Stomach Cancer - Causes, Symptoms and Treatment .MF .
Stomach cancer - a malignant tumor that develops from cells of the gastric mucosa.
Causes of stomach cancer can be divided into several types:
1. Nutritional - related features of food: the abuse of fatty, fried, spicy food and canned.The damaging effect of reactive substances on the gastric mucosa is the destruction of the protective layer of mucus on the surface epithelium and penetration of carcinogenic (cancer-causing) substances in the cells, with subsequent destruction or degeneration.At the same time the consumption of large amounts of fruits and vegetables, vitamins and trace elements is significantly reduced the incidence of cancer.
2. affects the development of stomach cancer smoking and alcohol.
3. Prior chronic diseases of the stomach: peptic ulcer, erosive and atrophic gastritis.Often the cause of most chronic diseases of the stomach is gelikobakter - a bacterium that can live and reproduce in the stomach, and, sometimes, in the human gut.The organism allocates products of their vital
4. Genetic factors: genetic predisposition - the presence of family relatives with cancer of the gastrointestinal tract or other organs.
5. Constitutional features and hormonal activity.Large weight and obesity are underlying diseases for the genital organs and the gastrointestinal tract, including stomach cancer.
Up to 80% of patients with initial forms of stomach cancer do not complain.Often, access to a doctor due to comorbidities.Severe symptoms usually show far come process.
Symptoms of stomach
cancer characteristic symptoms of gastric cancer does not exist, but it is possible to identify a number of symptoms that help to suspect the disease, they can be divided into two groups:
1) Non-specific stomach weakness, rise in body temperature, decreased or absentof appetite, weight loss.
2) specific for diseases of the stomach:
- abdominal pain: is characterized by aching, nagging, dull epigastric pain (under the left edge of the ribs).Can be periodic, usually occurs after a meal.The pain becomes constant as a result of joining the concomitant inflammation or tumor invasion of adjacent organs.
- nausea and vomiting: a symptom of various diseases of the stomach: acute gastritis, peptic ulcer disease, cancer characterized by tumor larger, spanning the exit from the stomach.
- vomiting stagnant content (eaten on the eve of the 1-2 days of food) in tumors output (antrum) of the stomach, on the border of the duodenum, causing stenosis and lead to stagnation in the stomach contents of the lumen to a few hours or days, and painful sensationspatient attrition.
- vomiting "black, coffee grounds," black liquid chair- characterizes bleeding from ulcers or stomach cancer, requires urgent remedial measures (stopping bleeding).
- difficulty passing food down to the impossibility of passing the liquid symptom of cancer of the esophagus and the initial portion of the stomach.
- the feeling of fullness after eating, heaviness, discomfort, early satiety.
- worsening heartburn, belching - complaints intensity change of the patient may notice.
3) symptoms of far-gone 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, pale skin as a result of anemia (decrease in red blood cells).
- increasing the supraclavicular lymph nodes on the left, the left axillary lymph nodes and around the navel (metastatic disease).
In the event of a patient such complaints, as well as changing the intensity and nature of the common complaints, you should seek immediate medical attention.
Vomiting "coffee grounds" should immediately call the ambulance.
number of surveys that identify gastric cancer:
conducting research in this case is videoezofagogastroduodenoskopiya (EGD).
This method allows a detailed study to examine the esophageal mucosa, gastric and duodenal ulcers and detect a tumor, determine its boundaries and take a slice for examination under a microscope.
method is safe and well tolerated by patients.In identifying small tumors in the early stages, it is possible to remove them using the same apparatus using short-intravenous anesthesia.
Two mirrored tumor in the antrum of the stomach, the view through the gastroscope
type of stomach tumor NDI mode via the gastroscope
All patients after 50 years, as well as suffering from chronic gastritis, and have a history of ulcersstomach, you must annually perform a gastroscopy (from the Latin "Guster" - the stomach, "Skopje" - inspected) to identify tumor pathology at an early stage.
Fluoroscopy stomach - one of the oldest methods of research.To a greater extent to evaluate organ function capabilities.It allows suspected tumor recurrence after surgery on the stomach.Effective with infiltrative forms of cancer when biopsy results may be negative, it is safe for the patient and does not bear large radial load.
Ultrasound examination of the abdominal cavity reveals indirect signs of gastric cancer (a symptom of mass in the upper abdomen), tumor invasion into underlying organs (pancreas), metastatic liver damage, nearby lymph nodes, the presence of fluid in the abdomen (ascites), metastatic involvement of the serous membrane of the internal organs (peritoneum).
Computed tomography of the abdominal cavity allows for more detail to interpret the changes identified by the US - to exclude or confirm the metastases in the internal organs.
Endoscopic ultrasound is used for suspected gastric submucosal tumor growing in the thickness of its walls, the detection of early cancers to evaluate the germination depth of the tumor in the body wall.
Diagnostic laparoscopy - operation performed under intravenous anesthesia through punctures in the abdominal wall where the camera for inspection of the abdominal cavity is entered.Used study in unclear cases, as well as to detect sprouting tumor into the surrounding tissue, and liver metastases, and peritoneal biopsy.
Blood tests for tumor markers - proteins produced by the tumor and not present in the healthy body.To detect gastric cancer using Ca 19.9, CEA, CA 72.4.But they all have a low diagnostic value and are usually used in the treated patients to detect possible metastasis in the early stages.
Types of tumor lesions of the stomach, depending on the location of the tumor in the body:
- cardia cancer otdela- area pischevodno- gastric junction;
- cancer of the lower third of the esophagus;
- cancer of the stomach body;
- cancer of the antrum (output card);
- cancer of the stomach angle (the angle between the stomach and duodenum);
- total defeat at the infiltrative gastric cancers.
Schematic representation of the stomach
Schematic representation of the lining of the stomach (the mucosa)
forms of gastric cancer:
- exophytic cancer: the tumor grows into the lumen of the stomach, having a form of a polyp, "cauliflower"or ulcers may be in the form of a saucer and so on.
- infiltrative cancer: how to "travel along" along the wall of the stomach.
stages of stomach cancer vary depending on the depth of germination body wall:
Stage 0 - cancer "on the spot" - the initial form of cancer is limited outside the mucosa of the stomach wall does not germinate;
1 stage - a tumor grows in the submucosal layer of the stomach wall without metastases in the surrounding lymph nodes;
2 stage - grows in the muscular layer of the stomach, there are metastases in the surrounding lymph nodes;
Stage 3 - tumor invades the entire thickness of the gastric wall, there are metastases in the surrounding lymph nodes;
4 stage - a tumor grows into adjacent organs: the pancreas, the large vessels of the abdomen.Or has metastasized to the abdominal organs (liver, peritoneum, ovaries in women).
prognosis of gastric cancer
outlook is most favorable for the initial cancer, and 1 tumor stage, the survival rate reaches 80 to 90%.At 2-3 stages of the forecast depends on the number of metastases in regional lymph nodes, is directly proportional to their number.At stage 4 prognosis is extremely unfavorable and hope for recovery can be only in case of complete removal of the tumor as a result of expanded operations.
gastric cancer, unlike other cancers, returning dangerous local disease (relapse) in the remote organ walls or in the abdomen itself.Gastric cancer often metastasizes to the liver and the peritoneum (implantation metastases), the lymph nodes of the abdominal cavity, at least in other organs (supraclavicular lymph nodes, ovary, lung).Metastasis - is dropping out of the primary tumor, with its structure and capable of growing, disrupting the function of those organs where they develop.metastases appearance is connected with the natural growth of the tumor: tissue grows fast food enough not to all its elements, part of the cell loses contact with the rest, breaks away from the tumor and into the blood vessels, spreads throughout the body and into the bodies of a small and well-developed vasculature (liver, lungs, brains, bone), they are deposited from the bloodstream, and begin to grow, forming kolonii- metastases.In some cases, metastases can reach huge sizes (10 cm) and lead to the death of patients by poisoning the tumor waste products, and disruption of the body.
Relapses of the disease very difficult to treat and in some cases may be re-operation.
treatment of gastric cancer
In the treatment of gastric cancer, like any other cancer, the leading and the only method that gives hope for a cure is surgery.
There are several options for operation on the stomach:
- Removal of the body - the stomach resection (removal of the output distalnaya- department proksimalnaya- removal nearest to the esophagus) performed when exophytic tumors antral or cardia of the stomach respectively.
- gastrectomy (from the Latin "gastritis" -zheludok, "ectomy" - delete) - removal of the entire stomach is entirely with the subsequent formation of a "reservoir" of small bowel loops, performed for tumors of the stomach body (middle part).
- Combined extended operations - to remove a portion adjacent involved in tumor organov- pancreas, liver, and others.
- removing gastrostomy- forming a hole in the stomach in the abdomen, performed when tumors be permanently violating the passage of food to feed patients, to facilitate the patient's condition and prolong life.
- the formation of the bypass anastomosis between the stomach and loops kishechnika- creating a workaround for the passage of food, be permanently used for tumors to prolong the life of patients.
Often surgery is complemented by some specific anti-tumor treatment:
- confirmed the presence of metastases in the nearby (regional) lymph nodes is required to use preventive chemotherapy.Chemotherapy - is intravenous administration of toxic chemicals to destroy microscopic metastases that eye could not be found during the operation.
- the detection of metastases in other organs (liver, lung, peritoneum, etc.) is required to use chemotherapy, designed to reduce the size of metastases, or completely destroy them.
radiation treatment for cancer of the stomach is not used because the stomach is mobile in the abdominal cavity of the body of the tumor to radiation is not sensitive.Radiation therapy may be used in the postoperative period, if the tumor is not completely removed in the area of resection under a microscope are determined by tumor cells - irradiation anastomosis (formed anastomosis) between the esophagus and intestine.
Self-medication with gastric tumors is unacceptable and dangerous, as it can lead to a complete disruption of the passage of food from the stomach into the intestine - pyloric stenosis, which in turn leads to the death of patients from hunger.Use so-called "people's money" is not worth it, especially toxic, as many of them (hemlock, celandine, Chaga) can cause poisoning of the body and worsen the condition of patients.
only timely and qualified medical assistance in a possible early treatment allows the patient's recovery.
Complications of gastric cancer:
- bleeding of tumor threatening complication that can lead to the death of the patient very quickly.When symptoms such as vomiting "coffee grounds" - black coagulated blood or black liquid stool should immediately see a doctor or call an ambulance, especially if these symptoms are accompanied by abdominal pain, palpitations and pale skin, fainting.
- pyloric stenosis (obstruction) - the formation of tumor obstruction in the outlet of the stomach, completely covers the normal passage of food through the gastrointestinal tract.The symptoms of pyloric stenosis are: vomiting stagnant content (on the eve of 1-2 days, food eaten).It requires urgent surgical intervention.
Prevention Prevention of gastric cancer includes right and good nutrition, smoking cessation, timely annual examination of the stomach, especially in patients with a history of peptic ulcer and chronic gastritis.
Consultation of the oncologist on gastric cancer:
1. Question: Is it possible to detect gastric cancer at an early stage?
Answer: Yes, it is possible, for example, in Japan, the proportion of early gastric cancers is 40%, while they are not more than 10% in Russia.The most common cancers are detected early in the survey about other comorbidities.Leading to the detection of early cancers is an annual endoscopic examination of the stomach - EGD an experienced specialist, in a clinic with good facilities.
2. Question: What are the results of the treatment of early gastric cancers?
Answer: The cure for early cancers is almost 100%.Operations are performed endoscopically - through fibrogastroscopy using special equipment.It deletes only the mucous membrane of the stomach tumor.Such operations may only be carried out in early cancers, when all other forms of cancer shows abdominal surgery.
3. Question: What are the results of the treatment of gastric cancer in the later stages?
A: survival prognosis is more or less favorably only if the removal of the entire tumor and metastases as a result of expanded operations, but even in this case, the possible recurrence of the disease.
oncologist Barinov Natalia