Stomach cancer
Treatment of stomach cancer at the K+31 medical centers in Moscow.
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Causes of stomach cancer
A single cause for the development of stomach cancer has not been established, but a number of factors that contribute to its occurrence have been identified. Gastric carcinoma can develop under the influence of external and internal factors that cause chronic damage and degeneration of mucosal cells. These include:
- Genetic predisposition
- Infectious agents
- Diet and lifestyle
The combined effect of these factors significantly increases the risk of developing a malignant process.
Heredity and stomach cancer
Genetic factors play a significant role. Heredity determines a predisposition to stomach cancer, especially if close relatives have been diagnosed with cancer. A statistical association has been noted between gastric carcinoma and certain hereditary syndromes (for example, Lynch syndrome) and the presence of blood type A(II), indicating a genetic component in the development of this disease.
Bad Habits and Stomach Cancer
The main cause of stomach damage is aggressive impact on its walls. Regular consumption of strong alcohol and systematic smoking cause chronic inflammation and mucosal atrophy, which creates a favorable environment for malignant transformation. An unbalanced diet with excess salt, smoked foods, and a lack of fiber also contributes to the development of stomach cancer.
Helicobacter pylori and Stomach Cancer
Helicobacter pylori infection is recognized as one of the leading carcinogenic factors for stomach cancer. This bacterium causes chronic atrophic gastritis and peptic ulcers. These conditions lead to metaplasia—the replacement of the normal gastric mucosa by intestinal epithelium, a precancerous condition.
Other Risk Factors
Other factors that increase the risk of stomach cancer include age over 50, as cellular mutations accumulate over time. A significant cause is working in hazardous industries (coal and rubber industries). Immunodeficiency conditions also weaken the body's defenses against atypical cells.
Stomach Cancer Classification
Without an accurate classification, it is impossible to choose the right treatment strategy, type of surgery, or prognosis for the patient. Today, the disease is classified by many parameters, including location, histological structure, and extent of the process.
Classification by location and histological type
Gastric tumors are divided into groups based on their location in certain sections:
- Fundus
- Body
- Cardiac, pyloric, and antral sections
Treatment tactics also largely depend on the histological structure of the tumor, which is classified as adenocarcinoma (diagnosed in 95% of clinical cases), squamous cell, small cell, and undifferentiated cancers. The most common type is adenocarcinoma, which develops from the glandular cells of the mucosa.
Staging (TNM system)
Stage is one of the main factors in choosing a treatment strategy. For precise staging, the international TNM system is used, taking into account three main criteria:
- T (Tumor) – the depth of tumor invasion into the wall and adjacent tissues
- N (Nodus) – the number of affected regional lymph nodes
- M (Metastasis) – the presence or absence of distant metastases
Based on a combination of these criteria, four main stages of stomach cancer are distinguished, from I, in which the tumor is superficial, to IV, in which distant metastases are present.
Metastasis Pathways
Metastases are cancer cells that enter the blood and lymph and spread throughout the body. Stomach cancer metastases travel via the lymph to the abdominal lymph nodes, then to the supraclavicular lymph nodes. Metastases most often spread through the blood to the liver, and in some cases to the lungs, bones, and brain.
Metastases of gastric cancer
Gastric cancer metastases are secondary tumor foci that arise from the spread of malignant cells throughout the body. A cancer cell that has separated from the primary tumor can travel in two main ways.
The presence of metastases is the main factor determining the stage and prognosis of the disease.
- The lymphogenous pathway carries lymph to regional (nearby) and distant lymph nodes
- The hematogenous pathway carries blood, most often to the liver, which is the main "filter" for blood flowing out of the organ, as well as to the lungs, bones, and brain
Stages of Stomach Cancer
The stage of stomach cancer is determined based on three criteria of the international TNM staging system: tumor depth (T), lymph node involvement (N), and the presence of distant metastases (M). The final diagnosis is based on the combination of these factors. Stage I indicates a superficial tumor within the mucosa. At stage II, the tumor has invaded the muscularis propria. Stage III is characterized by deeper growth and multiple lymph node involvement. Stage IV is assigned in the presence of distant metastases to other organs.
Types of Stomach Cancer
The main histological type of stomach cancer is adenocarcinoma, which accounts for up to 95% of all cases. This gastric tumor develops from the glandular cells of the mucosal layer. Other, rarer types include squamous cell carcinoma, which originates from squamous epithelial cells; lymphoma, which arises from the lymphoid tissue of the stomach wall; and carcinoid tumors, which develop from neuroendocrine cells. The precise histological type of gastric carcinoma determines treatment strategy and prognosis.
Stomach Cancer Treatment Methods
Modern gastric cancer treatment is based on a multidisciplinary approach. The choice of treatment depends on the stage and characteristics of the tumor. Surgery remains the primary method. Chemotherapy, radiation therapy, and targeted therapy are used as adjunctive or independent treatments. A combination of several approaches is often used to achieve the best outcome.
Today, surgery remains the primary radical treatment method: gastrectomy and gastric resection (subtotal distal and subtotal proximal). The main requirement for surgery is the ability to remove the affected organ or part of it, along with regional lymph nodes and surrounding tissue.
Surgical treatment is also combined with chemotherapy and radiation therapy. The type and sequence of treatment is determined individually for each patient, taking into account the type, structure, location, and extent of the tumor, as well as the patient's medical history and age.
Surgical removal of stomach cancer
Main Types of Surgical Removal of Malignant Tumors
- Subtotal gastrectomy, in which most of the stomach, except the cardiac region, is removed. In stages I and II gastric cancer, as well as when the tumor is located in the antrum, lymph node dissection (removal of affected lymph nodes) is also performed during surgery.
- Total gastrectomy is the complete removal of the stomach. This procedure is performed as a last resort. If at least ¼ of the organ can be preserved, complete stomach removal is not performed.
Both of these surgical interventions involve restoring the integrity of the gastrointestinal tract through anastomoses (connections) between the small intestine (jejunum or duodenum) and the esophagus or the remaining upper portion.
Advances in modern medicine in early stages (I and II) allow for surgical treatment using laparoscopy (endovideosurgery), which is less invasive than the surgical options listed above. Removal of affected areas is performed through punctures, requiring only a small incision to extract the removed material.
Thanks to advances in science and technology, so-called "early cancer" is also treated with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). But these methods are effective and possible only if the tumor is detected at the earliest stages, when cancer cells have not yet left the polyp or the gastric mucosa.
Radiation Therapy
Radiation therapy for stomach cancer is used before surgery (neoadjuvant radiation therapy) to shrink the malignant tumor, making it operable and easier to treat. It is also used after surgery (adjuvant radiation therapy) to remove any remaining cancer cells. Radiation therapy has side effects, including nausea, diarrhea, and possible digestive problems.
Chemotherapy
Chemotherapy is also used in the treatment of stomach cancer before or after surgery and, accordingly, is classified as adjuvant or neoadjuvant. Chemotherapy is often combined with radiation therapy (chemoradiation therapy). If stomach cancer is already in the final stage 4 and surgery is not possible, chemotherapy is used as a standalone treatment, but in this case, it is palliative. In such situations, chemotherapy can reduce the size of the malignant tumor, alleviate symptoms, and prolong the patient's life.
Sometimes, targeted drugs are used for treatment.
General information
General Symptoms
Nonspecific manifestations of the disease include the "minor signs" syndrome. This symptom includes unexplained weakness, decreased performance, loss of appetite, development of anemia, and unexplained weight loss.
Early Stage Symptoms
The early stages of stomach cancer often progress insidiously. The first early symptom may be subtle: discomfort in the upper abdomen, a feeling of rapid satiety even after a small meal, or heaviness in the abdomen.
Late Stage Symptoms
Late stage stomach cancer presents with pronounced clinical symptoms. Characteristic symptoms include persistent pain, vomiting of food, and difficulty swallowing (dysphagia). The presence of blood in vomit or black stool (melena) indicates complications.
Diagnosis of Stomach Cancer
The primary method for diagnosing the disease is fibrogastroscopy with tumor biopsy and histological (morphological) examination of the biopsy material. It is the only reliable and trustworthy method for the initial detection of malignant tumors in this area.
Visualizing and differentiating cancer in its early stages is difficult, making it critical to use high-quality videoendoscopic equipment with the ability to magnify the image and perform a narrow-spectrum examination. This equipment allows for tumor detection in the earliest stages, including when the lesion is only a few millimeters in size.
Multifocal biopsy and the use of special vital dyes ensure an objective and accurate diagnosis. To determine the stage of development and develop a treatment plan, a contrast-enhanced spiral computed tomography (CT) scan is necessary.
For diagnostic purposes, patients may also be prescribed:
- X-ray
- Computed tomography
- Positron emission tomography
- Diagnostic laparoscopy
- Blood tests and other laboratory tests
Stomach cancer treatment costs
The final price for stomach cancer treatment at our clinic is determined individually. The cost depends on the stage of the disease, the complexity of the required surgery, and the chosen chemotherapy or radiation therapy regimen. Detailed information on the cost of services can be obtained during an in-person consultation with an oncologist.
Questions and Answers
We've compiled answers to the most frequently asked questions from patients during oncology appointments to provide greater clarity on the diagnosis and treatment of the disease.
Is it possible to completely cure stomach cancer?
Is it necessary to remove the entire stomach?
Can gastritis or ulcers develop into cancer?
Bibliography
The following scientific article and clinical guidelines on stomach cancer were used in preparing this material:
- Stomach Cancer. Clinical Guidelines of the Russian Federation (Russia). – Ministry of Health of the Russian Federation, 2020.
- Davydov M.I., Aksel E.M. Statistics of Malignant Neoplasms in Russia and the CIS Countries in 2012. – Moscow: Publishing Group of the Russian Oncology Center, 2014.
- Stilidi I.S., Nered S.N. Current Concepts of the Basic Principles of Surgical Treatment of Stomach Cancer // Bulletin of the N.N. Blokhin Russian Oncology Center, Russian Academy of Medical Sciences. – 2009. – Vol. 20, No. 3. – Pp. 63–71.
- Chissov V.I., Davydov M.I. Oncology: National Guidelines. – Moscow: GEOTAR-Media, 2013. – 1072 p.
- Besova N.S., Belyaev A.M. Surgical treatment of locally advanced gastric cancer // Issues of oncology. – 2014. – Vol. 60, No. 5. – Pp. 529–535.
- Ajani J.A., D'Amico T.A., Bentrem D.J. et al. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology // Journal of the National Comprehensive Cancer Network. – 2022. – Vol. 20, No. 2. – Pp. 167–192.
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Symptoms and signs of stomach cancer
The following symptoms indicate the disease:
The initial symptoms and clinical picture of a tumor in different parts of the stomach may vary. If the tumor affects the cardiac region (the upper part of the organ), symptoms will include difficulty swallowing large pieces and coarse food (dysphagia) and increased salivation. As the condition worsens, these symptoms may be accompanied by pain, vomiting, and a feeling of heaviness in the chest and between the shoulder blades.
If the tumor is located in the lower part of the stomach (in the antrum), the patient will experience problems with food stagnation and symptoms such as abdominal heaviness, belching, vomiting, and bad breath.
However, in the early stages, stomach cancer can often be asymptomatic, or symptoms may overlap with other conditions, such as chronic stomach diseases.
Clinical manifestations depend on the stage and extent of the disease. As the disease worsens, symptoms become more pronounced: persistent abdominal pain that can radiate to the back, frequent heartburn, vomiting immediately after eating, abdominal distension, and a noticeable, bulging mass under the pit of the stomach—a sign that the tumor has grown into the anterior abdominal wall. Symptoms then worsen, with black stools or black or bloody vomit due to bleeding. Blood loss causes pallor and dizziness.
If you experience the above symptoms, please contact our clinic's oncology department for an examination. You can contact us on our website or by phone.
The clinical manifestation of the disease depends on the extent of the disease. Any symptom can indicate both early and late changes, so it is important to pay attention to any new sensations.