- Causes and factors of stomach cancer
- Classification of stomach cancer
- Symptoms of stomach cancer
- Diagnosis of stomach cancer
- Treatment of stomach cancer
- Prognosis of stomach cancer
- Prevention of gastric cancer
Unfortunately, every day the number of patients in oncology dispensaries is growing. And when you enter the hospital you can see not only "people over 60", but also relatively young men and women. The only good news is that the population has become more concerned about their health, i.e. more often seek help from specialists.
The modern possibilities of medicine make it possible to detect malignant cells and tumors at the earliest stages, so the fight against such ailments has become much more effective and safer.
One of the leading positions in the frequency of occurrence in the structure of oncological diseases is stomach cancer. The disease is extremely unpleasant and dangerous, it often leads to death. We will talk about it in detail.
Stomach cancer is found everywhere. Everyone can face such a problem. However, in general, the incidence and frequency of deaths in the world is decreasing.
Nevertheless, these figures remain extremely high in Japan, Iceland, Chile, the USA, Russia and many other countries. The stomach cancer occupies the seventh highest place in the general structure of oncological diseases in terms of the number of deaths.
Gastric cancer in men is more common than in women. In addition, the risk of encountering this pathology is higher among representatives of the Negroid race and among the poor.
Causes and factors of stomach cancer
As a rule, stomach cancer arises from several factors directly affecting the human body. Let's look at the most significant of them:
- The impact of the environment (radiation, harmful production, etc.) The results of numerous studies confirm the fact that when a group of people migrate from a zone of increased morbidity to one where this level is significantly lower, the incidence of gastric cancer is significantly reduced. And in the second generation, this dependence is only confirmed;
- Nutrition, or exogenous alimentary factor. The risk of developing gastric cancer is increased by the abuse of fried, fatty, spicy and canned food. In this case, the protective mucous layer is damaged, and carcinogenic (those that cause cancer) easily enter the cells. However, there is an opposite side to the question. If you eat fresh fruits, vegetables, fiber and vitamins (especially beta- caratins and / or vitamin C), the risk of developing this disease is significantly reduced;
- Helicobacter pylori. It has long been known that this infection provokes the development of gastritis and, subsequently, stomach ulcers. But they in turn lead to atrophy and intestinal metaplasia - precancerous conditions. Scientists have proved that the risk of developing gastric adenocarcinoma increases 3.5-3.9 times in case of human infection with Helicobacter pylori;
- Other infectious agents - for example, the Epstein-Barr virus - cause low-grade tumors with lymphoid infiltration (lymphoepithelioma-like cancer);
- Drinking alcohol and smoking. These two factors are now becoming more relevant, due to the high urbanization of the population.
- Genetic predisposition. In recent years, experts have increasingly linked the facts of the development of stomach cancer with heredity. The chances of encountering this disease are especially high among those people whose close relatives (closely related first-line connections) suffered from this pathology.
- Medicinal products. Long-term use of certain drugs can provoke the development of stomach cancer. One of the most dangerous is considered to be medicines used to treat rheumatic diseases.
In addition to all of the above reasons for the development of gastric cancer, there are other factors. And special attention should be paid to precancerous diseases:
- Culinary ulcer of the stomach ;
- Reginal antral gastritis ;
- Polyps and polyposis of the stomach;
- Chronic atrophic gastritis;
- Disease of the operated stomach;
- Pernicious anemia;
- Disease Menetries.
Classification of stomach cancer
To date, the following classification of gastric cancer is generally accepted:
- Papillary adenocarcinoma;
- Tubular adenocarcinoma;
- Mucinous adenocarcinoma;
- Adenoplasocellular carcinoma;
- Ring-like cell carcinoma;
- Small cell carcinoma;
- Squamous cell carcinoma;
- Undifferentiated cancer;
- Other forms of cancer.
Macrometric by Borrmann:
- 1 type - polypoid or mushroom-shaped;
- Type 2 - ulcerative with distinct edges;
- Type 3 - ulcerative infiltrative;
- 4 type - diffuse-infiltrative;
- Type 5 - unclassifiable tumors.
Macroscopic types of stomach cancer at an early stage:
- I type - sublime, i.e. When the height of the tumor exceeds the thickness of the mucosa;
- II type - superficial;
- IIa - raised;
- IIb - flat;
- IIc - deepened;
- III type - ulcerated (ulcer mucous)
However, the most popular all over the world is the classification of TNM , which is used by doctors to formulate a diagnosis:
To correctly assess the degree of damage to the body, you need to know the anatomical structure of not only the stomach itself, but all surrounding tissues and organs.
In the stomach, the following anatomical parts are distinguished:
- Antral department;
- The Department of Agriculture;
When determining the tactics of treatment, an important point is the presence of regional lymph nodes affected by the tumor process.
Regional lymph nodes in stomach cancer are: peri-gastric nodes, which are located along the small (1, 3 and 5) and large (2, 4a-b, 6) curvatures along the common hepatic (8), left gastric (7), spleen (10 -11) and celiac (9) arteries, hepatoduodenal nodes (12).
If intraperitoneal lymph nodes (retropancreatic, para-aortic) are affected, then they are considered to be distant metastases.
And now, for your reference, we present you the clinical classification of TNM:
T - primary tumor:
- Tx - insufficient data for evaluation;
- T0 - primary tumor is not visualized;
- Tis - carcinoma "in situ" or an intraepithelial tumor with high dysplasia;
- T1 - the tumor affects not only its own plate of the mucosa, but also the muscular plate or submucosa;
- T1a - the tumor affects its own plate or muscular plate of the mucosa;
- T1b - the tumor affects the porous layer;
- T2 - tumor lesion of the muscular membrane;
- T3 - the tumor affects the subserous layer;
- T4 - the tumor perforates (a perforated hole is formed), the serosa and / or affects adjacent structures;
- T4a - tumor develops serosa
- T4b - the tumor spreads to adjacent structures
N - regional nodes:
- NX - insufficient data;
- N0 - there are no signs of regional lymph node involvement;
- N1-metastases in I-II regional lymph nodes;
- N2 - metastases in III-VI regional lymph nodes;
- N3 - metastases in VII and more regional lymph nodes;
- N3a - metastases in VII-XV regional lymph nodes;
- N3b - metastases in XVI or more regional lymph nodes
M - distant metastases:
- M0 - there is no data for the presence of distant metastases;
- M1 - distant metastases are determined.
Another classification, according to which tumors are divided by the degree of differentiation of tissues. The higher it is, the more active the cancer develops.
Histopathological differentiation (G):
- G4 - undifferentiated cancer;
- G3 - low degree of differentiation;
- G2 - the average degree of differentiation;
- G1 - high degree of differentiation;
- GC - can not be evaluated.
Symptoms of stomach cancer
Unfortunately, stomach cancer is hard to detect in the early stages, because he does not have any specific first signs, only on the basis of which, it would be possible to state with certainty the fact that we are talking directly about a malignant tumor.
Symptoms of stomach cancer are extremely diverse and can resemble many other diseases. And this is not necessarily signs of lesions of the gastrointestinal tract, very often the symptoms are similar to those that are observed in diseases of other systems. So, often there are changes characteristic for the defeat of the central nervous system (CNS), associated with a decrease in immunity or a violation of metabolism and weight loss.
Very rarely, people immediately notice a number of changes that may indicate the development of a malignant tumor. In many respects it depends on the size and localization of the tumor, as well as on its type and degree of differentiation.
Nevertheless, it is customary to identify several common features inherent in any pathological process, one way or another associated with the occurrence of malignant and / or benign tumors. It is worth remembering the local symptoms of these diseases, which are caused by germination in the walls of the stomach, damage to surrounding tissues, and, accordingly, a violation of the evacuation of gastric contents and the functioning of nearby organs.
Common symptoms of cancer
As already mentioned above, there are a number of symptoms that are inherent in almost all cancers. These include:
- sharp weight loss;
- lack of appetite;
- apathy, constant fatigue;
- increased fatigue;
- anemic skin color.
The above symptoms are characteristic of any cancerous tumor. That is why, for the purpose of early detection of stomach cancer (in the absence of other clinical symptoms), scientists dealing with stomach and whole gastrointestinal cancer issues suggested using a set of symptoms called the "small symptom syndrome" in the course of diagnosis.
With the help of this technique, it is possible to suspect quite easily, and later to reveal a malignant process. And this, in turn, will allow to start treatment on time and prevent the spread of tumor cells to other organs.
What does the term "small symptom syndrome" include?
- Unpleasant feeling of discomfort in the upper segment of the abdomen;
- Flatulence (or bloating) after eating;
- The unconditioned absence of appetite, which subsequently leads to a rapid decrease in body weight;
- Salivation, nausea until vomiting;
- Heartburn - when the tumor is located in the upper half of the stomach.
In general, the patients become apathetic, constantly feel bad and
very quickly get tired.
Local symptoms of stomach cancer
- As a rule, observed with a decrease in the functional activity of the stomach and are noted in the area of duodenal and stomach connections - in the antrum. Patients most often feel a feeling of heaviness in the abdomen. And because the food hardly passes through the gastrointestinal tract, and sometimes even stagnates there, there is an eructation of air often accompanied by a putrefactive odor.
- With a tumor localized in the initial parts of the stomach, the patient feels difficulty in swallowing, dysphagia is observed. This symptom is explained in the following way: the initial volume of food is not able to pass unhindered to the stomach, it stagnates and makes it difficult to freely feed new portions of food through the esophagus.
- Often there is increased salivation, which is associated with traumatism of a nearby vagus nerve.
Diagnosis of stomach cancer
Diagnosis for any cancer disease should be comprehensive with a mandatory examination of the entire human body. Only after this the doctor can accurately put the final diagnosis and proceed to treatment.
So, with stomach cancer, the survey plan should include:
- Clinical examination;
- Finger examination of the rectum;
- Standard laboratory tests, such as determination of the blood group, Rh factor, sero-reaction to syphilis , general blood test (UAC), general urine analysis (OAM), biochemical blood test (protein, creatinine, bilirubin, urea, ALAT, ASAT, alkaline phosphatase , glucose, amylase, electrolytes - Ca, Na, K and Cl)),
- Coagulogram according to indications;
- Functional tests, (ECG, ultrasonic dopplerography of vessels, examination of the function of external respiration, echocardiography, etc.)
- Consultations of narrow specialists;
- Fibrogastroscopy with tumor biopsy followed by a morphological study of this material;
- Ultrasound of the abdominal cavity, retroperitoneal space, small pelvis and supraclavicular zones (with suspected metastatic lesion).
- X-ray examination of the stomach
- X-ray examination of the lungs. In difficult cases, CT of the thorax, as well as of the pelvic organs and the abdominal cavity, is performed;
- Endoscopic ultrasound (EUS) The greatest value is with suspicion of early gastric cancer.
- Laparoscopy to exclude dissemination of tumor cells through the peritoneum.
In addition, in addition can be carried out: fibrocolonoscopy, scintigraphy of the bones of the skeleton, irrigoscopy, puncture of the tumor under the supervision of ultrasound and its morphological study.
Treatment of stomach cancer
To date, the treatment of stomach cancer is quite a complex and completely unsolved problem of oncology. Nevertheless, doctors around the world adhere to the following algorithm for treating this pathology:
Algorithm of treatment of patients with stomach cancer:
So, the main method of fighting this pathology is an operation intervention. And the indication to him is the diagnosis of operable stomach cancer in the total absence of any contraindications to the operation.
The main radical operations for stomach cancer are:
- Subtotal distal resection of the stomach (Operation Billroth-II);
- Subtotal proximal resection of the stomach;
The choice of the technique used depends on the location of the tumor, its macroscopic type, and also on the histological structure.
The main condition for the radical nature of the operation is the removal of a single block of a stomach affected by a tumor or its corresponding part together with regional lymph nodes and the surrounding fiber.
Volume of lymphodissection:
- D3 - removal of lymph nodes number 1-12;
- D2 - at least 14 (more often around 25) regional lymph nodes are removed;
- D1 - removal of peri-gastric lymph nodes (№ 1-6).
To determine the radicality and adequacy of the operation is the control for the absence of tumor cells along the line of intersection of the organs-esophagus, stomach or duodenum.
Indication for the implementation of distal subtotal resection of the stomach is the presence of an exophyte tumor or a small infiltrative tumor in the lower third of the stomach.
Indication for the implementation of proximal subtotal resection of the stomach is the presence of early gastric cancer in its upper third without a tumor transition to the cardiac pulp or abdominal segment of the esophagus.
In all other cases of gastric cancer , gastrectomy is indicated , which is associated with the biological features of the spread of cancer cells.
In the case of an exophytic tumor, the line of gastrectomy in the proximal direction should lie 5 cm from the visible border of the tumor, and in the endophytic form - 8-10 cm. The distal boundary of the resection should lie not less than 3 cm from the visible or palpable border of the tumor. Since endoscopic and radiographic detection of the boundaries of the tumor with diffuse infiltrative growth is difficult, the decision to perform subtotal resection of the stomach should be taken with great care and only on the basis of the results of clinical and instrumental research (fibrogastroscopy, roentgenology, endosonography), as well as intraoperative morphological studies of the borders resection.
When the tumor grows into neighboring organs (spleen, intestine, liver, diaphragm, pancreas, adrenal gland, kidney, abdominal wall and retroperitoneum), no signs of distant metastasis perform their removal or resection with a single block.
Doctors avoid splenectomy whenever possible, as the principle removal of the spleen does not improve the long-term results of treatment and significantly increases the frequency of postoperative complications and even lethality.
Indications from splenectomy are tumor germination, metastatic lesion of lymph nodes of the spleen gate, intraoperative trauma.
Unfortunately, oncologists all over the world state that the results of treatment of patients with stage 4 of gastric cancer are still extremely unsatisfactory. This problem is still open.
To eliminate the complications caused by the widespread tumor process, perform surgical interventions with a palliative purpose. В зависимости от конкретной ситуации выполняют различные виды паллиативную резекцию желудка, которая может дополняться обходным гастроэнтероанастомозом, гастро- или еюностомой.
Согласно мировым протоколам ХТ при рака желудка применяется лишь на 4 стадии. Однако сегодня стандартных схем химиотерапевтического лечения больных раком желудка IV стадии нет. Чаще всего используются комбинации на основе таких препаратов, как флуороурацил и цисплатин.
Кроме того, существует достаточно много схем, которые включают в себя следующие виды химипрепаратов:
- Кальция фолинат;
Эффективность химиотерапевтического лечения больных распространенным раком желудка остается на низком уровне, в большинстве случаев отмечается частичная и непродолжительная ремиссия опухолевого процесса.
Давайте рассмотрим лечение рака желудка в зависимости от стадии заболевания:
Стадии — 0, Iа.
- дистальная субтотальная резекция желудка;
- proximal subtotal resection
- lymphodissection in volume D1
Stages Ib, IIa, IIb, IIIa, IIIb.
- distal subtotal resection of the stomach,
- lymphodissection in the D 2 volume.
Standard: various variants of chemotherapy
- palliative surgery;
- endoscopic recanalization (diathermocoagulation of the tumor, stenting);
- Palliative chemotherapy (individualized).
Therapeutic tactics in patients with recurrence of stomach cancer is determined by the prevalence of the tumor process. Depending on the situation, radical or palliative surgical treatment is performed. It is possible to use combined therapies using various regimes and schemes of ionizing radiation, chemotherapy.
Prognosis of stomach cancer
It is proved that the forecast is much more favorable in the early stages. At 0 and I stages, the survival rate is about 80-90%. At later stages, everything changes significantly and depends largely on the type of tumor, the presence of metastases, the general condition of a person, and so on. As for the 4th stage, such patients survive in about 7% of cases. However, this is possible only with complete surgical removal of the tumor with further passage of the courses of PCT.
Despite the success of modern medicine in the field of oncology, stomach cancer still remains one of the most dangerous oncopathologies. This is due to the high risk of recurrence of the disease. And they are very difficult to treat, which is why in most cases, a re-operation is required.
In addition, gastric cancer is characterized by an aggressive course and the presence of a large number of metastases localized in the liver and peritoneum (the so-called "implantation metastases"), as well as in the lymph nodes of the abdominal cavity.
Metastases are screenings of the main tumor, which have a similar structure and are able to grow uncontrollably, disrupting the functioning of those organs into which they have entered the blood or lymphatic drainage.
Prevention of gastric cancer
Prevention of gastric cancer should take an important place in the life of each person, because this significantly reduces the risk of encountering such an unpleasant (and sometimes even fatal) disease.
- Prevention of the development of chronic gastrointestinal diseases. For this, it is necessary to observe general sanitary and hygienic standards, eat right and, as much as possible, protect yourself from all sorts of stressful situations;
- Timely detection and treatment of precancerous diseases, such as pernicious anemia, chronic ulcer of the duodenum and others;
- Elimination of harmful environmental factors. For example, automobile exhaust, industrial waste, etc.
- It is necessary to avoid excessive consumption of nitrates, nitrites, which are found in large quantities in greenhouse plants (tomatoes, cucumbers) and smoked products.
- Do not abuse various medications in the treatment of lungs colds, infections and other diseases;
- Eat as many fresh and pure fruits and vegetables as possible. They are rich in vitamins, macro- and microelements, due to which they balance the diet and serve as an excellent source of antioxidants;
- And, of course, accustom yourself to daily evening walks and frequent physical training. Also useful and hardening procedures. So you can strengthen your immunity, get a charge of vivacity and acquire additional vitality.