Stomach
cancer is sometimes called gastric cancer. Worldwide it is one of the
most common cancers. Stomach cancer is more common in men than in women
and ten/ds to occur mainly in older people. Most people who develop
stomach cancer are over the age of 55.
In
most cases, stomach cancer begins from a cell which is on the inside
lining of the stomach (the mucosa). This type of stomach cancer is
called adenocarcinoma of the stomach. As the cancer cells multiply :
- The tumour may invade deeper into the wall of the stomach. In time, it may pass through the wall of the stomach and invade nearby organs such as the pancreas or liver.
- The tumour may spread up or down the stomach into the oesophagus (gullet) or small intestine.
- Some cells may break off into the lymph channels or bloodstream. The cancer may then spread to nearby lymph nodes or spread to other areas of the body (metastasise).
Types of Stomach Cancer
- Adenocarcinoma : is the most common type of stomach cancer. More than 95 out of every 100 stomach cancers (95%) diagnosed are adenocarcinomas. The cancer starts in the gland cells in the stomach lining. The gland cells produce mucus and stomach juices.
- Squamous : cells are the skin like cells that lie between gland cells to make the stomach lining. These cancers are treated in the same way as adenocarcinomas.
- Lymphoma : is another type of cancer altogether. It is very rare. There is a whole section on non Hodgkin's lymphoma, which will be more relevant to you if you have been diagnosed with lymphoma of the stomach.
- Gastrointestinal Stromal Tumour GISTs : can be cancerous or non cancerous (benign). These rare tumours develop from the cells of the connective tissue that support the organs of the digestive (gastrointestinal) tract. Most are found in the stomach.
- Neuroendocrine tumours (NETs) : can be cancerous or non cancerous. They grow in hormone producing tissues, usually in the digestive system. They are rare, but the most common is carcinoid tumour.
Diagnosis of Stomach Cancer
If
you have symptoms that suggest stomach cancer, your doctor will check to
see whether they are due to cancer or to some other cause. Your doctor
may refer you to a gastroenterologist, a doctor whose specialty is
diagnosing and treating digestive problems. Your doctor will ask about
your personal and family health history. You may have blood or other lab
tests. You also may have :
- Physical exam : oncologist feels the abdomen of the patient for fluid, swelling, or other changes. They also will check for swollen lymph nodes.
- Endoscopy : Surgical Oncologist uses a thin, lighted tube (endoscope) to look into the stomach after numbing the throat with an anesthetic spray. Patient may be given medicine to help him relax. The tube is passed through the mouth and esophagus (food pipe) to the stomach.
- Biopsy : An endoscope has a tool for removing tissues. Surgical Oncologist uses the endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.
Stages of Stomach Cancer
- Stage 0 (Carcinoma in situ): In this stage, cancer is present in the inner lining of the mucosal layer of the wall of the stomach.
- Stage I : This stage is categorized into two stages- IA and IB that also depends on the spread of the cancer.
- Stage IA : Here in this stage, the cancer has spread completely from the mucosal layer of the wall of the stomach.
- Stage IB : Cancer has spread to the muscularis layer of the stomach wall or has completely spread from the mucosal layer of the stomach wall that can be found in almost 6 lymph nodes surrounding the tumor.
- Stage II : In this stage, the cancer has spread –
- To the serosal layer of the wall of the stomach but not to other organs or to lymph nodes
- To the middle layer of the stomach wall and can be found in almost 6 lymph nodes surrounding the tumor, or
- From the innermost layer of the wall of the stomach and can be found in 7-15 lymph nodes surrounding the tumor
- Stage III : This stage is categorized into IIIA and IIIB that depend on the spread of the cancer. In stage IIIA, cancer has spread to –
- Organs just next to the stomach that has not spread to other body parts or to lymph nodes
- The middle layer of the wall of the stomach and can be found in 7-15 lymph nodes surrounding the tumor, or
- The outermost layer (serosal) of the wall of the stomach and can be found in 1-6lymph nodes surrounding the tumor
- Stage IV : Here in this stage, the cancer has spread to –
- Different body parts
- Organs just next to the stomach and to at least 1 lymph node, or
- More than 15 lymph nodes
Most Advanced Stomach Cancer Surgery and Treatment in India
Surgery
The goal of surgery is to remove all of the stomach cancer and a margin of healthy tissue, when possible. Options include :
- Removing a Portion of the Stomach (Subtotal Gastrectomy).
During subtotal Gastrectomy, the surgeon removes only the portion of the
stomach affected by cancer. Subtotal gastrectomy can be of two types :
- Distal subtotal gastrectomy is performed if the tumor cells are present in the lower part of the stomach near to the stomach duodenum junction.
- Proximal subtotal gastrectomy is done when the tumor is situated in the upper part of the stomach and also involves the esophagus.
- Removing the Entire Stomach (Total Gastrectomy). Total Gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system.
- Removing Lymph nodes to look for Cancer. The surgeon examines and removes lymph nodes in your abdomen to look for cancer cells.
Chemotherapy
Chemotherapy
is a drug treatment that uses chemicals to kill cancer cells.
Chemotherapy drugs travel throughout your body, killing cancer cells
that may have spread beyond the stomach. Chemotherapy can be given
before surgery (neoadjuvant chemotherapy) to help shrink a tumor so it
can be more easily removed. Chemotherapy is also used after surgery
(adjuvant chemotherapy) to kill any cancer cells that might remain in
the body.
Radiation therapy
Radiation
therapy may be used to kill the cancer cells. Radiation therapy can be
administered using a machine outside the body (external radiation
therapy) or using needles, seeds, wires, or catheters placed in the body
in or near the cancer (internal radiation therapy). External radiation
therapy uses a machine outside of the body to send radiation toward the
cancer. Internal radiation therapy uses a radioactive substance sealed
in needles, seeds, wires, or catheters that are placed directly into or
near the cancer.
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