Gastric cancer

Gastric cancer is a malignant tumour that originates from the epithelium of the mucous membrane of the stomach. It is the fifth most common cancer, behind lung, breast, prostate and colorectal cancers. Each year, 989 600 new cases and 738 000 deaths (10% of all cancer deaths) occur worldwide.

The most common methods of diagnosing gastric cancer include:
1) FGDS (fibrogastroduodenoscopy).
2) CT (computed tomography) of the abdomen and chest cavity with contrast.
3) MRI (magnetic resonance imaging) if pelvic spread is suspected.
4) Biopsy of the tumour, followed by histological examination.
5) Diagnostic laparoscopy with peritoneal swabs followed by cytology.
6) Clinical and biochemical blood tests.
7) Cancer markers: REA, CA 19-9, CA 72-4. Markers are studied to assess the dynamics of treatment.
8) PET (positron emission tomography) allows detection of distant metastases.
Stages of gastric cancer
Stage I
The tumor is located within the mucosa and submucosa of the stomach, without reaching the muscular layer. There are no metastases in the lymph nodes or other organs.
Stage II
The tumor infiltrates the muscular lining of the stomach, but is still located inside the organ, not reaching beyond its serous cover. In this stage, there may be single metastases to lymph nodes located near the stomach wall and removed during surgery.
Stage III
The tumor reaches a significant size, may occupy several parts of the stomach, and extends beyond the stomach, growing into neighboring organs. Smaller tumors, if there are multiple metastases to regional lymph nodes, also belong to this stage.
Stage IV
Independent of the size of the primary tumor, determined by the presence of distant metastases, and characterized by an extremely poor prognosis.
Depending on the stage of the disease, treatment begins with surgery or neoadjuvant polychemotherapy followed by surgery. Surgery has been and remains the mainstay of gastric cancer treatment, and there are no alternatives at present.
Different types of surgical intervention are performed depending on the localisation of the process and the size of the tumour:
- gastrectomy (complete removal of the stomach);
- Subtotal and proximal gastric resection (removal of the affected part of the stomach within healthy tissue);
- gastrectomy with resection of the lower third of the oesophagus for tumours of the oesophagogastric junction.
The main condition for the radicality of the surgery is the removal of the affected stomach or its corresponding part and regional lymph nodes with surrounding tissue in a single block. This allows for proper staging and reduces the risk of future disease progression. After evaluation of the tumour by the pathologist, treatment can be supplemented with adjuvant polychemotherapy. Surgical treatment in the early stages is done laparoscopically (endovideosurgically). The operation is done without making a big cut on the abdomen wall, and optical equipment and special instruments are inserted through the puncture wounds. A small incision is made to remove the removed stomach with the tumour.
This type of surgery is currently accompanied by a short period of hospitalisation, fast recovery, low post-operative complication rate and low mortality.
Postoperative period
After the operation, the patient will stay in the intensive care unit for 24 hours, where vital functions will be monitored and adequate analgesia will be administered under the supervision of intensive care doctors.
After 24 hours, the patient is transferred to the specialist ward, where thromboembolic, infectious and ulcerative complications are prevented, infusion and anti-inflammatory therapy is administered and pain management continues.
The patient begins to sit down and get up from the bed the first day, he moves about in his room the second day, and from the third day he moves about freely in the ward and clinic. A therapeutic exercise therapist works with the patient at all stages, which speeds up the recovery.
Starting from the second day the patient is given oral nutrition in the form of nourishing mixtures and broths, from the fifth day he is transferred to the sparing table, from the 10th-11th day he is transferred to the common table.
On the 7th day the patient is discharged home.
Postoperative follow-up
In our experience, the optimal scheme is FGDS in 1, 3, 6, 12 months after surgical treatment and then once a year, a CT scan once in 2 years and then once a year.
The dynamic examination plan should include:
- Complaints clarification and physical examination by an oncologist;
-abdominal, thoracic and pelvic CT with contrast,
abdominal, thoracic and small pelvis CT with contrast -FGDS (esophagogastroduodenoscopy) with biopsy if necessary;
- Blood tests for cancer markers (REA, CA19, AFP, SF72-4).
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