeling of disgust for certain dishes. This is due to the fact that as the size of the tumor increases, the capacity of the stomach gradually decreases. The elasticity of the mucous and submucosal layer also decreases, as a result of which food is no longer able to stretch the stomach. It is because of this that rapid saturation occurs while eating a relatively small amount of food. |
| Small signs | |
| Asthenia (increased fatigue and weakness) | Asthenia occurs against the background of exhaustion of the body as a whole. With any malignant process, the compensatory and restorative functions of the body are gradually depleted. This leads to rapid fatigue, chronic fatigue, and is also manifested by rapid mood swings, moodiness and tearfulness. Prolonged mental and physical activity becomes impossible. In addition, sleep disturbances may occur, which are expressed in the appearance of episodes of insomnia. It is also common to have difficulty falling asleep. |
| Change in taste preferences | With stomach cancer, in some cases there may be a feeling of aversion to certain foods. As a rule, patients with stomach cancer refuse to eat meat and meat products because they cannot tolerate their taste and smell. With stomach cancer, the synthesis of the enzyme pepsin, which breaks down proteins into amino acids, gradually decreases. This leads to the body being unable to digest meat normally. |
| Weight loss | Weight loss can occur for several reasons. First, weight loss is a direct consequence of decreased appetite. Secondly, there is a violation of protein, lipid and carbohydrate metabolism due to disruption of digestion processes. Thirdly, cancer intoxication leads to weight loss - when tumor tissue disintegrates, a large number of toxic metabolic products are released, which disrupt various processes in the body and deplete it. |
| Anemia (anemia) | Occurs due to the fact that the body receives a small amount of food containing iron ( meat). Anemia can also appear against the background of massive or prolonged and hidden bleeding that can occur in the gastrointestinal tract. |
| Characteristic symptoms | |
| Cachexia (pronounced weight loss) | Occurs with a rapidly progressing malignant tumor of the stomach. If a cancer tumor grows to a large size, the human body blocks the production of lipids ( fat) to slow down the rate at which cancer grows. With stomach cancer, the human body can lose more than 70–80% of fat and muscle tissue in a short period of time. |
| Pain in the upper abdomen | Pain syndrome can manifest itself in different ways. Pain may intensify while eating if the cancerous tumor is located in the cardiac part of the stomach ( upper third of the stomach). If the tumor grows into the pancreas, the pain often radiates to the lower back and resembles radiculitis ( damage to the spinal roots). As a rule, pain in stomach cancer is aching in nature and is not associated with eating. It is worth noting that these symptoms may not be observed, since they are characteristic only of the painful form of stomach cancer. |
| Presence of blood in vomit and/or stool | When a cancerous tumor ulcerates, a certain amount of blood may enter the stomach from destroyed blood vessels. In the future, blood can be excreted from the gastrointestinal tract in the form of black, tarry stool - melena. The color and consistency of this stool is given by blood cells ( mostly red blood cells), which are modified under the influence of gastric and intestinal juice. Blood can also be found in vomit. In this case, the vomit resembles the color of coffee grounds ( hemoglobin under the influence of hydrochloric acid is broken down into hematin, which has a brown tint). The presence of a large amount of fresh blood in the vomit indicates massive bleeding. |
| Enlarged lymph nodes | The tumor can spread through the lymphatic system to other tissues and organs. As a rule, the lymph nodes of the supraclavicular, axillary or cervical region are affected. Sometimes the lymph nodes may also become enlarged around the belly button. |
In some cases, nonspecific symptoms and some minor signs of stomach cancer may be absent or extremely mild. This occurs during a rapidly progressing malignant process. In this case, the characteristic symptoms of stomach cancer come to the fore.
It is worth noting that the symptoms of stomach cancer may resemble diseases of the gastrointestinal tract such as peptic ulcer, gastritis and some benign tumors. That is why, when the above symptoms appear, it is necessary to promptly carry out endoscopic diagnosis ( gastroscopy) or X-ray of the stomach with contrast ( using barium suspension), since the earlier cancer is detected, the greater the chance of completely curing it.
How long do you live with stomach cancer?
Stomach cancer has a poor prognosis. It all depends on the size of the tumor, its location, how quickly it grows and into which layers of the stomach wall it grows. The prognosis is also affected by the spread of metastases to regional lymph nodes, as well as to distant tissues and organs. The age of the patient is no less important. For example, the prognosis is better in young people than in older people. It is worth noting that the earlier this cancer was detected, the greater the likelihood of a complete cure.
Prognosis and survival rate for stomach cancer
| Stage of stomach cancer | Prognosis and survival |
| First stage The tumor penetrates only into the mucous and submucous membrane of the stomach. Most often, one to six lymph nodes close to the stomach can be affected ( regional lymph nodes). There are no distant metastases. | The chances of a full recovery are quite high. Five-year survival rate ( percentage of people who remain alive five years after being diagnosed with cancer) ranges from 65 to 80%, while complete recovery is observed in 70% of cases. Despite the good prognosis, gastric cancer at the first stage is extremely rarely detected due to its asymptomatic course. As a rule, this pathology is detected during examination of other nearby organs. |
| Second stage A cancerous tumor grows into the mucous, submucosal and muscular layers of the stomach wall. As a rule, an increase in 3 to 6 local lymph nodes is detected. There are no distant metastases in other tissues and organs. | The five-year survival rate for stage 2 gastric cancer is, on average, 50–60%. This stage of tumor disease is also diagnosed extremely rarely. |
| Third stage The tumor grows into all layers of the stomach wall ( mucous, submucosal, muscular and serous). The third stage is characterized by damage to more than seven local lymph nodes. Metastases in other organs are not detected. | The prognosis is quite unfavorable. Despite the fact that stage 3 gastric cancer is detected relatively often ( one case out of seven), the five-year survival rate ranges from 15 to 40%. |
| Fourth stage A malignant tumor affects not only the stomach, but can also spread through the blood and lymphatic vessels into the pancreas, peritoneum ( serous membrane covering the abdominal organs), liver, lungs, brain and other organs. | Stage 4 gastric cancer is detected in 80–85% of cases. Due to the fact that the tumor quickly spreads throughout the body, the five-year survival rate in this case does not exceed 3–5%. In some cases, to reduce general intoxication and reduce pain in inoperable malignant tumors of the stomach, chemotherapy is prescribed ( the use of drugs that stop the growth of tumor cells). However, this method helps only in 15–35% of cases and does not particularly affect life expectancy and prognosis. |
What should be the diet for stomach cancer?
A diet for stomach cancer is an absolute necessity, since the body with this pathology needs proper and balanced nutrition. The diet has the following tasks:
- provides the human body with all the necessary macroelements ( proteins, fats and carbohydrates) and microelements ( vitamins and minerals);
- normalizes metabolism;
- improves the results of antitumor treatment;
- reduces the likelihood of postoperative complications;
- helps strengthen the immune system;
- improves quality of life before and after surgery.
Proper nutrition for stomach cancer involves the following:
- Complete nutrition. The human body must receive the required amount of proteins, lipids, carbohydrates, vitamins and minerals every day. The recommended ratio of macronutrients is as follows - 55% carbohydrates, 30% lipids and 15% proteins. It is also worth noting that in each individual case this ratio must be adjusted. It is necessary to fully cover the body's needs for all nutrients, as this helps to strengthen and restore the compensatory functions of the body. It is worth noting that with poor nutrition, the chances of successful treatment are significantly reduced.
- Fractional meals. It is extremely important not to put too much strain on the stomach. To do this, you need to eat small portions 4 to 8 times a day. In this case, the load on the gastrointestinal tract will be reduced to a minimum. You should also chew your food thoroughly, since when large particles of food enter the stomach, more hydrochloric acid and enzymes for digestion should be produced ( pepsin, gelatinase).
- Elimination of all irritating substances from the diet. It is necessary to exclude from eating excessively sweet, salty, spicy, fatty and smoked foods, as they can greatly irritate the organs of the gastrointestinal tract. It is worth significantly reducing your intake of vegetables that can cause bloating, namely beans, peas, soybeans, cabbage and onions. It is not recommended to eat fruits that contain a lot of acid - lemons, oranges, grapefruits, plums, currants. Any products that contain large amounts of preservatives and food additives are contraindicated for consumption. Also, often with stomach cancer there is a change in taste habits. Most often, patients develop intolerance to meat products. In this case, it is necessary to exclude meat from the diet and find an alternative to protein nutrition. It is worth noting that food should be at the optimal temperature, that is, neither hot nor cold, so as not to irritate the gastric mucosa.
- Complete abstinence from alcohol. Ethyl alcohol, which is contained in alcoholic drinks, has an extremely adverse effect on the mucous membrane of the entire gastrointestinal tract and on the stomach in particular. Alcohol increases the secretion of hydrochloric acid and also disrupts the integrity of the gastric mucosa. That is why the intake of any alcoholic beverages should be completely excluded.
For parenteral nutrition, solutions of amino acids and fat emulsions are used ( solution of fats in water), glucose solution, multivitamin complexes and microelements, as well as combined preparations, which may include several of the above-mentioned solutions at once.
Is it possible to treat stomach cancer with folk remedies?
Stomach cancer is an extremely serious pathology that requires immediate treatment. As a rule, the most commonly chosen surgical treatment method is partial or complete removal of the stomach. In some cases, they resort to the use of complex regimens using chemotherapy, which uses chemicals that can stop the growth of a cancerous tumor, as well as radiotherapy using ionizing radiation ( X-rays, neutron radiation, and gamma and beta radiation).Traditional medicine is by no means an alternative to the above-mentioned treatment methods, since no medicinal tincture or decoction can protect against tumor growth and metastasis ( penetration of cancer cells into other organs and tissues). However, traditional medicine can be effective already in the postoperative period, when the general condition is stabilized and the risk of relapse occurs ( recurrence of the disease) is significantly reduced. The folk remedies described below normalize metabolism, increase immunity, and also help speed up the recovery period.
During the convalescence period(end of illness)You can use the following folk remedies:
- Tincture of celandine. Take 1 kilogram of celandine root and dry it well for 6 hours. Then you need to scroll this root in a meat grinder. Add 0.5 liters of vodka to 0.5 liters of juice obtained. You should insist for 3 weeks. The tincture should be taken one tablespoon 4 to 5 times a day before meals. The course of treatment lasts from 1 to 3 months.
- Black radish tincture. You need to grate 1 kilogram of washed radish ( along with the peel) and pour in 1 liter of vodka. Subsequently, the tincture is kept for 14–15 days in a dark and warm place, shaking occasionally. The tincture should be taken 50 milliliters 3-4 times a day, half an hour before meals.
- Decoction of potato flowers. Brew 10 grams of dried potato flowers in a liter of boiling water. Then the broth should be placed in a thermos and left for 4 to 5 hours. A decoction of 100 milliliters is taken daily after each meal.
- Tincture of pelargonium and aloe leaves. Dilute 20 grams of aloe juice with 0.5 liters of vodka. Pour 50 milliliters of boiling water over 4 pelargonium leaves and place in a thermos for 12 hours. Pelargonium tincture is mixed with aloe and vodka and 3-4 drops of iodine are added. This tincture should be taken 50 grams 15 – 20 minutes before breakfast.
- Propolis pills. Melt 400 grams of butter and 100 grams of propolis. After the mixture has cooled, add 2 tablespoons of honey. This mixture is then rolled in corn flour and made into pea-sized pills. It is necessary to take three pills 3 times a day 15 – 20 minutes before meals.
What is signet ring cell cancer of the stomach?
Signet ring cell cancer of the stomach is one of the types of diffuse ( common) cancer, which has an aggressive course and quite often metastasizes ( tumor cells spread to other organs and tissues). This type of stomach cancer develops from glandular cells, which line the gastric mucosa in large numbers. Most often, signet ring cell cancer affects young and middle-aged people, mainly women. Cytological and histological examination ( examination of tissue taken after a biopsy) modified flat cells of the stomach in a microscope resemble rings ( which is why this form got its name).
Signet ring cell cancer of the stomach has the following features:
- It is a hormone-dependent tumor. The majority of male patients with signet ring cell cancer of the stomach showed an increase in testosterone in the blood ( main male sex hormone), while the patients had increased levels of estrogen - female sex hormones. This proves that this tumor most often occurs against the background of hormonal disorders.
- It occurs more often in women than in men. Various studies have shown that ring cell gastric cancer is diagnosed in women somewhat more often than in men. On average, this form of cancer is detected in 55% of cases in women, while in men - in 45% of cases.
- It is more often detected in young people. It was noted that this type of stomach cancer is most often detected in people whose age does not exceed 35–40 years.
- High degree of aggressiveness. Signet ring cell carcinoma is characterized by rapid growth and an aggressive course. Often this type of cancer is diagnosed in the later stages, when the tumor has already metastasized to other organs.
- There is no connection with the occurrence of this form of cancer due to poor nutrition. It has been found that people who eat a balanced diet and limit their consumption of excessively fatty, salty and spicy foods are diagnosed with signet ring cell cancer at the same rate as people who do not follow a diet.
Can stomach cancer be cured?
Stomach cancer can only be cured if the tumor has not started to spread ( metastasize) to neighboring as well as distant tissues and organs. Also, the success of treatment depends on the size of the cancer tumor, the type of tumor, the number of affected lymph nodes, the age of the patient and the presence of concomitant diseases. The most favorable prognosis is observed when the cancer is at the first or second stage of its development. In this case, the tumor grows only into the mucous and muscular layer of the stomach wall and is characterized by a relatively small size ( up to 5 centimeters in diameter), and also does not give distant metastases to other organs ( kidneys, liver, bones, brain, lungs). The only problem is that at these stages of stomach cancer, the tumor, as a rule, does not manifest itself, which greatly complicates its detection. Treatment of stage three gastric cancer, when the tumor affects the entire wall of the stomach and is large ( more than 6 - 10 centimeters) presents considerable complexity. The prognosis in this case is unfavorable, and the five-year survival rate ( percentage of people who remain alive five years after being diagnosed with cancer) after surgical treatment accounts for, on average, 15–40% of all patients. The worst prognosis is observed when diagnosing stage 4 gastric cancer. In this case, the five-year survival rate is less than 3–5%.
Treatment of stomach cancer is carried out using the following methods:
- Surgical method is the gold standard treatment for stomach cancer. If the tumor is relatively small in size and does not metastasize, then only partial removal of the stomach is performed. In this case, the tumor and part of the nearby healthy tissue are removed along with regional ( local) lymph nodes. This operation is currently performed laparoscopically, in which access to the stomach is carried out through small holes in the upper part of the abdominal wall. The surgeon inserts a laparoscope into one of the holes, containing an optical system that transmits the image to the screen. For more massive tumors, the stomach is completely removed ( resection) with subsequent restoration of the continuity of the digestive tract ( perform abdominal surgery). If the tumor grows into neighboring organs, the surgeon decides to remove these affected tissues. In case of multiple metastasis of a cancer tumor, a palliative operation can be performed, in which the main goal is to improve the patient’s quality of life, since a cure is no longer possible.
- Chemotherapy. Chemotherapy is often used in combination with surgical treatment. This treatment method is based on the use of highly toxic and toxic substances that stop the growth of tumor cells. Chemotherapy drugs can be taken orally or intravenously. They can be prescribed both before surgery, in order to stop the growth of the tumor and reduce its size, and after the intervention, to reduce the likelihood of metastases. In some cases, not one, but several types of chemotherapy drugs are used ( polychemotherapy). It is worth noting that these chemotherapy drugs affect not only tumor cells, but also healthy cells, which can cause various side effects ( bone marrow suppression, hair loss, damage to the gastrointestinal tract, heart, liver, skin, etc.).
- Radiotherapy It is used quite rarely in the treatment of stomach cancer. The fact is that exposure to ionizing radiation ( X-rays, gamma radiation, beta radiation, and neutron radiation) in the case of stomach cancer has more disadvantages than advantages. Radiotherapy can only be used in the postoperative period to prevent tumor recurrence ( relapse). Typically, radiotherapy is part of complex treatment regimens that include surgical removal and chemotherapy.
Is chemotherapy necessary for stomach cancer?
Most often, in order to completely cure stomach cancer, surgical treatment alone is not enough. In this case, there is a need to prescribe chemotherapy. This treatment method is based on the use of various toxic and poisonous substances that can suppress the growth and destroy cancer cells ( cytostatic and cytotoxic effect) with relatively less negative impact on the human body. These poisonous and toxic substances are chemotherapy drugs. Chemotherapy drugs can be taken in different ways. Most often they are taken orally ( orally) or intravenously. Depending on the type of chemotherapy, treatment may be carried out in the hospital or at home.
There are several types of chemotherapy:
- Adjuvant chemotherapy used in the postoperative period. The main goal of adjuvant or additional chemotherapy is to reduce the likelihood of metastases ( spread of tumor cells to other tissues and organs). Previously, it was believed that this type of chemotherapy was ineffective, but recently many oncologists are reconsidering this point of view. It is also possible to use neoadjuvant chemotherapy, when drugs are taken before surgery to slow the growth and reduce the size of the tumor.
- Palliative chemotherapy It is used when the cancer has already metastasized to other organs and surgical treatment is impossible. In fact, palliative chemotherapy is used only to improve the quality of life and cannot affect the outcome of malignant cancer.
- Polychemotherapy is a complex treatment in which several types of chemotherapy are used at once. As a rule, medications are selected that block the growth of tumor cells in various ways. Unlike monochemotherapy ( single drug treatment), polychemotherapy has a greater likelihood of success, although it causes more complications.
Since toxic and highly toxic substances are used during chemotherapy, various side effects often occur after a course of treatment.
The following complications most often occur after chemotherapy:
- Inhibition of hematopoiesis. Chemotherapy drugs have an inhibitory effect not only on cancer cells, but also on absolutely all cells of the human body. Bone marrow cells, which are responsible for hematopoiesis, are very sensitive to this effect. The precursors of white blood cells are most often damaged ( leukocytes), as well as blood platelets ( platelets). Inhibition of hematopoiesis is maximally manifested 1–2 weeks after the start of chemotherapy treatment.
- Hair loss ( alopecia) It is also a fairly common side effect that occurs during chemotherapy. Some chemotherapy drugs can negatively affect and damage the hair follicle ( pouch), which leads to hair loss. This complication is a significant psychological trauma for young people, especially for girls and women. It is worth noting that hair loss is a temporary phenomenon and after 4 – 6 months the hair begins to grow again.
- Decreased local and general immunity. Chemotherapy drugs can significantly reduce immunity by suppressing cells of the immune system ( lymphocytes). This can lead to the human body becoming extremely sensitive to various types of infectious diseases.
- Damage to the gastrointestinal tract. While taking certain chemotherapy drugs by mouth ( in tablet form) various symptoms of damage to the mucous membrane of the digestive tract often occur. Most often this is manifested by the appearance of nausea, vomiting, diarrhea or stomatitis ( inflammation of the oral mucosa). Liver cells may also be damaged. In this case, an increase in liver tests will be detected in the blood ( aminotransferases) and bilirubin ( hyperbilirubinemia).
Is surgery necessary for stomach cancer?
The surgical method is the so-called gold standard in the treatment of stomach cancer. In most cases, only complete removal of the tumor tissue can lead to a complete cure for this cancer. The extent of surgery depends on various factors. First, the size of the tumor itself is taken into account. Secondly, the number of affected local ( regional) lymph nodes. Thirdly, how deep the tumor has grown into the stomach wall. And fourthly, the presence or absence of distant metastases ( spread of tumor cells) in tissues and organs. Also an important factor is the general state of health and the presence of concomitant diseases.
Before surgery, patients most often must undergo chemotherapy. Chemotherapy drugs, which are toxic and poisonous medications, stop the growth of a cancerous tumor and also reduce its size.
If a small cancerous tumor has been discovered, in which tumor cells grow only into the mucous and muscle layers, then surgery is performed laparoscopically. This method is minimally invasive ( low-traumatic) and involves making several small incisions in the upper abdominal wall. A laparoscope, a special instrument that has an optical system and transmits an image to a monitor, is inserted through one of these holes, and surgical instruments are inserted into the other holes. Removal requires not only the tumor itself, but also nearby healthy tissue, as well as local lymph nodes, since they may contain tumor cells.
With larger malignant processes, when the tumor affects the entire or almost the entire stomach, the question arises of complete removal of the stomach ( total gastrectomy). In this case, they resort to abdominal surgery. During this operation, the surgeon makes a wide incision through which access to the stomach is gained. After gastrectomy, the surgeon also examines nearby organs for the presence of metastases. After gastrectomy ( stomach removal) the continuity of the digestive tract is restored by suturing the stump of the stomach with a loop of the small intestine.
After surgery, it is also necessary to undergo a course of chemotherapy. In this case, chemotherapy drugs reduce the likelihood of recurrence ( relapse) cancerous tumor.
In addition to the above operations, there is also a palliative operation. This operation is performed when stage IV gastric cancer with metastasis to various organs is diagnosed ( lungs, kidneys, liver, bones, brain). The idea is to alleviate the patient's suffering, improve nutrition, and somewhat improve quality of life. There are two types of palliative surgery for stomach cancer. The first type of operation is aimed at creating anastomoses ( anastomosis) between the stomach and small intestine. The second type of palliative surgery involves the complete removal of the tumor along with all metastases to slow the spread of cancer cells in the body.
The choice of a particular surgical technique depends on many factors and should be carried out by an experienced oncologist. It is worth noting that today there are no alternatives to surgical treatment of stomach cancer.
