Cancer Treatment
Stomach Cancer
Stomach cancer, as the name suggests, an abnormal condition with the growth of tumours that starts in the stomach and can occur in any area of the stomach. The stomach is a muscular sac-like structure that receives food that we eat from the oesophagus.
The food remains in the stomach for 2-3 hrs. During this time, the food starts getting digested and is then passed into the small intestines for further digestion. Stomach cancer is also known as gastric cancer and can affect any part of the stomach.
Symptoms of Stomach Cancer:
Difficulty in swallowing
Feeling bloated after eating or feeling full after eating a small portion of food
Heartburn
Indigestion
Nausea
Pain or fullness in the upper abdomen
Unintentional weight loss
Vomiting with or without blood in vomitus
Gastric outlet obstruction
This occurs when the cancerous growth obstructs the passage of food from the stomach into the small intestine. As a result, the food starts accumulating in the stomach, causing distension of the stomach, fullness after meals and vomiting of food particles every few days.
Cancer Treatment
Types of Stomach Cancer
- Carcinoma:Cancers stemming from the epithelial cells lining the stomach are called carcinomas and are of multiple types; with adenocarcinoma accounting for nearly 90 to 95% of stomach cancer cases. The other rare types are squamous cell carcinoma small cell carcinoma, adenosquamous carcinoma, etc.
- Lymphoma:This is the cancer of the body’s immune cells, usually the T & B lymphocytes. These cells are also present in the walls of the stomach and hence can give rise to gastric lymphomas.
- Gastrointestinal stromal tumour (GIST):These cancers originate in the interstitial cells of the stomach cells, called the Cajal cells. Some of these tumours are benign, but in some cases also lead to the formation of malignant tumours.
- Gastrointestinal Carcinoid tumour:The stomach also has hormone-producing cells which can become malignant leading to the formation of carcinoid tumours.
- Sarcomas:These are relatively rare cancers and include Leiomyosarcomas, Lymphosarcomas, Fibrosarcoma, Myxosarcoma, etc.
Diagnostics Facilities
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General Diagnostic Facilities
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Cancer Treatment
Causes of stomach cancer:
It’s not clear what causes stomach cancer, but extensive research indicates the following factors increase the risk of developing stomach cancer:
- High salt and nitrate consumption
- Low dietary intake of Vitamin A & C
- Excessive consumption of smoked or cured food
- Lack of refrigeration
- Consumption of contaminated water eg. well water
- Gastro-oesophagal reflux disease
- Obesity
- Workers in the rubber and coal industries
- Cigarette smoking
- Infections with Helicobacter pylori or Epstein-Barr virus
- Radiation exposure
- Prior gastric surgery for benign gastric ulcer disease
- Family history of gastric cancer
- Genetic Conditions such as the Li-Fraumeni syndrome, Familial Adenomatous Polyposis (FAP), and Lynch syndrome can also predispose individuals to stomach cancer
When to see the Doctor?
Indigestion and heartburns are very common symptoms and may overlap with other gastric problems. The symptoms can appear in diverse forms as mentioned above and hence, if you are experiencing a combination of any of these symptoms, especially over longer periods, you should consult a doctor.
Individuals with a family history of stomach cancer should undergo routine testing and screening to detect cancer at the initial stages for the best treatment outcomes.
Prevention of Stomach Cancer
To reduce the risk of stomach cancer, you can:
Exercise regularly and keep your weight under control
Try to incorporate more fruits and vegetables into your diet each day
Reduce the intake of salty and smoked foods
Quit smoking
People with a family history of stomach cancer should undergo periodical testing and screening to detect cancer at the early stages
Do not delay seeking a medical consultant, when you start exhibiting symptoms.
Testing for Stomach cancer includes:
Once, you see a specialist, the following tests may be carried out:
A physical exam: A thorough physical examination will be carried out, after taking a detailed history of your symptoms.
Endoscopy: Usually upper gastrointestinal endoscopy i.e. UGI scopy is performed, wherein an endoscope a thin tube with a camera at its end will be inserted through your mouth into the oesophagus and stomach, to rule out any abnormal growth or ulceration.
Biopsy: A biopsy is performed at the time of UGI scopy to determine the type of stomach cancer.
Blood tests: Routine blood tests will be taken along with special tests to determine tumour marker levels eg. CEA, CA 19.9
CT scan: A CT scan of the chest, abdomen and pelvis is done to determine the stage of disease; which in turn help decide on the best treatment approaches for the patient.
PET CECT scan: A PET CT scan is recommended in advanced or recurrent cases to rule out the spread of cancer to other sites, eg lungs, liver, bone, etc.
Diagnostic laparoscopy and biopsy: In advanced cases, a diagnostic laparoscopy is done to document the spread of the disease, and a biopsy is also executed simultaneously.
Treatment for Stomach Cancer
Surgery:
Surgical procedures to remove cancer include:
- Endoscopic Mucosal Resection (EMR)or Endoscopic submucosal dissection (ESD) uses an endoscope and special instruments to remove small early tumours present on the mucosal or submucosal layer.
- Subtotal gastrectomy: In large-size malignant tumours, a part of the proximal or distal stomach is removed along with adjacent lymph nodes. The rest of the stomach is then anastomosed to the upper part of the small intestine (jejunum) to establish continuity for food passage and digestion.
- Total gastrectomy:The whole of the stomach sometimes needs to be removed, depending upon the length of the stomach affected with cancer. In such cases, the oesophagal tube is connected directly to the small intestine (jejunum).
- Bypass surgeries:In some advanced cases (stage IV), only bypass procedures are performed, like gastro-jejunostomy, to allow the patient to eat, during treatment.
Chemotherapy:
Chemotherapy in the form of injections or tablets is suggested depending on the stage of the disease.
- Adjuvant chemotherapy:This type of chemotherapy is given after surgery, usually, 6 cycles with each cycle having a duration of 2-3 weeks.
- Neoadjuvant chemotherapy:This type of chemotherapy is given before surgery and is called neoadjuvant chemotherapy, consisting of 3 cycles with each cycle having a duration of 3 weeks, and, the remaining 3 cycles are given as adjuvant chemotherapy, after surgery.
- Chemo-radiation:Chemo is recommended along with radiation therapy; called concurrent chemo-radiotherapy, which can be used as a neoadjuvant or adjuvant.
- Intraperitoneal chemotherapy:This is a special form of chemotherapy delivered directly into the peritoneal (abdominal cavity) in patients with advanced stomach cancer. An intraperitoneal (IP) port system is introduced underneath the skin of the abdominal wall with a tubing passed into the abdominal cavity, under general anaesthesia. This new approach has been used successfully as neoadjuvant treatment also, especially in patients with peritoneally metastasised gastric cancer and has been shown to increase the chances of completely eliminating diseased cells with higher survival chances.
Radiation therapy:
Radiation therapy either alone or in combination with chemotherapy is recommended depending on the surgical histopathological report.
Targeted therapy:
Targeted therapy uses drugs to target specific proteins within the cancer cells, to eliminate them. For example, Trastuzumab targeting Her2neu protein in stomach cancer cells expressing Her2neu protein is suggested during treatment for stomach cancer.
Immunotherapy:
In advanced cases, biological therapy or immunotherapy is suggested as a treatment approach. Immunotherapy targets the cells, which affect the body’s immune response and helps the body in eradicating cancer cells.
Doctors
Surgical Oncology
Dr. Aruna Prabhu
MS, MCh
Surgical Oncology
Dr. Deepti Mishra
MS, MCh
Medical Oncology
Dr. Bhavesh Poladia
DNB, DM
Medical Oncology
Dr. Deepan Rajamanickam
MD, DM
