Stomach cancer: first symptoms in women. How long do they live with him? на flymega.ru

Stomach cancer is a dangerous malignant disease localized to the gastric mucosa.

It ranks 2-3rd in prevalence among other cancers. More often than gastric cancer, only malignant neoplasms of the lungs and breast are usually found. The factors that provoke stomach cancer are quite diverse. Here we have an unhealthy diet, alcohol abuse, smoking, an infectious factor, and simply the combined negative impact of the environment.

Symptoms of stomach cancer are more often diagnosed in people over 50 years of age. To diagnose the first signs of stomach cancer, annual preventive screening examinations are very important. Only early detection of symptoms of stomach cancer and timely initiation of treatment gives the most optimistic prognosis for stomach cancer, up to complete healing.

Reasons for development

A combination of factors leads to the occurrence of cancer. When DNA mutations occur in the body, the damaged cells are removed by immune cells (natural killer or NK cells). If antitumor immunity fails to remove defective cells, they become susceptible to uncontrolled division.

An initial tumor node is formed, destroying the affected organ from the inside, which then grows into nearby tissues and spreads throughout the body in the form of metastases to distant organs. The same thing happens with stomach cancer. These processes at the cellular level take a long period of time, so the asymptomatic stage of the disease can last for years.

Provoking environmental factors:

radiation (ionizing radiation) - affects the cell nucleus with the DNA it contains, causing cell mutations
smoking, alcohol abuse - irritate the gastric mucosa
medications - painkillers, corticosteroid hormonal drugs, antibiotics, etc.
products - refined white flour, sugar, refined oil, excesses in spicy, fried, fatty foods, food additives, residues of agricultural fertilizers in greenhouse vegetables and fruits, etc. - cause damage to the gastric wall with a decrease in its protective properties.
associated diseases, that is, provoked by Helicobacter Pylori bacteria that live on the inner wall of the stomach, they come in several types, some provoke stomach ulcers and chronic gastritis. Chronic gastritis with high acidity can lead to stomach ulcers, which, in turn, can lead to malignancy.
unfavorable environmental conditions, smoke in cities with exhaust gases, industrial waste, an abundance of harmful chemicals in everyday life (household chemicals - harmful to health, cosmetics, low-quality furniture, household appliances, toys made of toxic materials) - reduce overall immunity, contribute to the accumulation of carcinogenic substances in the body .

Internal factors:

metabolic disorders – vitamin metabolism disorders, immune and hormonal disorders;
age – the risk of developing cancer processes in the body increases after 50-60 years;
genetic predisposition – experts have proven that most diseases are hereditary. Oncological lesions of the body, including stomach cancer, are no exception;
predisposing diseases - formations in the stomach of a benign nature (adenomas, polyps), which can degenerate into malignant ones, as well as deficiency of folic acid and B12, which are involved in the process of cell reproduction and division without DNA mutation.

Classification

According to histological type, stomach cancer is divided into the following types:

Adenocarcinoma. Detected in almost 95% of cases. The tumor develops from the secretory cells of the mucous layer.
Squamous. A tumor of this type is the result of cancerous degeneration of epithelial cells.
Signet ring cell. The tumor begins to form from goblet cells responsible for producing mucus.
Glandular cancer. The reason for the formation of this type of cancer is an atypical transformation of ordinary glandular cells.

Differs in growth form:

Polypoid - resembles a mushroom on a stalk, growing into the lumen of the stomach, the slowest growing form;
Saucer-shaped - has the appearance of a clearly limited ulcer, bordered by a high shaft along the periphery, gives late metastasis;
Infiltrative-ulcerative - the edges of the ulcerative lesion are blurred, cancer cells diffusely spread deep into the stomach wall;
Infiltrating - the cancer focus has no visible boundaries.

The last two types are especially malignant: they quickly affect the entire thickness of the gastric wall, actively metastasize at an early stage, scattering metastases throughout the peritoneum.

The classification of stomach cancer according to its forms does not end there; a separate part of it is based on the specific part in which the tumor developed; the following types of cancer are distinguished:

Cardiac. This form of cancer develops in the upper part of the stomach organ, specifically in the place where it “joins” the esophagus.
Body of the stomach. In this form, the cancer affects the middle part of the organ.
Small curvature. Covers the area of the right gastric wall.
Pylorus (pyloric region). In this variant, cancer develops from the side from which the anatomical transition of the organ to the duodenum occurs.

Classification of stomach cancer

Today, the following classifications of stomach cancer are considered generally accepted:

Histological:

Adenocarcinoma:
Papillary adenocarcinoma;
Tubular adenocarcinoma;
Mucinous adenocarcinoma;
Adenosquamous cell carcinoma;
Signet ring cell carcinoma;
Small cell cancer;
Squamous cell carcinoma;
Undifferentiated cancer;
Other forms of cancer.

Macroscopic according to Borrmann:

Type 1 – polypoid or mushroom-shaped;
Type 2 – ulcerative with clear edges;
Type 3 – ulcerative-infiltrative;
Type 4 – diffuse-infiltrative;
Type 5 – unclassified tumors.

Macroscopic types of stomach cancer at an early stage:

Type I - sublime, i.e. when the height of the tumor exceeds the thickness of the mucous membrane;
Type II - superficial;
IIa – raised;
IIb - flat;
IIс - in-depth;
Type III - ulcerated (mucosal ulcer)

However, the most popular worldwide is the TNM , which is used by doctors to formulate a diagnosis:

To correctly assess the degree of damage to the body, you need to know well the anatomical structure of not only the stomach itself, but also all nearby tissues and organs.

The following anatomical parts are distinguished in the stomach:

Bottom;
Body;
Antrum;
Pyloric department;

When determining treatment tactics, an important point is the presence of regional lymph nodes affected by the tumor process.

Regional lymph nodes for stomach cancer are considered to be: perigastric nodes, which are located along the lesser (1, 3 and 5) and greater (2, 4a-b, 6) curvature, along the common hepatic (8), left gastric (7), splenic (10 -11) and celiac (9) arteries, hepatoduodenal nodes (12).

If the intraperitoneal lymph nodes are affected (retropancreatic, para-aortic), then they are considered to be distant metastases.

And now, for your information, we present to you the clinical classification of TNM:

T-primary tumor:

Tx - insufficient data for assessment;
T0—the primary tumor is not visualized;
Tis—carcinoma in situ or intraepithelial tumor with high-grade dysplasia;
T1 - the tumor affects not only the lamina propria, but also the muscular lamina or submucosal layer;
T1a - the tumor affects the lamina propria or muscularis lamina of the mucous membrane;
T1b - the tumor affects the mucosal layer;
T2 - tumor lesion of the muscle membrane;
T3 - the tumor affects the subserous layer;
T4 - the tumor perforates (a perforation is formed) the serosa and/or affects adjacent structures;
T4a – tumor invades the serosa
T4b – tumor spreads to adjacent structures

N – regional nodes:

NХ - insufficient data;
N0 - no signs of damage to regional lymph nodes;
N1- metastases in I-II regional lymph nodes;
N2 - metastases in III-VI regional lymph nodes;
N3 - metastases in VII or more regional lymph nodes;
N3a - metastases in VII-XV regional lymph nodes;
N3b - metastases in XVI or more regional lymph nodes

M - distant metastases:

M0 - no evidence for the presence of distant metastases;
M1 – distant metastases are determined.

Another classification according to which tumors are divided according to the degree of tissue differentiation. The higher it is, the more actively cancer develops.

Histopathological differentiation (G):

G4 – undifferentiated cancer;
G3 – low degree of differentiation;
G2 – average degree of differentiation;
G1 – high degree of differentiation;
GC – cannot be assessed.

Ultimately, all types of classifications come down to one thing - an accurate determination of the stage of the disease. After all, this is what the patient’s treatment tactics will depend on in the future.

Symptoms

Cancer in women does not have any clear symptoms, based on which one could firmly and confidently say that we are talking about a cancerous tumor.

The symptoms of stomach cancer are numerous and varied. Clinical symptoms of cancer in women cover not only those associated with dysfunction and functioning of the stomach and gastrointestinal tract as a whole, but also concern other organs and systems, such as changes in the central nervous system, metabolic disorders with weight loss and increased susceptibility to infections. The development of a tumor process in the stomach is not immediately noticed. It all depends on the size of the tumor, where it is located, and in advanced stages, on which organs the cancer cells penetrate (metastases).

There are general signs inherent in any pathological process associated with the development of benign or malignant tumors. There are also local symptoms of this type of disease, caused by tumor growth into the walls of the stomach, compression of surrounding tissues, disruption of the evacuation of gastric contents and other functions of nearby organs.

Onset of symptoms

1 Occurrence of symptoms
2 First manifestations 2.1 General and secondary early signs
2.2 Bleeding

3 Classification and diagnosis

4 Possible treatment

Stomach cancer is classified according to the International Classification of Diseases (10th revision) - ICD 10. This is the standard for dividing the disease into types and subtypes. The ICD 10 code for cancer of the digestive organ is C16. The ICD 10 classification has a worldwide distribution.

All signs of stomach cancer differ depending on the type of tumor and its location. Experts have identified some factors on which the occurrence of a particular symptom depends:

If the tumor is located in the area where part of the stomach adjoins the esophagus, the first symptoms that a person will feel are the difficulty of swallowing large pieces of food, and the secretion of saliva may significantly increase. These signs become more pronounced if the tumor grows. Gradually, women and men experience heaviness in the area of the shoulder blades and heart, and vomiting.
If the middle part of the digestive organ is affected, then early stomach cancer may not manifest itself at all. Later, the disease is characterized by loss of appetite, a sharp decrease in body weight and anemia.
When a formation occurs in the lower gastric region, the first symptoms are vomiting and bad breath (most often rotten), severe heaviness.

Depending on how stomach cancer manifests itself, specialists conduct more detailed diagnostics in both women and men. Treatment is based on surgical intervention: the operation, its type, is selected based on the severity of the disease and the individual characteristics of the patient’s body, as well as the stage of stomach cancer.

General symptoms

Cancer of any localization is characterized by general signs that indirectly indicate that a tumor-like formation may exist in the body.

These signs include: weight loss, constant fatigue, increased fatigue. These symptoms are inherent in any cancerous tumor, therefore, in order to suspect stomach cancer, in the absence of other clinical symptoms of any disease, doctors - specialists in the field of oncology of cancerous lesions of the stomach and the entire gastrointestinal tract, proposed using a complex of symptoms in the diagnosis of recognizing the cancerous process of the stomach , called the syndrome of small signs.

Minor sign syndrome includes symptoms associated with disruption of the gastrointestinal tract. Together with the general signs of a tumor process, a cancer process can be easily suspected and identified, which will allow timely treatment to begin and avoid the spread of cancer cells to other organs.

Minor trait syndrome includes:

Feeling of constant discomfort in the upper abdomen.
Bloating (flatulence) after eating.
Unreasonable loss of appetite, and subsequently weight.
Feeling of nausea and light drooling accompanying it.
Heartburn. Perhaps one of the symptoms of stomach cancer when the tumor is localized in the upper half of the stomach.

Patients become apathetic, get tired quickly, and constantly feel unwell.

Local symptoms when the functions and functioning of the stomach are impaired most often occur when the tumor is localized at the junction of the stomach and duodenum, that is, in the antrum. The patient will feel a feeling of heaviness in the abdomen. Food is more difficult to pass into the next section of the gastrointestinal tract, stagnates and belches of air appear, sometimes with a putrid odor.
With a cancer tumor localized in the initial part of the stomach, that is, in the cardia, the patient will feel difficulty swallowing (dysphagia). The symptom is explained by the fact that the initial volume of food does not pass further through the stomach and thereby prevents the free flow of new portions of food from the esophagus.
In the cardiac part of the stomach, close to the mucous membrane, the vagus nerves are located, irritation by the tumor causes salivation.

Signs of clinical manifestations of cancer

It is difficult to diagnose stomach cancer at an early stage based on the first symptoms, but they can help identify the initial manifestations of stomach cancer. In the vast majority of cases, the primary symptom of cancer looks like a manifestation of a stomach ulcer or gastritis (it is difficult to distinguish them at the first stage of the disease). Treatment occurs in accordance with the incorrect diagnosis, and at the same time the cancer progresses further.

Initial signs are important to obtain results. If you pay attention to them in a timely manner, then diagnosing carcinoma is much easier. In oncology, there is the concept of “small sign syndrome,” which appeared in medicine thanks to Dr. A. I. Savitsky. Minor signs are not anything special, but it is by them that experienced doctors can recognize early oncological tumors in the stomach:

Feeling of persistent discomfort in the upper abdomen;
Nausea and accompanying slight drooling;
Flatulence after eating;
Loss of appetite, without good reason, followed by severe weight loss;
Heartburn (cardia insufficiency). It may be one of the symptoms of gastric cancer when the tumor is located in the upper part of the stomach.

Symptoms depending on the stage of cancer

Clinical symptoms of stomach cancer depend on the stage of the process.

Stage O : carcinoma in situ, “cancer in situ” - there are no clinical manifestations, and the diagnosis in most cases is an incidental finding during a mucosal biopsy for other diseases.

Stage 1 of stomach cancer: characterized by localization of the tumor in the mucous membrane without growing into the muscular layer of the stomach wall, as well as possible damage to 1 - 2 lymph nodes located along the organ (T1 N0 M0 or T1 N1 M0). Already at this stage, early symptoms of stomach cancer appear, which include:

unmotivated general weakness
fast fatiguability
lack of appetite
anemia (decreased hemoglobin, see iron supplements for anemia)
pronounced weight loss
aversion to animal protein in food (meat or fish products, as well as to any one type of meat)
a prolonged slight increase in temperature is possible (see causes of low-grade fever)
depressive emotional background

Stage 2 : the tumor can either remain within the mucous membrane, but a larger number of lymph nodes are affected - 3 - 6, or grow into the muscle layer with damage to 1-2 lymph nodes (T1 N2 M0 or T2 N1 M0). The first symptoms from the gastrointestinal tract appear:

heartburn (see heartburn pills)
feeling of discomfort in the stomach
nausea (anti-nausea pills)
vomiting, which brings short-term relief
belching air
progressive weight loss
increased gas formation in the intestines (flatulence)
defecation disorders

These complaints are not permanent, and therefore patients do not attach due importance to their occurrence and hesitate to see a doctor.

Stage 3: the tumor grows not only into the muscle layer, but also through the outer lining of the stomach with damage to nearby tissues and organs, as well as the presence of cancer in seven or more lymph nodes. There are no metastases (T2 -4 N1-3 M0).

the above complaints become pronounced,
pain in the epigastric region intensifies and becomes constant,
the patient practically cannot eat food, since it does not pass into the stomach,
with cancer of the cardiac, “initial” part of the stomach, dysphagic phenomena occur - frequent choking, regurgitation, the need to wash down solid food with water or take only liquid food,
with cancer of the pyloric, “exiting” part of the stomach, food is not digested and stagnates in the stomach for several days, a feeling of rapid satiety, constant fullness in the epigastrium, vomiting with stagnant contents, and belching with the smell of rotten eggs occur.

Stage 4 means complete germination of the stomach wall, destruction of neighboring organs, damage to a large number of lymph nodes (more than 15), metastasis to distant organs and lymph nodes - to the ovary in women, to the lymph nodes of the pararectal (around the rectum) fatty tissue, to the lymph node located in the fossa above the left collarbone.

symptoms become permanent
the patient is exhausted, unable to eat on his own, only through a tube
experiences excruciating constant pain, relieved by taking narcotic analgesics with a short-term effect
the body is poisoned from the inside by the products of metabolism and tumor decay, does not receive the required amount of nutrients from the outside, tumor cells capture nutrients from the patient’s blood, dystrophic changes occur in all organs and tissues of the body, and the person dies.

It is at stages 3 and 4 of stomach cancer - late stages - that 80% of patients consult a doctor when the diagnosis is no longer in doubt, which significantly worsens the prognosis of the disease.

Symptoms of esophageal cancer

A tumor in the esophagus does not have severe symptoms and is similar to a type of inflammatory disease. The patient may feel discomfort, also a burning sensation in the chest, and have problems swallowing solid food. While eating, you often feel the urge to drink water.

After some time, the symptoms increase and problems arise even when swallowing pureed food. Over time, it becomes difficult to drink any liquid, as severe pain is felt. Permanent weakness and loss of strength occur.

Symptoms of intestinal carcinoma

The following symptoms occur:

Poor appetite or complete absence of it;
nausea, urge to vomit;
Heaviness in the stomach after eating;
Problems with swallowing food;
Pain near the navel;
Fatigue, dizziness, weakness and loss of strength;
Bleeding.

Symptoms of signet ring cell tumor of the stomach

It is difficult to determine this disease, and it is important to diagnose the disease in time, due to the fact that the disease quickly develops into its final form. A patient with this diagnosis has the following symptoms:

Persistent belching, nausea, urge to vomit;
Decreased appetite, unreasonable weight loss;
Pain in the intestines;
Painful sensations when swallowing;
Problems with stool, blood clots in stool and vomit.

Inoperable gastric cancer with metastases

This designates the stage of the disease at which it is impossible or impractical to use 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 operations to alleviate the patient’s condition.

Inoperable cancer can be:

Locally widespread, when a significant part of the stomach is damaged or multiple lesions are located in a mosaic pattern and affect vital parts of the body (large vessels, nerve nodes), cells spread lymphogenously, by contact or by 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 data, life expectancy after a course of combined treatment can be increased to 20-24 months. At the same time, complications from exposure to ionizing radiation are significantly lower than the therapeutic effect, and the patient gets a chance to prolong life without pain. Unfortunately, it is impossible to guarantee more in the conditions of modern medicine.

The main routes of metastasis pass through the lymphatic system, therefore secondary neoplasms and the most significant metastases are found primarily in the lymph nodes.

Gastric cancer metastases:

In pararectal tissue or in the space near the rectum - Schnitzler;
In the navel area - Sisters Marie Joseph;
In the left supraclavicular region - Virchow's;
In the area of the ovaries - Krukkenberg.

These secondary tumors are evidence of 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.

Diagnostics

Diagnosis for any cancer disease must be comprehensive with a mandatory examination of the entire human body. Only after this can the doctor accurately make a final diagnosis and begin treatment.

So, for stomach cancer, the examination plan should include:

Clinical examination;
Digital examination of the rectum;
Standard laboratory tests, such as determination of blood group, Rh factor, seroreaction to syphilis, complete blood count (CBC), complete urinalysis (UCA), biochemical blood test (protein, creatinine, bilirubin, urea, ALT, AST, alkaline phosphatase , glucose, amylase, electrolytes - Ca, Na, K and Cl)),
Coagulogram according to indications;
Functional tests (ECG, vascular Doppler ultrasound, pulmonary function testing, echocardiography, etc.)
Consultations of narrow specialists;
Fibrogastroscopy with tumor biopsy followed by morphological examination of this material;
Ultrasound of the abdominal organs, retroperitoneal space, pelvis and supraclavicular areas (if metastatic disease is suspected).
X-ray examination of the stomach
X-ray examination of the lungs. In complex cases, a CT scan of the chest, as well as the pelvic and abdominal organs is also performed;
Endoscopic ultrasound (EUS) is most important if early gastric cancer is suspected.
Laparoscopy to exclude dissemination of tumor cells throughout the peritoneum.

In addition, the following can be additionally performed: fibrocolonoscopy, scintigraphy of skeletal bones, irrigoscopy, puncture of the tumor under ultrasound control and its morphological examination.

Prevention of stomach cancer

Prevention of stomach cancer should occupy an important place in the life of every person, because this significantly reduces the risk of encountering such an unpleasant (and sometimes even fatal) disease.

It includes:

Prevention of the development of chronic gastrointestinal diseases. To do this, you need to observe general sanitary and hygienic standards, eat right and protect yourself as much as possible from all kinds of stressful situations;
Timely detection and treatment of precancerous diseases, such as pernicious anemia, chronic duodenal ulcer and others;
Elimination of harmful environmental factors. For example, automobile exhaust gases, industrial waste, etc.
You should avoid excessive consumption of nitrates and nitrites, which are found in large quantities in greenhouse plants (tomatoes, cucumbers) and smoked meats.
Do not abuse various medications when treating mild colds, infectious and other diseases;
Eat as many fresh and clean fruits and vegetables as possible. They are rich in vitamins, macro- and microelements, due to which they balance the diet and serve as an excellent source of antioxidants;
And, of course, train yourself to take daily evening walks and frequent physical exercise. Hardening procedures are also useful. This way you can strengthen your immune system, get a boost of energy and gain additional vitality.

Complications

Bleeding from a tumor:

symptoms – vomiting of contents mixed with blood, black tarry stools, loss of consciousness, nausea, severe weakness;
diagnostics: fibrogastroduodenoscopy;
treatment: surgical using a laparoscope, endoscopic (cauterization of the wound using an endoscope).

Cicatricial stenosis of the pyloric pylorus at the junction of the stomach and duodenum. It is characterized by partial or complete obstruction of food from the stomach to the intestines.

symptoms - frequent vomiting of stagnant contents, after which relief comes, belching with a rotten odor, a feeling of fullness in the epigstrum, rapid satiety, constant nausea, weakness;
diagnostics - FEGDS and fluoroscopic examination of the stomach after taking a barium suspension;
treatment is surgery.

Treatment

Currently, the main and practically the only method of radical treatment for stomach cancer is surgery. Gastric resection also provides the best palliative treatment: the cause of pain, dysphagia and bleeding is eliminated, the number of tumor cells in the body is reduced, which helps to increase life expectancy and significantly alleviate the patient’s condition. Radiation exposure and chemotherapy are of auxiliary importance.

Usually the entire stomach is removed (gastrectomy). The indication for it is the location of the tumor above the angle of the stomach, subtotal or total damage to the stomach.

Less often (in the early stages of the disease) its resection is performed (as a rule, subtotal): for cancer of the antrum - distal, for cancer of the cardiac and subcardial sections of stages I-II - proximal. In addition, the greater and lesser omentum and regional lymph nodes are removed; if necessary, other organs are partially or completely removed: ovaries for Krukenberg metastases, tail of the pancreas, spleen, left lobe or segment of the liver, transverse colon, left kidney and adrenal gland, part of the diaphragm, etc.

For stomach cancer, removal of lymph nodes is indicated. The following types of lymph node dissection are distinguished by volume:

D0 - lymph nodes are not removed;
D1 - resection of nodes located along the lesser and greater curvature, supra- and infrapyloric, lesser and greater omentums;
D2 - removal of the above nodes and nodes of the second level;
D3 - the same + resection of lymph nodes along the celiac trunk;
D4 - includes removal of the same nodes as in D3, with removal of para-aortic nodes;
Dn - resection of all regional lymph nodes, removal of organs affected by the stomach tumor.

The radicality of the operation is ensured by options D2-D4.

Treatment of stomach cancer

Today, the treatment of stomach cancer is a rather complex and not fully resolved problem of oncology. Nevertheless, doctors around the world adhere to the following treatment algorithm for this pathology:

Treatment algorithm for patients with stomach cancer:

This table is used by doctors; it will not be entirely understandable to the average person, so below we will try to talk about the treatment of stomach cancer in a more accessible language.

Surgery

So, the main method of combating this pathology is surgical intervention. And the indication for it is establishing a diagnosis of operable stomach cancer in the complete absence of any contraindications to surgery.

The main radical operations for stomach cancer are:

Subtotal distal gastrectomy (Billroth-II operation);
Subtotal proximal gastrectomy;
Gastrectomy.

The choice of the technique used depends on the location of the tumor, its macroscopic type, as well as on the histological structure.

The main condition for the radicality of the operation: removal in a single block of the tumor-affected stomach or its corresponding part, together with regional lymph nodes and surrounding tissue.

Scope of lymph node dissection:

D3 – removal of lymph nodes No. 1-12;
D2 - at least 14 (usually about 25) regional lymph nodes are removed;
D1 – removal of perigastric lymph nodes (No. 1–6).

To determine the radicality and adequacy of the operation, check for the absence of tumor cells along the intersection of the organs - the esophagus, stomach or duodenum.

The indication for distal subtotal gastrectomy is the presence of an exophytic tumor or a small infiltrative tumor in the lower third of the stomach.

The indication for performing proximal subtotal gastrectomy is the presence of early gastric cancer in its upper third without the tumor spreading to the cardiac sphincter or abdominal segment of the esophagus.

In all other cases of stomach cancer, gastrectomy is indicated , which is due to the biological characteristics of the spread of cancer cells.

With an exophytic tumor, the line of gastric resection in the proximal direction should lie 5 cm from the visible border of the tumor, and with an endophytic form - 8-10 cm. The distal resection border should lie at least 3 cm from the visible or palpable border of the tumor. Since endoscopic and radiological determination of the boundaries of a tumor with a diffuse-infiltrative type of growth is difficult, the decision to perform subtotal gastrectomy must be made with great caution and only based on the results of clinical and instrumental studies (fibrogastroscopy, X-ray examination, endosonography), as well as intraoperative morphological examination of the boundaries resections.

If the tumor grows into neighboring organs (spleen, intestines, liver, diaphragm, pancreas, adrenal gland, kidney, abdominal wall and retroperitoneal space) without signs of distant metastasis, they are removed or resection en bloc.

Doctors, if possible, avoid performing splenectomy, since the fundamental removal of the spleen does not improve long-term treatment results and significantly increases the incidence of postoperative complications and even mortality.

Indications for splenectomy are tumor growth, metastatic lesions of the lymph nodes of the splenic hilum, and intraoperative trauma.

Unfortunately, oncologists around the world note the fact that the results of treatment of patients with stage 4 gastric cancer still remain extremely unsatisfactory. This problem still remains open.

To eliminate complications caused by a widespread tumor process, surgical interventions are performed for palliative purposes. Depending on the specific situation, various types of palliative gastrectomy are performed, which can be supplemented by gastrojejunostomy, gastro- or jejunostomy.

Chemotherapy

According to global protocols, chemotherapy for stomach cancer is used only at stage 4. However, today there are no standard chemotherapy treatment regimens for patients with stage IV gastric cancer. The most commonly used combinations are based on drugs such as fluorouracil and cisplatin.

In addition, there are quite a lot of schemes that include the following types of chemicals:

Calcium folinate;
Etoposide;
Capecitabine;
Vinorelbine.

The effectiveness of chemotherapy treatment for patients with advanced gastric cancer remains low; in most cases, partial and short-term remission of the tumor process is observed.

Let's look at the treatment of stomach cancer depending on the stage of the disease:

Stages - 0, Ia.

Surgery:

distal subtotal gastrectomy;
gastrectomy;
proximal subtotal resection
lymph node dissection in volume D1

Stages Ib, IIa, IIb, IIIa, IIIb.

Surgery:

distal subtotal gastrectomy,
gastrectomy.
lymph node dissection in volume D 2.

Stage IV

Standard: Various Chemotherapy Options

Relapse

palliative surgical interventions;
endoscopic recanalization (tumor diathermocoagulation, stenting);
Palliative chemotherapy (individualized).

Therapeutic tactics in patients with recurrent gastric cancer are determined by the prevalence of the tumor process. Depending on the situation, radical or palliative surgical treatment is performed. It is possible to use combined treatment methods using various modes and schemes of ionizing radiation and chemotherapy.

Nutrition

Therapeutic dietary nutrition for stomach cancer performs the following tasks:

Prevents weight loss through a balanced diet;
Increases the tolerability of aggressive antitumor 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 restoration activity of body tissues after partial or total resection of the stomach;
Improves quality of life.

Principles of therapeutic nutrition for stomach cancer:

Cooking methods - boiling, baking, stewing;
The diet of patients is four to six times a day;
Individual approach to nutrition - taking into account energy costs and metabolic characteristics, the introduction of proteins, including animal origin, fats, carbohydrates and liquids into the diet is carried out gradually.
Nutrition correction taking into account the stages of treatment is carried out in order to reduce the side effects of antitumor therapy.

Three diet options have been proposed for patients with stomach cancer, taking into account the characteristics of metabolism and body weight.

First option

– organization of nutrition for a patient with normal body weight in the absence of pronounced metabolic disorders:

Energy value – no higher than 2400 kilocalories per day;
The total amount of protein is 90 grams, including animal protein – 45 grams;
The total amount of fat is 80 grams, including vegetable fats – 30 grams;
Total carbohydrates: 330 grams.

Second option

– organizing nutrition for a patient with severe underweight, exhaustion, with visible metabolic disorders, as well as after surgery, chemotherapy or radiation therapy:

Energy value – not higher than 3600 kilocalories per day;
The total amount of protein is 140 grams, including animal protein – 70 grams;
The total amount of fat is 120 grams, including vegetable fats – 40 grams;
The total amount of carbohydrates is 500 grams.

Third option

– for patients with critical loss of body weight and laboratory confirmed impairment of the excretory function of the kidneys and liver:

Energy value – not higher than 2650 kilocalories per day;
The total amount of protein is 60 grams, including animal protein – 30 grams;
The total amount of fat is 90 grams, including vegetable fats – 30 grams;
The total amount of carbohydrates is 400 grams.

How to distinguish cancer from ulcers?

The difficulty of diagnosing and treating stomach cancer lies in the fact that its symptoms are practically no different from the symptoms of gastritis, ulcers and other pathologies. You can suspect the presence of a malignant tumor based on the following signs:

pain becomes longer lasting, occurs mainly at night and is not associated with meals;
body weight decreases sharply without changing the diet or other objective reasons;
defecation disorders appear, and the stool becomes black, and impurities of mucus or blood appear in them;
anemia develops - the concentration of hemoglobin in the blood is seriously reduced;
symptoms do not disappear even after adjusting the diet and taking medications.

It is impossible to make a diagnosis of stomach cancer on your own; to do this, you need to see a doctor and undergo a comprehensive examination. It includes blood tests for tumor markers, endoscopic examination methods, and x-ray examination. CT and MRI are considered the most informative diagnostic methods - they allow you to identify malignant tumors even in the early stages.

Forecast for life

As with many other types of cancer, the outcome and effectiveness of treatment for gastric cancer currently depends on the stage of the disease[12].

In most cases, stomach cancer is detected only in advanced stages and is already common, in which case the overall 5-year survival rate is only 15%. If a person survives the first 5 years, then further survival rate increases - the 10-year survival rate is 11%, which is only 4% lower than the 5-year survival rate.

First stage . Patients with stage I gastric cancer have a high chance of a full recovery. The five-year survival rate is 80%, with 70% making a full recovery. At stage I, stomach cancer is detected very rarely and, as a rule, by chance.
Second stage . In patients with stage II gastric cancer, the five-year survival rate is 56%, of which 48-50% recover completely. At the time of diagnosis, only six out of a hundred cancer cases (6%) are stage 2.
Third stage . Patients with stage III gastric cancer have a 5-year survival rate of 38%, with about 26% making a full recovery. Patients with stage IIIb gastric cancer (metastasis) have a five-year survival rate of only 15%, of whom only 10% are cured. At stage III, detection of stomach cancer is quite common.
Fourth stage . For patients with stage IV gastric cancer, the five-year survival rate is usually less than 5%, and the 10-year survival rate is 2.3%. Of these, only 1.4% make a full recovery. At stage IV, gastric cancer is detected in 80% of patients and is the most common.

Younger people have higher survival rates than older people. For patients under 50 years of age, the five-year survival rate is 16-22%, while for patients over 70 years of age the rate is 5-12%.

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Common symptoms of stomach cancer in the early stages

Timely diagnosis allows cancer to be cured completely. However, early diagnosis in men and women is difficult due to the poor clinical picture. The disease is asymptomatic and disguises itself as gastric inflammatory processes. As a rule, oncology of the digestive organs is diagnosed in the later stages of the disease. Early signs of stomach cancer:

increased acidity, belching;
feeling of fullness in the stomach;
shortness of breath, feeling tired, bleeding;
increased blood clotting.

The main cause of cancer is considered to be poor diet, constant consumption of too hot foods, and alcoholic beverages. The environment plays a major role in the development of the disease. In industrial cities, the incidence rate is higher. Hypovitaminosis, smoking, ulcers or gastritis increases the risk of tumor development. Precancerous diseases include Barrett's syndrome and achalasia cardia. If the tumor affects the lower esophagus, then there is a high risk of complications from the cancer process spreading to the stomach.