Causes, signs, symptoms and treatment of stomach cancer. Stomach cancer - the first symptoms Yandex stomach cancer symptoms
is a malignant transformation of the cells of the gastric epithelium. In 71-95% of cases, the disease is associated with damage to the walls of the stomach by Helicobacter Pylori bacteria and is a common oncological disease in people aged 50 to 70 years. In men, stomach cancer is diagnosed 10-20% more often than in women of the same age.Epidemiology
In the structure of oncological diseases in Russia, gastric cancer occupies a leading position along with malignant lesions of the lung, breast, large intestine and skin.
The incidence rate is 17-19 people per 100 thousand inhabitants of Russia per year. According to some reports, it reaches 30 people per 100,000 people. The duration of the preclinical period of the disease is from 11 months to 6 years.
There is a geographical heterogeneity in the incidence rate on a global scale:
High level - Russia, Japan, South Korea, Finland, Chile, Brazil, Colombia, Iceland.
Low level - Western Europe, USA, Canada, Australia, Indonesia.
The debut of stomach cancer is associated with H. Pylori and previous pathologies: mucous membranes, peptic ulcer, polyps on the walls of the stomach, gastritis and other diseases. Certainly, the negative impact of smoking and strong alcohol on the body, as well as the regular use of food colors, flavors and flavor enhancers, has been proven.
In countries with a high level of medical care, cancer is detected at an early stage, so the mortality statistics look quite optimistic. The five-year survival rate for patients with gastric cancer in Japan, provided early diagnosis, is about 70-90%.
How long do people live with stomach cancer?
Men with stomach cancer live an average of 12 years, and women are 15 years less than their peers.
In Russia, the structure of detection and survival of patients is as follows:
Stage I of the disease is determined in 10-20% of patients, survival for five years is 60-80%;
Stage II-III with damage to regional lymph nodes is determined in 30% of patients, survival for five years fluctuates at the level of 15-45%;
Stage IV with metastases to neighboring organs is diagnosed in 50% of patients, the survival rate for five years is no more than 5-7%.
Active attempts are being made to create systems for objective prediction of the outcome of the disease. Oncologists use various enzyme systems, including MMP-9, as immunohistochemical markers of this form. The method is used in clinical oncology to determine the possibility of surgical treatment.
The disease does not show clinical signs for a long time.
The main diagnostic errors are associated with symptoms that make stomach cancer look like non-cancer pathologies of the heart or gastrointestinal tract:
Similar to heart disease. Localization of the tumor in the cardial part of the stomach is accompanied by retrosternal pain (angina pectoris), especially against the background of people over fifty.
Similar to diseases of the gastrointestinal tract. Localization of the tumor closer to the intestinal part of the stomach is manifested by signs resembling gastritis, peptic ulcer, cholecystitis. All these diseases are manifested by pain in the abdomen, vomiting and stomach bleeding.
An erroneous diagnosis can hide the underlying disease for a long time. Moreover, a cardiologist and a gastroenterologist, during an in-depth examination, usually find multiple deviations in patients of solid age, while there are no obvious signs of oncology.
The doctor leading the patient should alert:
No effect after the course of treatment;
The patient has a history of chronic diseases of the gastrointestinal tract.
The patient and the doctor should also be concerned about subjective sensations (at least two or three) indicating signs of small stomach cancer:
Constant discomfort in the abdomen (fullness, heaviness);
Difficulty swallowing food, retrosternal pain that radiates to the back;
Pain that does not subside after eating and is not relieved by taking medications;
Fatigue and chronic weakness after minimal physical exertion;
Rapid weight loss (by 10-20 kg in 6 months with a body weight of 80-90 kg) and loss of appetite;
Aversion to meat dishes, not previously observed pickiness in food;
Fast satiety with a minimum amount of food.
Based on clinical studies, regularities have been established for the appearance of signs of the disease (at least two or three of the following at the same time), which are further identified as signs of oncology, namely:
Pain in the central region of the epigastrium, about 60% of patients report this;
Progressive weight loss reported by about 50% of patients;
Nausea and vomiting after eating - about 40% of patients;
Nausea and vomiting with blood - about 25%;
Paleness of mucous membranes - about 40%.
Clinical symptoms have some differences depending on the localization of the tumor in the upper, middle and lower parts of the stomach:
The defeat of the upper part of the stomach is manifested by cardiological symptoms (pain in the region of the heart), as well as difficulty in swallowing, up to the inability to eat. Dehydration develops, threatening the syndrome of disseminated intravascular coagulation (DIC). Protein starvation is also dangerous, which exacerbates nitrogen metabolism disorders and leads to a critical level of under-oxidized substances in the blood.
The defeat of the middle part of the stomach is manifested by gastric bleeding and the development of anemia. Large vessels are located in this zone. Latent bleeding is determined by simple laboratory methods, and massive bleeding is determined by a change in the consistency and color of the feces - it becomes black and tarry. Pain is most often associated with involvement in pancreatic carcinogenesis. Other symptoms are general.
The defeat of the lower part of the stomach is manifested by dyspepsia (diarrhea, constipation, vomiting and stomach pain), belching with the smell of rotten eggs.
The earliest symptoms of stomach cancer
The first signs should be paid attention to long before the symptoms that characterize stage III-IV of gastric cancer. Identification of the disease in the last stages is almost a sentence to the patient.
The following pathologies should be associated with precancerous diseases:
Chronic (atrophic) gastritis, regardless of the causes, is characterized by common signs that are well detected during the clinical examination of the patient - this is nausea and vomiting.
A stomach ulcer, regardless of the options, is manifested by gastric bleeding in the form of bloody vomiting, massive or hidden blood loss during defecation, constant or periodic pain in the stomach. Peptic ulcer disease is characterized by seasonal exacerbations and successful pain relief by taking medications.
Polyps of the walls of the stomach, including large (adenomatous) and small (hyperplastic). The early stages proceed subclinically, benign neoplasms bleed when traumatized. Polyps located in the initial part of the stomach are prone to malignancy.
Dysplasia, metaplasia. All stages of cellular atypia (dysplasia) up to the last stage IV (cancer in situ) are detected mainly by laboratory methods in cytological and histological examination. In the last stages, digestive disorders, nausea and vomiting are diagnosed.
Vomiting in stomach cancer
Unmotivated, at first glance, vomiting may indicate early signs of oncology. Vomiting in combination with other symptoms is of diagnostic value.
The gag reflex can be triggered by:
Narrowing of the digestive tube by a developed tumor that creates an obstacle to the advancement of food (has diagnostic value in the later stages);
Irritation of the receptors of the vomiting center during the chemical and mechanical effects of pathogenesis products (it is of great diagnostic value, including in the early stages).
In the first case, food is thrown out immediately after eating. Vomit contains swallowed food without signs of splitting it with gastric juice. Accompanying symptoms indicating cancer of the digestive tube are dramatic weight loss, pallor of the mucous membranes, and changes in the walls of the stomach at the cellular level. Vomiting of undigested food is observed during intoxication in a short period of time. But if it is associated with stomach cancer, it manifests itself for a long time.
Second case when the vomiting center is irritated, vomiting occurs regardless of the meal. Most often, it is associated with intoxication of the body with carcinogenesis products.
With a single spasm, vomiting contains semi-digested, with multiple - liquid contents:
Yellow color (bile ducts are normal);
Light color (obstruction of the ducts, possible metastasis to the liver);
Dark red streaks or clots (damage to blood vessels).
Vomiting and cancer are definitely related in the presence of two or three additional signs of damage to the digestive tract.
Blood in stomach cancer
Changes are observed in feces (in the form of melena - the so-called "currant jelly"), as well as in vomit. Not always gastric bleeding is associated with cancer. The combination of bleeding and small signs of gastric cancer (see above) greatly increases the likelihood of an association with an underlying disease.
Signs of stomach bleeding:
The vomit is dark in color and does not foam, this distinguishes blood from the stomach from pulmonary bleeding;
Feces due to coagulated blood are black in color, the consistency is liquid, the smell is fetid, it is excreted in small portions.
The transformation of normal cells into malignant cells is a multi-stage chain of events.
The following is a simplified view of carcinogenesis and a step-by-step inclusion of a variety of causes:
Stimulation and accumulation of mutations under the influence of external and / or internal carcinogens;
The development of precancerous diseases in the walls of the stomach (chronic gastritis, peptic ulcer, benign neoplastic formations);
Stimulation of the development of oncology against the background of precancer and exposure to carcinogens.
First stage
For mutations to occur, a carcinogenic effect on the epithelium of the stomach is necessary.
External carcinogens (primarily food and drink), including:
Excessive regular consumption of table salt, nutritional supplements labeled "E". For example, meat products and delicacies, in which sodium nitrate E251 is always (provided by technology) added to give the meat a red color, monosodium glutamate or E261 to improve the taste. Smoked, spicy, pickled, canned and fried foods, strong alcohol, tobacco smoking, drug use (aspirin, hormones) also contribute to stomach cancer;
Lack of ascorbic acid (vitamin C), which normalizes the level and quality of hydrochloric acid, reduces bleeding, thereby preventing the development of primary disorders in the walls of the stomach. The low level of vitamin E (tocopherol), which regulates the resistance of mucous membranes, beta-carotene and some macro and microelements, also has a detrimental effect.
Internal carcinogens (infectious, hereditary, immune factors), including:
Infectious - the negative impact of Helicobacter pylori, micrococci, strepto- and staphylococci, fungi of the genus Candida, Epstein-Barr virus. The participation of the latter as a cause of gastric cancer has been unconditionally proven by the detection of herpes markers in tumor cells of certain types of tumors;
Hereditary - it has been proven that the incidence of certain forms of cancer is 20% higher in people who inherit the A (II) blood group. Also confirmed is the hereditary transmission of a low level of a gene called E-cadherin, an epithelial protein that under normal conditions inhibits the growth of tumor cells;
Immune - a decrease in the resistance of the epithelium due to a lack of immunoglobulin (Ig) A in the wall of the mucous membranes. The influence of autoimmune processes on the formation of cancer has also been proven.
Second phase
Includes the development of diseases that precede cancer, including:
Resection of the stomach and other operations on the stomach;
Dysplasia and metaplasia of the walls of the stomach.
Diseases can develop without the participation of carcinogens, then the pathogenesis is limited to a benign course. In the case of their impact, the disease is transformed into a malignant one.
Third stage
Carcinogenesis is directly triggered by a combination of the above two factors and unknown additional causes. The underlying mechanisms of transformation of normal cells into malignant ones are not fully understood. However, it is known that in almost 100% of cases, gastric cancer is preceded by infection with H. Pylori, damage to the walls of the stomach and the unconditional participation of carcinogens.
The designation of the primary tumor is T with the addition of numbers from 1 to 4 and small capital letters (a, b) to describe the details of carcinogenesis occurring in the primary tumor. The designation of the defeat of regional lymph nodes is N with the addition of numbers from 0 to 3 and small capital letters (a, b). To designate distant metastases, use the Latin letter - M and the numbers - 0, 1 to indicate the absence or presence of distant metastases.
stage 1 stomach cancer
Stage 1 can be encrypted in three ways, namely:
stage 1A (T 1 N 0 M 0), the primary tumor of the first stage, grows into the mucous and submucosal layer, without damage to the lymph nodes and distant metastases;
stage 1B, option 1 (T 1 N 1 M 0), the primary tumor grows into the mucous and submucosal layers, metastases in one to six regional lymph nodes, there are no distant metastases;
stage 1B, option 2 (T 2a/b N 0 M 0), the primary tumor has grown into the muscle and subserosal layer, no damage to the lymph nodes and distant metastases is observed.
stage 2 stomach cancer
Stage 2 can be encrypted in three ways, namely:
(T 1 N 2 M 0), the primary tumor grows into the mucous and submucosal layers, 7-15 regional lymph nodes are involved, there are no distant metastases;
(T 2a/b N 1 M 0), the primary tumor in the muscular and subserous layer, the involvement of 1-6 regional lymph nodes and the absence of distant metastases are diagnosed;
(T 3 N 0 M 0), the primary tumor is located in the serous membrane and the visceral wall without involvement of neighboring organs, lesions of regional lymph nodes and distant metastases are not observed.
stage 3 stomach cancer
Stage 3 can be encrypted in four ways, namely:
Stage IIIA, option 1 (T 2a/b N 2 M 0), which means the involvement in the pathogenesis of the muscular and subserous layer of the stomach wall, the defeat of 7-15 regional lymph nodes and the absence of distant metastases;
Stage IIIA, option 2 (T 3 N 1 M 0), means damage to all layers of the serous membrane of the stomach without involving neighboring organs, damage to 1-6 regional lymph nodes and the absence of distant metastases;
Stage IIIA, option 3 (T 4 N 0 M 0), spread to neighboring organs in the absence of damage to regional lymph nodes and without distant metastases;
Stage IIIB, (T 3 N 2 M 0), damage to all layers of the serous membrane, damage to 7-15 regional lymph nodes, absence of distant metastases;
stage 4 stomach cancer
Stage 4 can be encrypted in three main variants, namely:
(T 4 N 1, N 2, N 3, M 0), spread of the tumor to neighboring organs, damage to regional lymph nodes (1-6) -N 1, or (7-15) - N 2, or (more than 15) - N 3 , absence of distant metastases;
(T 1 T 2 T 3, N 3 M 0), damage to the mucous and submucosal layer - T 1 or damage to the muscular and subserosal layer - T 2 or damage to all layers of the serous membrane, damage to more than 15 regional lymph nodes, no distant metastases;
(T any, N any, M 1), primary tumor of various growth variants, also any variants of damage to regional lymph nodes and the obligatory presence of distant metastases.
Inoperable gastric cancer with metastases
This is the stage of the disease at which it is impossible or inappropriate to apply methods of surgical removal (resection) of part of the stomach and lymph nodes in order to stop the disease. Inoperable cases do not include palliative surgery in order to alleviate the patient's condition.
Inoperable cancer can be:
Locally advanced, when a significant part of the stomach is damaged or multiple lesions are arranged in a mosaic pattern and affect vital parts of the body (large vessels, nerve nodes), cells spread by lymphogenous, contact or implantation;
Metastatic when lesions of distant organs are detected, usually the liver, lungs, adrenal glands, bones and subcutaneous tissue. Cancer cells spread through the bloodstream.
The most positive results are observed with radical radiation therapy of locally advanced processes. According to some reports, life expectancy after a course of combined treatment can be increased up to 20-24 months. At the same time, complications from exposure to ionizing radiation are much lower than the therapeutic effect, and the patient gets a chance to prolong life in the absence of pain. Unfortunately, it is impossible to guarantee more in the conditions of modern medicine.
The main metastasis pathways pass through the lymphatic system, so secondary neoplasms and the most significant metastases are found primarily in the lymph nodes.
Metastases of stomach cancer:
In pararectal tissue or in the space near the rectum - Schnitzler;
In the navel area - sisters Marie Joseph;
In the left supraclavicular region - Virchow;
In the region of the ovaries - Krukkenberg.
These secondary tumors are evidence of the advanced stages of the disease, when the treatment strategy and tactics are chosen individually and, most often, are palliative in nature, that is, aimed at improving the patient's quality of life.
Gastric cancer is divided according to the place of localization and methods of spread - it can be, for example, squeezing out the surrounding tissues or vice versa, infiltration into the surrounding tissues. Significant influence on the pathogenesis is exerted by histological forms of cancer: diffuse or polypoid.
Ring cell carcinoma of the stomach
It is diagnosed by cytological and histological examination. This is a type of diffuse cancer. The altered area consists of flat cricoid cells. The disease is characterized by an aggressive course.
Histochemical studies established the hormonal nature of this tumor. In the tissues of neoplasms in women, an increase in the level of estrogen is found, and in men - testosterone.
A distinctive feature of this type of disease:
The predominance of women in the structure of patients. The number of sick women - 55%, men - 45%. The ratio may vary, but the pattern has been confirmed by numerous studies;
Peaks of incidence in age intervals from 40 to 50 years and 60-70 years. In other intervals of life, such cancer is diagnosed significantly lower;
The structure of patients is dominated by people with blood group A (II) - about 45%, with other variants of blood groups is significantly lower.
The dependence of the onset of the disease on the presence of previous bad habits (alcohol, salty, smoked, pickled food) and exogenous factors (work with radiation, in chemical production) has not been established.
This type of stomach cancer is more often found in urban residents.
Infiltrative gastric cancer
Morphological form of carcinoma, without a clear definition of the boundaries of the neoplasm. The growth of malignant cells occurs mainly in the thickness of the stomach wall.
Features of the disease:
It can occur in relatively young people, a hereditary predisposition is noticeable;
Small foci of cancer cell growth are found at a distance of 5-7 cm from each other;
This is one of the most malignant forms of cancer, often gives metastases;
The pathogenesis of the clinical stage is accompanied by symptoms associated with dyspeptic symptoms (chronic vomiting, impaired peristalsis);
In the last stages, the tumor is defined as a dense stone-like formation, the stomach decreases in size.
Poorly differentiated stomach cancer
Normal epithelial cells are updated at a high rate, after about 3-4 days the generation is completely replaced. A high update rate is an important factor in the appearance of defects.
The high rate of reproduction of poorly differentiated cells underlies the aggressiveness of cancer pathogenesis. Poorly differentiated gastric cancer is a form of gastric adenocarcinoma composed of stem cells.
Features of the disease:
High growth rate, development of inflammatory and necrotic foci around the tumor;
The inability to determine the type of changes is the latent development of carcinogenesis in the thickness of the stomach wall;
The absence of clear boundaries of the tumor, growth occurs according to the type of diffuse impregnation of the walls of the stomach;
Rapid formation of metastases in regional lymph nodes and distant organs: metastasis reaches 90% of all cases of low-grade oncogenesis.
Diagnosis of stomach cancer
Of particular importance for the early detection of the disease is the alertness and attentiveness of the general practitioner. Diagnosis is carried out in stages and includes physical, instrumental and laboratory methods.
Diagnosis begins with a clinical examination, palpation and auscultation.
In the early stages of gastric cancer, it allows you to identify remote signs of the disease by the condition of the skin, color, humidity, temperature, pain, including in the abdomen.
On auscultation of the heart, chest pain is a common complaint of the patient. Noises and splashes that are not characteristic of pathologies of the cardiovascular system should be excluded. On palpation of the abdominal wall in the early stages of the disease, there are no changes, and in the later stages it is possible to detect seals under the skin in the epigastric region.
2. Instrumental methods
Contrast X-ray diagnostic methods, as well as endoscopy, are used.
X-ray diagnostics. It is an indirect method, it helps to quickly determine the presence of pathology by the nature of the x-ray shadow.
The radiologist takes into account the following changes in the negative image, where dense are light areas, and loose are dark areas:
Local change (thickening, folding) of the wall;
Defects of various sizes in the form of filled areas on the contour of the inner wall in polypoid forms of gastric cancer;
Seals, decreased elasticity of the stomach tissue;
Niches with a zone of infiltration and folding of the walls of the mucous membranes;
Deformations in the form of pushing sections of the walls around the tumor or impregnation of the tissues of the walls of the stomach;
Decreased peristalsis (not determined by all methods).
Modern methods of X-ray diagnostics allow indirectly, by the nature of blackouts, to identify up to 85% of changes in the walls of the stomach. A more valuable method for diagnosing gastric oncology is endoscopy.
Gastroendoscopy
The value increases when obtaining a biopsy from various parts of the stomach wall for histological and cytological examination. Color visualization of the organ walls helps to identify minimal deviations from the norm in terms of the color of the inner walls, the thickness of the folds, the presence of gastric peristalsis and foci of bleeding, and the shape of the wall defect (raised, undermined, deepened).
Modifications of gastroendoscopy:
Staining helps to identify areas of metaplasia and other early pathologies not visible to the naked eye;
Treatment with drugs that selectively accumulate in tumor cells, with laser illumination, helps to determine the altered area by fluorescence;
Endoscopy with nozzles for optical magnification helps to determine changes in the walls of the stomach at the cellular level;
Endoscopes with ultrasonic tips - a combination of ultrasound and imaging;
A relatively new method is the introduction of an unguided video capsule into the stomach, which in real time shows an overview of the non-targeted picture of the stomach wall.
Disadvantages of endoscopy:
Unpleasant sensations in the patient when swallowing a tube of a relatively large diameter. This is usually accompanied by a reflex gag reflex, which is prevented with the help of drugs (Deprivan, Cerucal);
Difficulty in differentiating between benign and malignant tumors.
Therefore, endoscopy is usually combined with electrocoagulation of neoplasms on the walls of the stomach.
Morphological method
Based on histological and cytological studies in the laboratory, the histological type of the tumor is determined with a high degree of certainty. General pattern: tumors located closer to the cardial part (entrance to the stomach) are more likely to have malignant properties.
3. Additional methods
Ultrasound diagnostics. Conducted in three main options:
Outside, through the abdominal wall;
Outside, after filling the stomach with a degassed liquid;
From the inside, using an endoscopic probe.
Laparoscopy is the second additional method for diagnosing stomach cancer. This technique is used to determine the operability of the tumor and the presence of metastases. A laboratory study of biological fluids is used to clarify the patient's condition before surgery. In recent years, methods for determining oncological disease using oncomarkers have been used.
Differential diagnosis of stomach cancer
The above methods are used to differentiate cancer from less dangerous or cancer-precursor diseases, including:
Atrophic forms of gastritis;
peptic ulcer;
Various polyps;
Infectious diseases with similar symptoms (, tuberculosis of the stomach,);
Diseases of the lower esophagus (narrowing, achalasia - incomplete relaxation of the sphincter closer to the stomach).
The choice of treatment tactics is determined by the stage of carcinogenesis and is discussed at a consultation with the participation of specialists from several medical specialties. The main treatment for early-stage tumors is surgical removal combined with adjuvant and non-adjuvant chemotherapy. Late stage treatments are palliative and symptomatic.
All patients are conditionally divided into three groups:
First - patients have early stages (patients with carcinoma in situ and the first stage);
The second - patients with an operable locally advanced stage (patients up to stage III correspond);
The third is patients with inoperable stage of generalized gastric cancer (corresponding to stage IV patients with severe concomitant symptoms or involvement of vital organs and systems in the oncological process).
Sometimes even patients with early forms of oncology are recognized as inoperable, for example, when a tumor affects vital parts of the body or it is impossible to perform an operation for other reasons.
The highest probability of complete recovery (up to 90% with a five-year survival rate) without significant consequences for the body in the first group of patients. The prognosis within the second group has a significant variation, due to the many nuances of this stage of the disease. A minimally favorable prognosis in patients of the last, third group. In this case, we should talk about prolonging and improving the quality of life of patients during the period of illness.
Removal (resection) of the stomach for cancer
Patients, with the exception of some categories, are shown laparoscopic diagnostics before surgery in order to exclude metastasis on the omentum and in the peritoneum.
Endoscopic resection
Depending on the stage of the disease, the clinical condition of the patient and the size of the tumor, an operation with a minimal opening of the abdominal wall can be prescribed - endoscopic resection. There are several options - the choice is up to the doctor.
Possible complications of endoscopic resection:
Postoperative pain - stopped by drugs or dosed radiation;
Perforation (complete, partial) of the walls of the stomach - is eliminated by physical methods of exposure;
Postoperative bleeding - stopped by physical methods and pharmaceuticals.
A simplified version of the intervention is cauterization of neoplasms by electrothermal or laser exposure to the walls of the stomach.
Abdominal operation
It is carried out in the absence of absolute and relative contraindications. If it is impossible to perform resection, the issue of chemotherapy or radiation exposure of the tumor is decided in order to reduce carcinogenesis before further surgery.
With indications for surgery, preoperative preparation is carried out, which consists of a series of manipulations aimed at stabilizing the patient's condition.
The planning of the operation algorithm includes the choice of:
Access to the tumor during the operation;
The volume of surgical intervention in the organ;
Tactics for removing packs of lymph nodes;
method of organ reconstruction.
An important stage of treatment is postoperative recovery, which includes the application of drainage tubes to drain exudate. In the absence of complications, patients are allowed to sit down on the first day, and walk on the second day after the operation.
Contraindications to abdominal surgery for stomach cancer are violations:
Hemodynamics in the form of instability of blood pressure and DIC;
Rhythm of breathing (respiratory arrhythmias).
Planned postoperative measures:
Postoperative pain relief, from the first days;
Stimulation of intestinal peristalsis, on the third day;
Enteral (through a tube and if necessary) nutrition with special mixtures, from the first days;
Antibiotic therapy in the form of a four- or six-day course;
The introduction of drugs that reduce blood viscosity (according to indications).
All manipulations are carried out under the supervision of a physician. There are restrictions and contraindications. The need for additional therapeutic measures is determined individually. Removal of sutures - not earlier than 7 days after the intervention.
Chemotherapy for stomach cancer
Surgery is usually not enough to completely cure stomach cancer. The patient is observed for a long time in order to determine the clinical dynamics. During this period, chemotherapy is prescribed to eliminate hidden local foci of secondary carcinogenesis.
Chemotherapy has a general negative effect on the body. Its use is justified only if there is a real possibility of increasing the chances of recovery or at least improving the patient's quality of life.
Adjuvant Chemotherapy: The term "adjuvant" means an enhancement or addition. That is, this type is used after surgery, as opposed to non-adjuvant chemotherapy, which is used before surgery in order to reduce the size of the tumor before surgery. In recent years, attitudes towards adjuvant exposure have changed. Previously, this method of chemotherapy for stomach cancer was considered ineffective.
Such treatment is carried out in the form of polychemotherapy (exposure to several drugs) in two or three courses at different intervals. Pharmaceutical cytostatics are used in various combinations: Doxorubicin, Etoposide, Cisplatin, Fluorouracil, Mitomycin, Cisplatin and others.
palliative chemotherapy. Another type of therapy that is used when partial or total removal of the stomach and affected lymph nodes is not possible.
Complications after chemotherapy are inevitable. Cytostatics inhibit the growth of malignant cells.
But at the same time, side effects develop in the form of toxicosis, accompanied by:
Recoverable hair loss;
Toxic damage to the liver;
Violation of hematopoiesis;
Suppression of cooperation of humoral and cellular immunity.
Usually these phenomena are completely eliminated during rehabilitation treatment.
Juices for stomach cancer
The disease is accompanied by the loss of large volumes of fluid by the body after repeated vomiting and stomach bleeding. With cancer, patients complain of a decrease in appetite due to loss of taste and smell sensations, pain and other reasons.
Meaning of juices:
Acidic - increase acidity, since the walls of the stomach reduce the production of hydrochloric acid, as well as reduce the need for salt and increase the threshold of the gag reflex. Sweet and sour juices have the best tonic effect;
Sweet - they should saturate the body with vitamins, minerals, indigestible fiber, which is contained in the pulp and is necessary to improve peristalsis. Too sweet juices are best diluted with water;
Slightly bitter - for example, from cabbage, turnips or grapefruit to stimulate appetite and peristalsis.
After agreement with the attending physician, the amount of liquids, especially in the form of refreshing juices and fermented milk drinks:
increase during the course of taking chemotherapeutic agents, with dehydration, diarrhea and vomiting;
reduce with edema, accumulation of ascitic fluid in the pleural and abdominal cavity.
After a course of gastric cancer treatment with chemotherapy, some patients are shown to take up to 20-30 ml of table wine before meals instead of juice. A small amount of wine has a stimulating and tonic effect, improves immunity and soothes.
Liquid is necessary for a person to remove metabolic products from the body, improve tissue nutrition, improve well-being and increase immunity.
Therapeutic dietary nutrition for stomach cancer performs the following tasks:
Prevents weight loss through a balanced diet;
Increases the tolerability of aggressive anticancer treatment and reduces the risk of postoperative complications;
Normalizes metabolism and minimizes its disturbances;
Increases and maintains the body's resistance to physical stress;
Supports immunity, prevents infections, including slow ones that develop against the background of immunodeficiency;
Accelerates the regenerative activity of body tissues after partial or total resection of the stomach;
Improves the quality of life.
Principles of therapeutic nutrition for stomach cancer:
Cooking methods - boiling, baking, stewing;
The diet of patients - four to six times a day;
An individual approach to nutrition - taking into account energy costs and metabolic characteristics, proteins, including animal origin, fats, carbohydrates and liquids are introduced into the diet gradually.
Correction of nutrition, taking into account the stages of treatment - is carried out in order to reduce the side effects of anticancer therapy.
Three dietary options for patients with gastric cancer are proposed, taking into account the characteristics of metabolism and body weight.
First option
- organization of nutrition of a patient with normal body weight in the absence of pronounced metabolic disorders:
Energy value - no more than 2400 kilocalories per day;
The total amount of protein - 90 grams, including animal - 45 grams;
The total amount of fats is 80 grams, including vegetable fats - 30 grams;
The total amount of carbohydrates is 330 grams.
Second option
- organization of nutrition of a patient with severe underweight, malnutrition, with visible metabolic disorders, as well as after surgery, chemotherapy or radiation therapy:
Energy value - no more than 3600 kilocalories per day;
The total amount of protein is 140 grams, including the animal - 70 grams;
The total amount of fats is 120 grams, including vegetable fats - 40 grams;
The total amount of carbohydrates is 500 grams.
Third option
- for patients with a critical decrease in body weight and laboratory-confirmed violation of the excretory function of the kidneys and liver:
Energy value - no more than 2650 kilocalories per day;
The total amount of protein - 60 grams, including animal - 30 grams;
The total amount of fat - 90 grams, including vegetable - 30 grams;
The total amount of carbohydrates is 400 grams.
They carry out work that includes general activities: increasing the level of medical knowledge of the population, informing about the causes of stomach cancer.
General events
Dialogue with the public:
Explaining the dangers of cancer and increasing people's alertness;
Description of the algorithm of actions in case of detection of the first signs of stomach cancer;
Promoting a healthy lifestyle.
Medical events
Work in this direction is carried out in risk groups. It consists of measures for the prevention and treatment of precancerous diseases.
It is necessary to carry out therapy against Helicobacter pylori bacteria before the development of precancerous changes in the body. This type of bacteria is the etiological factor in 71-95% of all cases of stomach cancer.
The risk group includes people with a history of:
genetic predisposition;
Carriage of H. Pylori;
Resection of the stomach;
Long period of work in hazardous and chemical industries;
Gastric cancer does not show the first symptoms. Therefore, this disease is dangerous for humans. Particular attention is paid to patients suffering from gastrointestinal diseases. The causes of stomach cancer depend on various factors (comorbidities, long-term diet). Therapy is prescribed after a comprehensive examination of the patient.
Medical indications
Signs of the disease (early symptoms of stomach cancer: soreness, nausea, anorexia, exhaustion) are very non-specific. They occur with gastritis, stomach ulcers. Therefore, the risk group includes patients with such diagnoses.
What is stomach cancer? The disease is in second place in terms of mortality from oncology (out of every hundred patients, 12 men and 10 women die).
How does stomach cancer develop? Initially, oncology affects the mucous membrane of the organ, and then causes the rapid appearance of metastases that damage the nearest organs, including the lungs.
The causes of stomach cancer are not known. But there are factors that provoke the development of the disease:
- Defeat Helicobacter pylori - the bacterium lives in the acidic environment of the stomach, provoking gastritis and peptic ulcer. Such ailments lead to oncology, as they are precancerous diseases. The bacterium destroys the mucosa of the organ. Hydrochloric acid corrodes the walls, causing erosive changes. Ulcers, atrophic lesions are a favorable environment for the progression of stomach cancer, the signs of which will not keep you waiting.
- Another reason is dietary preferences. It has been proven that the abuse of fatty, fried, spicy and smoked foods increases the risk of cancer. In countries with a high incidence of cancer (Japan), residents consume a lot of starchy foods (bread, potatoes, rice).
The course of the disease is adversely affected by:
- rare, quick snacks;
- binge eating.
This overloads, weakens the stomach, provoking relapses and complications of the pathology.
Alcohol, drugs, chemicals
Nitrates and nitrites violate the integrity of the gastric mucosa, penetrate into its structure, causing rebirth. Sources of chemicals for the body - vegetables. Their pollution is associated with an excess of nitrogen fertilizers and low culture.
It is noted that an excess of salts of nitric or nitrous acid in significant concentrations is found in smoked meats, dried foods, beer, cheese, tobacco, and cosmetics.
The development of cancer provokes ethyl alcohol (causes acute erosive processes, malignant degeneration of cells). Smoking destroys the stomach, which is manifested by the corresponding symptoms. There are some drugs that are dangerous for the body (anti-inflammatory, antibiotics, corticosteroids). Their constant use causes ulcers and, as a result, stomach cancer. In this case, the signs of the disease can be both early and late.
It has been proven that radioactive irradiation in significant doses contributes to the degeneration of the cells of the organ. Persons are more prone to pathology:
- with obesity;
- after surgery on the stomach;
- with low acidity;
- having a deficiency of vitamins (pernicious anemia);
- with oncology of other organs;
- working with asbestos, nickel;
- with a genetic predisposition (the probability of getting sick in blood relatives is more than 25%);
- with the presence of viral pathology (in particular, infection with the Epstein-Barr virus);
- suffering from malignant (pernicious) anemia;
- with immunodeficiency states;
- with confirmed Helicobacter pylori infection (carcinogen of the first class).
There are so-called precancerous diseases that adversely affect the mucous membrane, provoking the appearance of unusual epithelium:
- polyposis growths;
- B12 - deficiency anemia (vitamin deficiency impairs the formation of the gastrointestinal epithelium);
- some subtypes of chronic gastritis (in particular, atrophic gastritis, leading to the death of stomach cells);
- Menetrier's pathology, which contributes to the abnormal growth of the mucosa;
- stomach ulcer.
Origin mechanism
A malignant tumor in the stomach will not occur if the patient is healthy. The properties of the mucosa are preliminarily changed. The transition of the process into a tumor takes up to 20 years. With stomach cancer, the symptoms of the disease can manifest themselves in stages.
At the initial stages, the neoplasm is small - up to 2 cm. Only increasing in size, sprouting all the walls of the organ, the tumor makes itself felt. It disrupts digestion, prevents the passage of food through the digestive tract. The patient begins to lose weight rapidly.
The tumor progresses rapidly, growing into neighboring organs and tissues. This process leads to the early manifestation of metastases: cancer cells spread throughout the body hematogenously or lymphogenously, forming new tumor nodes. Often, metastases affect the lymph nodes, liver, ovaries, peritoneum, bones, and lungs. There may be violations in the work of all organs, which will lead to the death of the patient.
The main clinical manifestations of the disease
The clinic entirely depends on the localization of the neoplasm. So, a tumor of the upper esophagus has the following signs of stomach cancer in women and men:
- hypersalivation;
- dysphagia;
- regurgitation;
- soreness in the chest;
- stagnation of food in the esophagus.
If such a clinical picture begins to develop, it is recommended to consult a specialist. What are the symptoms of stomach cancer in the early stages?
Common manifestations of pathology include heaviness, soreness in the abdomen, vomiting of overcooked food, weight loss. All manifestations of cancer can be divided into several subgroups. With oncology of the stomach, the first symptoms of a general nature are as follows:
- fast fatiguability;
- poor performance;
- weight loss;
- lethargy;
- tearfulness;
- unmotivated weakness;
- anemia.
Local symptoms of stomach cancer at an early stage include:
- lack of satisfaction with food;
- loss of appetite;
- aversion to certain foods;
- constant vomiting;
- fever.
Specific symptoms of stomach cancer in women and men:
- vomit and feces with a black color;
- difficulty moving food;
- morning vomiting of yesterday's food.
It is especially important to monitor your health for people with stomach ulcers. When new symptoms appear, the course of the disease changes, it is important to contact specialists. So, the relationship of pain with eating, changes in taste, a decrease in the effectiveness of therapy are early signs of stomach cancer.
Forms of manifestation of pathology
The disease often has 3 main development options:
- Latent - asymptomatic. The only manifestation is the presence of a neoplasm on palpation. Most often, the disease is detected by chance, during the first examination (conducting FGDS, x-rays).
- A painless ailment is characterized by a more distinct clinic, but is not accompanied by pain.
- The pain course is accompanied by soreness of the upper part of the stomach (radiates to the lower back). Often the first symptoms of stomach cancer have a constant course, aggravated by movement.
The development of the disease includes 4 main stages. They show how much and how quickly stomach cancer develops:
- The early stages are manifested by a small formation in the layers of the stomach.
- The second stage: the tumor increases, deepens, spreads to nearby lymph nodes. There is a violation of digestion.
- The tumor grows into the wall of the organ, passes to neighboring tissues.
- Metastasis - cancer cells spread to different parts of the body, disrupting the functioning of systems.
Stages of oncology
There are four main stages of progression. The detection rate of each subsequent one increases significantly, but life expectancy decreases, the probability of healing patients.
Stage 0 The lesion of the organ includes exclusively the mucosa. Most favorable stage: 9 out of 10 patients are healed.
Stage 1 There is a germination of the tumor in the mucous membrane. The detection of pathology is extremely low, the survival rate is up to 80%, since such an ailment is completely curable.
Stage 2 The neoplasm sprouts almost all layers of the organ, metastasizes to the lymph nodes. Survival rate - 5 people out of 10.
Stage 3 There is a germination of cancer of all the walls of the stomach. Because of this, the survival rate is 3 out of 10 people.
Stage 4 The terminal stage of the development of the disease. Metastases spread to neighboring organs. Cancer is difficult to cure, the hope for survival is 5 patients out of 100. The life of such patients becomes unbearable: they are often constantly on pain medication.
Diagnosis of pathology
Since the first signs of stomach cancer are absent, therefore, the examination is carried out at stages 2-3 of the disease. Diagnosis of the disease in men and women includes endoscopy, histology and biopsy. Cancer process well gives in to detection by means of a contrast roentgenoscopy. Allows you to identify a defect in the filling of an organ, a decrease in its peristaltic activity, changes in the size, shape, relief of the organ.
In the early stages, the disease is often determined using ultrasound. For screening, the study of cancer markers in the blood is widely used. To protect yourself from oncological damage, it is important to know all the manifestations of pathology, regularly visit a gastroenterologist. Only an experienced specialist after a thorough examination will be able to identify the disease and prescribe treatment for stomach cancer. Successful therapy will allow patients to live fully after treatment.
Differential diagnosis from an ulcer consists in a comparative analysis of the anamnesis of two diseases. A developing oncological disease provokes the following symptoms:
- increased duration and severity of pain;
- development of nocturnal pain attacks not associated with eating;
- sudden weight loss;
- manifestations of anemia;
- rejection of certain products;
- the appearance of black liquid stools;
- vomiting with blood.
Therapy Methods
The main treatment for stomach cancer is surgery, during which the neoplasm is removed along with part of the organ (treated by gastrotomy) or with the entire stomach (gastrectomy). Sometimes the surgical treatment of cancer is complex: in addition to the organ, the spleen, liver, and sections of the intestine are removed. This will prevent the further development of the disease, minimize the signs of the tumor.
How to treat stomach cancer further? After surgery, it is important to continue therapy. The next stage of the fight against the disease is the appointment of chemotherapy or rays. Can stomach cancer be cured? The success of the course depends entirely on the complexity, prevalence and neglect of the process, as well as on the presence of metastases.
Numerous studies have shown that the treatment of early stages of gastric cancer is considered the most successful. An oncological lesion can be eliminated and it is necessary to try to do this. How to cure stomach cancer in the terminal stages? Usually, therapy is palliative in nature, since it is impossible to heal such patients. In these patients, symptoms and treatment are completely intertwined. How long patients with this diagnosis live depends on comorbidities.
Prevention of pathology
Every stomach ailment is much easier to prevent than to treat. Special recommendations have been developed to prevent the appearance of cancer. Among them:
- Regular and thorough examinations in the development of precancerous ailments.
- Strict adherence to all doctor's instructions.
- Diet correction: minimizing fatty foods, excluding smoked meats, spicy dishes. It is required to avoid the use of preservatives.
- Avoid using vegetables high in nitrates.
- Use medicines wisely (analgesics, antibiotics).
- Minimize the negative impact of the environment.
- Eat more fruits and vegetables.
- Refuse to take alcohol.
The effectiveness and success of therapy is assessed by the survival of people after treatment. They take into account data on how long patients live after the end of therapy (survival for 5, 10 years).
Successful cancer treatment depends on many factors. It is important for patients to understand that timely diagnosis and adequate, complete therapy will help to recover from such a difficult disease. It must be remembered that with stomach cancer, the causes of occurrence are not fully known. Therefore, you should protect yourself from all adverse factors as much as possible.
Gastric cancer is a malignant neoplasm that develops from the epithelial tissue of the gastric mucosa. It is one of the most common cancers, second only to lung cancer in men and breast cancer in women. The disease occurs 1.3 times more often among men. The average age of patients is about 60 years.
Factors that cause stomach cancer
The formation of stomach cancer is mainly due to the influence of external causes:
- the nature of the diet - the use of marinades, smoked meats, dried foods, overheated fats (fried food with a crispy crust, chips, fried pies);
- consumption of salty foods in large quantities, foods with nitrates;
- infection with the spiral bacterium Helicobacter pylori, which lives in the pylorus of the stomach;
- smoking, especially when combined with alcohol.
A significant role in the occurrence of oncology is played by diseases, for the most part of the gastrointestinal tract (GIT), accompanied by the degeneration of the mucous surface before cancer (background diseases):
- Chronic atrophic gastritis. It is the culprit in the formation of stomach cancer in 60 - 70% of cases, Helicobacter pylori infection is the main causative factor. It has been established that in people with atrophic gastritis of the main part of the stomach - the body of the stomach, the risk of developing a malignant tumor increases by 3-5 times compared to people with a normal, healthy stomach, in which there is no inflammation, no atrophy, no Helicobacter pylori. In the case of severe atrophic gastritis, limited to the antrum (narrowed lower part of the stomach), the incidence of oncological disease is 18 times higher than in healthy individuals. If atrophic changes are present in the entire digestive organ, the risk increases by about 90 times.
- Pernicious anemia is a violation of hematopoiesis due to a lack of vitamin B12 in the body. It is characterized by dysfunction of the immune system, damage to the gastric mucosa with the development of atrophic changes.
- Adenomatous polyps growing on the surface of the colon.
- Barrett's esophagus is a degeneration of the epithelium of the esophagus.
- The operation on the stomach, transferred more than 10-15 years ago, with the formation of a reverse reflux of bile into the stomach, a lack of hydrochloric acid and the enzyme pepsin in the gastric juice, atrophy, mucosal dysplasia, replacement of the gastric epithelium with intestinal.
- Gastric ulcer - indications are contradictory. With peptic ulcer of the body of the stomach, the probability of neoplasm growth increases by almost 2 times, with an ulcer of the lower part of the risk there is no.
- Menetrier's disease (hypertrophic gastropathy) is a degeneration of the mucous membrane of the digestive organ.
Much less often, the formation of a tumor of the stomach is due to hereditary predisposition. In 5% of cases, the disease progresses against the background of some inherited syndromes: familial multiple colon polyposis, syndrome of hereditary diffuse gastric cancer, hereditary non-polyposis colorectal carcinoma.
Symptoms of stomach cancer
Gastric cancer develops for a long time with mild clinical signs. At the beginning of the development of the tumor process, 20-40% of patients feel pain, more often in the presence of ulcers. The same percentage of patients feel discomfort in the upper part of the abdominal region: a feeling of heaviness below the sternum, belching, nausea, heartburn.
The named symptomatology is unstable, it is well eliminated by diet food and medicines. Further, the progression of oncological disease leads to a consistent increase in external signs. There is a general and local clinic for advanced cancer of the digestive organ.
Local symptoms are due to the location of the tumor. If the neoplasm is concentrated in the sections of the stomach with a smaller diameter, it relatively early increases in volume, thickens, narrowing the lumen, disrupts the passage of the contents and makes itself felt. Malignant formations located in a wide part of the stomach usually do not reveal themselves for a long time.
Penetrating through all layers of the stomach, cancer affects neighboring internal organs and systems. In most cases, the diaphragm, spleen, left sector of the liver, pancreas, transverse colon and mesentery, nerves and vessels from the diaphragm to the small pelvis.
In some variants of the pathology, the symptoms are due to metastases of the neoplasm, in 90% of cases affecting the liver, and occasionally the skin, bones, pancreas, and lungs.
| Tumor localization | Symptoms | |
| Sections of the stomach with a smaller diameter. | Cardiac department (directly connected to the esophagus). |
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| The pyloric section is a transversal (lower segment of the stomach, passing into the small intestine). |
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| Complete destruction of the stomach. |
|
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| Ingrown through all layers of the stomach into adjacent organs and systems. | Stretching to the pancreas, systems located behind the peritoneum, lymph node metastases. | Expansion of lower back pain |
| Penetration of the neoplasm into the diaphragm. | Expansion of pain to the chest area, hiccups. | |
| Tumor metastases. | Damage by liver metastases. |
|
| Large-scale damage to the lymph nodes. | Compression of the bile ducts forms obstructive jaundice, proceeding with skin itching, clay stools and dark urine. | |
| Krukenberg tumor - damage to the ovaries. | By palpation of the small pelvis, protruding tuberous neoplasms are outlined. | |
| The defeat of the neoplasm of the peritoneum. |
|
In general, when recognizing in patients with oncology of the stomach, it is noted:
- discomfort or pain in the stomach area (part of the abdomen below the sternum) - in 60 - 90% of patients;
- vomiting, nausea - in 40%;
- symptoms of bleeding in the stomach - pallor of mucous membranes and skin, vomiting with masses that have a dark color and a granular texture, an increase in heart rate, a decrease in blood pressure - in 10 - 15% of patients.
With the progression of the pathology, the general signs of the toxic effect of a malignant formation on the body become more pronounced, indicating an unfavorable prognosis: weight loss, sudden weight loss, mild swelling and pallor of the skin, general loss of strength, rapid fatigue, mental depression.
Diagnosis of stomach cancer
A promising examination method for determining risk groups is the analysis of serum pepsinogens (functionally inactive enzyme precursors produced in the stomach) - in combination with the detection of antibodies to H. Pylori or separately.
Pepsinogen I is produced in the chief cells of the mucosal surface of the body of the stomach. Its concentration in the blood increases with an ulcer and some erosive and ulcerative lesions of the upper gastrointestinal tract, but decreases in proportion to the rate of atrophy of the body of the stomach. Pepsinogen II is synthesized by the chief and cervical cells of the mucous layer of the digestive organ. The index of serum pepsinogen is less than 70 ng/ml and the ratio of pepsinogen I/pepsinogen II is less than 3 indicates the presence of a dystrophic-inflammatory change on the gastric mucosa that precedes gastric cancer.
An effective program for detecting gastric cancer at an early stage is a large-frame x-ray and an endoscope examination with the taking of biological material for biopsy. The detection rate of pathology reaches 50%.
Primary diagnostic methods
The main diagnosis involves endoscopic examination and x-ray of the stomach.
Fibroesophagogastroduodenoscopy - examination with an endoscope (FEGDS) - determines the size of the malignant formation, its location and shape, confirms the presence of the disease. Biological material of all identified focal changes is taken. It is advisable to simultaneously conduct a study on cytology.
FEGDS is less informative in the diffuse course of cancer, the accuracy of the method is no more than 65%. Often only indirect signs of the penetration of a malignant tumor into the submucosa of the stomach are found.
X-ray of the stomach determines cancer in 90% of clinical cases. The method determines the change in the size of the organ, its external outlines, the density of the walls, the disorder of the peristalsis of the organ. The method is ineffective at the initial stage of oncology.
An essential role in the detection of stomach cancer belongs to the examination of the patient. Pale skin indicates a decrease in hemoglobin in the blood. Unsharply pronounced puffiness of the skin, edema indicate a decrease in the content of albumin (protein) in the blood due to the widespread oncological disease.
The primary neoplasm of the middle section and the lower third of the stomach is detected by palpation (by touch). Splashing sounds identified on an empty stomach in the area of the stomach indicate a narrowing of its outlet section. The asymmetry of the abdomen, the contours of the swollen loops of the intestinal section, its increased motor activity with difficult sheep feces, the difficulties of gas passages, are typical of progressive intestinal obstruction.
A digital examination of the rectum reveals secondary oncological changes in the pelvis, bleeding symptoms (dark feces).
In women, an examination by a gynecologist reveals a Krukenberg tumor.
Laboratory methods
A blood test in the laboratory determines non-specific symptoms of common oncology: an increase in the erythrocyte sedimentation rate (ESR), a decrease in hemoglobin levels, a decrease in albumin content, and others.
Serological markers used in this type of cancer (CEA, CA 19 - 9, CA 72 - 4) have low sensitivity even at stage III of the disease, therefore they are not used to diagnose stomach cancer. But with an initially increased indicator of markers, their determination is practiced to assess the progression of the process of tumor spread.
Clarifying methods of diagnosis
Clarification is aimed at identifying indicators of the prevalence of the tumor, analysis of the depth of damage to internal organs.
Investigation by ultrasound (ultrasound). It detects damage by metastases of the liver, ovaries and lymph nodes in the retroperitoneal space, abdominal dropsy, in some situations it helps to determine the prevalence of the neoplasm, to see if adjacent organs are captured by the process.
X-ray is used to detect lymph nodes and lungs affected by metastases, inflammation of the serous membrane surrounding the lungs.
Additional diagnostic methods
Shown individually.
Endoscopic ultrasound examination (the probe is inserted into the lumen of the stomach) determines the depth of penetration of the tumor and metastases in the lymph nodes.
An alternative to ultrasound is MSCT - multislice computed tomography. Examined the abdominal cavity, small pelvis, chest. MSCT detects distant metastasis with extreme accuracy. But it is not suitable for analyzing the depth of the lesion, metastasis of the lymph nodes. It is practiced as the main method for clarifying diagnosis in economically developed countries of the world.
The method of nuclear magnetic resonance (MRI) has a high sensitivity for assessing tumor lesions of other organs, lymph nodes and soft tissues.
A laparoscopic examination is performed if it is suspected that it is impossible to surgically remove the tumor, when the spread of the oncological process is extensive, there are small metastases in the liver.
Forms and stages of stomach cancer. Disease prognosis
Chronic atrophic gastritis precedes gastric cancer. A detailed scientific study of the disease revealed that the formation of gastric oncology naturally goes through a series of successive stages: superficial gastritis → atrophic gastritis → small bowel metaplasia → colonic metaplasia → progressive dysplasia → stage 0 cancer (cancer in situ, the initial stage of malignant formation) → invasive (spreading) cancer . The process of tissue regeneration usually covers a period of 2-3 decades.
There are several forms of oncology: squamous cell carcinoma, glandular squamous cell carcinoma, glandular cancer (adenocarcinoma). The development of gastric cancer almost always (95% of cases) takes the form of adenocarcinoma - a malignant formation that develops from the glandular epithelium of internal and external organs. Its mucus-forming forms are progressing very aggressively - mucinous and cricoid.
According to the extent of the process, the following stages of progression of gastric cancer are classified:
Germination of the serous layer. In 1 - 2 lymph nodes
| Stage number | The nature of the organ damage | The presence of metastases |
| 0 stage | The tumor is inside the epithelium, without penetration into the mucous membrane. | No |
| Stage I-A | No | |
| Damage to the muscle layer. | No | |
| Stage I-B | The defeat of the mucous layer (connective tissue and smooth muscles) or submucosa. | In 1 - 2 lymph nodes |
| damage to the subserous layer. | No | |
| Stage II-A | Damage to the muscle layer. | In 1 - 2 lymph nodes |
| The defeat of the mucous layer (connective tissue and smooth muscles) or submucosa. | In 3 - 6 lymph nodes | |
| Germination of the serous layer. | No | |
| damage to the subserous layer. | In 1 - 2 lymph nodes | |
| Stage II-B | Damage to the muscle layer. | In 3 - 6 lymph nodes |
| The defeat of the mucous layer (connective tissue and smooth muscles) or submucosa. | ||
| Stage III-A | damage to the subserous layer. | In 3 - 6 lymph nodes |
| Damage to the muscle layer. | In 7 or more lymph nodes | |
| Expansion to adjacent organs. | No, in 1 - 2 lymph nodes | |
| Stage III-B | Germination of the serous layer. | In 3 - 6 lymph nodes |
| damage to the subserous layer. | In 7 or more lymph nodes | |
| Germination of the serous layer. | In 7 or more lymph nodes | |
| Stage III-C | Spread to adjacent organs. | In 3 - 6 lymph nodes, in 7 or more lymph nodes |
| Stage IV | Any type of lesion of the stomach. | Has distant metastasis |
The organs adjacent to the stomach are the retroperitoneal space, the transverse part of the large intestine, the small intestine, the liver, the kidney, the adrenal gland, the diaphragm, the spleen, the pancreas, and the abdominal wall.
According to the prognosis, two main types of gastric cancer are important - diffuse and intestinal.
In diffuse cancer, groups of cells scatter, contain a lot of mucin (the main component of the mucous secretion), and grow into the depths of the tissue. It develops at a young age, more often in women. There is a hereditary predisposition to it, development does not depend on external factors (nutrition). The tumor is localized more often in the upper third of the stomach, proceeds with early and rapid metastases.
The intestinal (intestinal) type forms jelly-like structures in the form of polyps and saucers. It develops against the background of external influence in the area of violation, pathological development of tissues. It happens more often in old age, in men. This form of cancer has a relatively favorable prognosis.
In the mixed type of gastric oncology, areas of both intestinal and diffuse cancer are found.
Preventive actions
The basics of a healthy diet play a major role in preventing the development of stomach cancer. It is necessary to limit the use of marinades, smoked meats, spirits, table salt, products with a high content of nitrates. Quit smoking. Practice basic hygiene to prevent H. pylori infection.
Secondary preventive measures are based on the treatment of pathologies against which cancer develops, regular examination with an endoscope with the collection of biological material for biopsy.
Since stomach cancer mainly occurs in various variants of adenocarcinoma, the main type of treatment for the disease is surgery, because adenocarcinoma is resistant to ionizing radiation and chemical therapy.
If people noticed the first signs of stomach cancer immediately after the onset of tumor formation, all the difficulties with the treatment of this disease could be avoided - this is what all oncologists say. However, until now, this pathology remains one of the most formidable diseases. Despite the unprecedented rise in medical technology, it is still considered intractable. According to statistics, cancer in half of the cases is diagnosed at 2 or later stages.
Knowing the initial symptoms of stomach cancer will allow you to start treatment on time and avoid the progression of the disease.
This is due, first of all, to the fact that in stomach cancer the first symptoms are erased or so weakly expressed that they are simply not noticed. That is why early diagnosis in most cases occurs by chance during a routine examination or during the diagnosis of other diseases of the gastrointestinal tract.
Particular attention should be paid to the state of their health by people with diagnosed chronic gastritis, adenomatous polyps of the intestines and stomach, as well as patients who have ever had surgery on this organ. It is they who form the basis of the risk group for oncological diseases of this organ.
As for the ulcers in the stomach, it was found that not always this disease can provoke the degeneration of cells into cancerous ones. Most often, ulcerations appear on the mucosa, already altered by the oncological process.
Men are more likely to develop stomach cancer than women
In addition, there is a gender dependence of risks - in men, stomach cancer occurs 3-4 times more often than in women. Experts tend to explain this by the fact that they prefer food that is harmful to the digestive tract:
- pickles and canned food;
- smoked meats, in which there are a lot of carcinogens and fat;
- fried foods.
Doctors note that the main reason for the degeneration of cells into cancer cells are violations of the rules of a healthy lifestyle. Fans of fast food, carbonated drinks and dry food are more likely to become a victim of oncology than those who have a genetic predisposition to cancer of the gastrointestinal tract.
The likelihood of developing cancer depends on the diet
The importance of early diagnosis of gastric cancer
Cancer cannot develop overnight. If at the initial stages it is possible to remove pathological cells from the body without significant consequences, then already at the second stage irreversible changes in tissues develop - cancer cells begin to grow rapidly and penetrate into neighboring tissues and organs.
What happens with the progression of stomach cancer and what the consequences of the disease can be can be seen from the table:
| Stage of tumor development | What's happening | Symptoms and prognosis |
|---|---|---|
| 0 stage | Malignant cells are few. They are localized within the epithelium of the stomach. The mucous membrane is not affected or changed slightly. | At this stage, there are no symptoms, however, if a tumor is detected, the prognosis is 90% favorable - after subtotal gastrectomy (up to 20% of the organ is removed), in most cases, a complete recovery occurs. |
| 1 stage | The tumor is located in the submucosal layer or in the lower layers of the mucous membrane without exit into the lumen of the stomach. The diameter of the neoplasm reaches 2 cm. | The first symptoms of stomach cancer appear in the form of mild dyspepsia. When detected at this stage, up to 80% of patients cope with the disease. |
| 2 stage | The tumor covers the mucous membrane, submucosal layer, muscular layers of the stomach, as well as regional lymph nodes. The diameter of the neoplasm can reach 5 cm. | Detection of a tumor in this degree occurs in 4-10%, since the symptoms are already quite pronounced. Complete recovery occurs in 50% of cases, in the other 50% five-year survival is guaranteed. |
| 3 stage | The malignant neoplasm becomes larger and clearly limited. It goes beyond the walls of the stomach and grows into neighboring organs and lymph nodes. The diameter of the main body of the tumor can reach 10 cm. Regional and distant lymph nodes (up to 15) are affected. | Detection of the disease is not complicated by the absence of symptoms, as numerous signs of gastrointestinal dysfunction and scarlet vomiting appear. The prognosis cannot be called favorable, since up to 7% of patients survive within 5 years. Most patients are inoperable. |
| 4 stage | The tumor enters the lumen of the stomach and reaches an impressive size. Cancer cells are found in other organs of the abdominal cavity and small pelvis, in the bone marrow and brain. | Due to the powerful intoxication of the body, the manifestation of the disease becomes apparent even without diagnosis. The prognosis is disappointing - less than 5% of patients survive within 5 years. |
Experts note that several factors can affect how quickly stomach cancer develops in individual patients. The main catalysts for the process of tumor growth are malnutrition, bad habits and lack of therapy. The emotional state of a person also plays an important role - severe stress can accelerate the progress of the disease.
In some patients with stomach cancer, it may take only a few weeks from stage to stage.
Since the risk of gastric cancer at an early stage is much lower, and the chances of a complete recovery remain high, the detection of disease in zero or first degree is an important task for maintaining a normal quality of life in patients. Due to the fact that the disease begins to appear too late, the overall statistics of stomach cancer remain unfavorable.
The presence of bad habits is a predisposing factor for stomach cancer
The first signs of a tumor process in the stomach
According to doctors, the symptoms of stomach cancer in the early stages in 90% of cases are similar to other diseases of this organ due to their non-specificity. They appear after the progress of the disease from the zero stage to the first, when the tumor is just beginning to develop in the submucosal layer of the organ.
The very first symptoms of stomach cancer doctors call the following manifestations:
- dizziness - occurs due to iron deficiency and a decrease in the level of hemoglobin in the blood;
- fatigue and fatigue - a consequence of the same iron deficiency anemia;
- pallor of the skin.
The appearance of causeless and regular fatigue may indicate the development of cancer in the stomach.
Of the eating disorders in the patient, only periodic sensations of heaviness are observed. When the stomach is damaged, the causes of this phenomenon lie in the fact that gastric juice is secreted in smaller quantities, the evacuation functions of the organ deteriorate. At the same time, even with adequate treatment, the symptoms of stomach cancer mentioned above do not disappear.
The voiced symptoms of stomach cancer in women over the age of 45 can be mistaken for manifestations of menopause, and in young women for manifestations of pregnancy.
Later, the described symptoms are added:
- an increase in the volume of the abdomen due to the accumulation of fluid in it;
- epigastric pain radiating to the back or lower back;
- unreasonable weight fluctuations;
- persistent stool disorder (constipation or diarrhea).
As the disease progresses, pain begins to radiate to the lower back.
As a rule, the presence of such symptoms indicates the transition of gastric cancer to a new, more difficult stage in therapy.
What to do if there are signs of illness
Careful diagnostics helps to differentiate the disease, the main task of which is to identify the root causes of a decrease in hemoglobin in the blood and to establish the source of iron deficiency anemia. It is possible to say that the initial stage of a tumor of the stomach is manifested in this way only after the following are excluded:
- chronic infectious and / or inflammatory diseases that provoked a violation of the reproduction of red blood cells;
- physical exhaustion due to a strict diet (most often found in women);
- chronic occult bleeding;
- deficiency of certain amino acids, vitamins and enzymes;
- consequences of long-term use of Ibuprofen, Aspirin and other NSAIDs.
A fecal test is given to diagnose cancer.
To establish the true picture, the examination should include an MRI procedure, laboratory blood tests (necessarily detailed). If the diagnoses listed above are not confirmed, additional studies are carried out:
- screening;
- examination of feces for occult blood;
- gastroscopy of the stomach with the sampling of material for biopsy.
They are carried out in both women and men, especially if the early symptoms of cancer are not complemented by signs of other diseases.
What happens if the cancer progresses further
If gastric cancer is not detected and confirmed, the symptomatic picture becomes more severe over time due to the increased negative effect of the tumor on the body.
Tumor growth leads to significant weight loss
In this case, the patient may appear:
- signs of dysfunction of organs and metabolic processes in the body;
- symptoms of obstruction of the stomach and intestines;
- aversion to certain foods (most often meat);
- severe weight loss up to anorexia;
- depressive disorders.
The general intoxication of the body also increases, which manifests itself in the form of the constant presence of fatigue, diffuse pains in the abdomen, vomiting and belching. At the same time, patients cannot explain what first manifestations of the disease appeared earlier, since many of the prerequisites for them were observed a long time ago.
Growing tumor causes vomiting
Progressive cancer, despite tumor growth and damage to the lymphatic and other systems, is more difficult to diagnose, since other organs are included in the pathological process.
What to do if stomach cancer is confirmed
After confirming the diagnosis, it is necessary to start treating the cancer as soon as possible, since even a slight delay can lead to the rapid growth of the tumor and the transition of the disease to a new, more severe degree.
The list of therapeutic measures depends on the stage at which the specialists diagnosed the tumor:
- when making a diagnosis at the zero stage, patients undergo a resection of the stomach;
- when cancer is detected at stage 1, patients are prescribed a course of chemotherapy and radiation treatment, and then the tumor is removed with part of the stomach;
Resection of the stomach - a method of treating a cancerous tumor at an early stage
- when oncology is detected at stage 2, hormonal, radiation treatment, as well as chemotherapy are indicated, and in the absence of complications and contraindications, gastrectomy (complete removal of the stomach) and resection of the affected regional lymph nodes are performed;
- when diagnosed with stage 3 and 4 stomach cancer, treatment consists in maintaining the basic functions of the body and curbing tumor growth and metastasis.
In order for the therapy to be as effective as possible, during each period of treatment, patients are advised to strictly follow the recommendations of the doctor. It is important to remember that this disease is very insidious and if at the initial stage of growth the tumor does not bother the patient, then at the final stage life can turn into torment.
You can learn about the signs of stomach cancer from the video: