Gastric cancer

It is one of the most dangerous types of cancer after lung cancer. 

Avoidable Risk Factors 

Nutrition

• Smoked, smoked foods
• Vitamin A and C deficiency, insufficient intake with food
• Foods that are stored or prepared by excessive salting

 

Professional

• Plastic
• Pitch
• exposure to radiation

 

Habits

• Cigarette

 

Infection

• Helicobacter pylori
• Epstein Barr virus

 

Precancerous lesions

• Adenomatous polyps
• Chronic atrophic gastritis
• Dysplasia
• İntestinal metaplazi
• Menetrier's disease

 

Other Risk Factors  

Genetic Factors

• On the group
• Pernicious anemia
• family history
• HNPCC and Lynch syndrome
• Li-Fraumeni syndrome

 

Resume

• Having had previous stomach surgery

 

Pathological 

İntestinal tip

It is mostly seen in the Far East, Japan region. It is better differentiated. (more similar to the cell type it originates from, it has a more benign character) Distal (stomach outlet part) often involves the stomach.

 

Diffuse type

It is mostly seen in Europe and America. It is poorly differentiated (less similar to the cell it originates from), and has a horny (malignant) character. It mostly holds the stomach entrance. (Proximal stomach)

 

Symptoms

• Stomach ache
• Anorexia
• weight loss
• Weakness
• Nausea
• Anemia
• Difficulty in swallowing (especially in types that involve the stomach entrance)
• It may give signs of gastric outlet obstruction (vomiting without bile, bloating and tension in the abdomen)

 

Results

• Supraclavicular lymph node (Wirchow): Swelling on the left side of the neck, above the collarbone
• Periumblical lymph node (Sister Mary Joseph nodule): Having a lymph node around the navel
• Left axillary lymph node (Irish node): Lymph node in the left armpit
• Extraluminal mass (Blummer's shelf) on rectal examination: It is a finding of peritoneal metastasis.

 

Diagnosis

Upper gastrointestinal endoscopy is diagnostic. 

Preoperative Evaluation

The patient should be evaluated for the spread of the disease before surgery. 

For this:

• Computed tomography
  • I. Local spread of the disease
  • ii. Ascites (malignant fluid in the abdomen),
  • iii. It allows us to understand whether there is distant metastasis (especially liver).
• Endoscopic ultrasound allows us to understand the depth of the disease in the stomach wall, this is necessary for staging.
• Whole body positron emission tomography (PET CT) is performed after surgery to find out if there is another metastasis in the body in recurrent disease or advanced stage tumors.
• Staging laparoscopy (staging laparoscopy) is a laparoscopy that cannot be detected by radiological methods, but is performed for staging before surgery if there is clinical suspicion. It is mostly done to detect small metastases on the peritoneal surface. If it is detected, the treatment method changes.

 

Staging

• The American Joint Committee on Cancer (AJCC) staging is used.
• This staging is made according to the depth of the tumor, lymph node metastases and distant metastases.
• Treatment varies according to each stage. 

Treatment

• It should be multidisciplinary. This team may include surgeon, oncologist, pathologist, radiologist, radiation oncologist, gastroentereologist, dietitian, internist, cardiologist, chest diseases specialist according to co-morbidities.
• Stage of the disease
• Co-morbidity of the patient

 

General Approach

• Early disease (Tis, T1a): endoscopic mucosal resection, endoscopic close follow-up is recommended.
• Local disease (T1b No): Surgical resection, regional lymph node dissection is recommended.
• Locally advanced disease (T2 regional lymph node metastasis): It should be approached multidisciplinary, preoperative (neoadjuvant) chemoradiation can be considered.
• Metastatic disease: Palliative chemotherapy is performed.

 

Operation

• Subtotal or total gastrectomy: It is preferred according to the location of the tumor. In tumors close to the exit site, subtotal gastrectomy can be performed if a clean surgical margin can be achieved.
• Wide surgical margin (approximately 5 cm): It is important to provide a clean surgical margin, since the tumor has the potential to spread submucosal. It is necessary to try to create a 5 cm border from the visible macroscopic tumor. If there is tumor infiltration in fundus and cardia tumors, the tail of the pancreas and the spleen can be removed together.
• Lymphadenectomy: Although the extent to which it should be performed is controversial, there are many publications showing that removal of the omentum and regional lymph nodes contributes to survival. Radical lymphadenectomy, its contribution to survival is controversial, it may increase morbidity. It must be done in competent hands.

 

Palliative Resection (For patients with advanced stage, no survival expectation)

• occlusive
• It is performed in bleeding tumors, with distant metastases.
• With simple resection or sometimes without resection, the obstruction is opened by by-pass. Treatment is then continued with adjuvant chemotherapy.

 

Adjuvant Chemotherapy

• It is done after resection for potentially curative treatment.
• It has been shown to prolong the Median Survival time.
• 5 Fluorouracil, Leucovorin or Taxane and radiotherapy can be done.

 

Prognosis (process)

Depends on three factors

• The depth of the tumor in the stomach wall
• To the involved lymph nodes
• To distant metastases

 

Survival

If the tumor is in the serosa and regional lymph nodes, it decreases dramatically. However, in the right hands, survival is improved if it has been appropriately surgically performed and received the necessary chemotherapy. It should be noted that human life should not be described in percentages. There is hope for every patient. All available weapons should be used for each patient. 

Relapse

Recurrence rates after gastric resection range from 40-80%.

 

Protection

I suggest you reread the preventable risk factors. In addition, it would be very appropriate for people with genetic risk factors to have an annual endoscopy 5 years before the age of the youngest gastric cancer case in the family. Apart from this, it would be appropriate for people with symptoms of stomach cancer to apply to a general surgeon or gastroenterologist for endoscopy.

Gastric cancer surgery, also known as gastrectomy, carries certain risks and potential complications, as with any major surgical procedure. The specific risks can vary depending on the type of surgery performed, the stage of the cancer, the overall health of the patient, and individual circumstances. It's important to discuss these risks with your healthcare team before undergoing gastric cancer surgery. Here are some potential risks and complications associated with gastric cancer surgery:

 

1. Infection: Infections can occur at the site of the surgical incision or in the abdomen. Antibiotics are typically administered before, during, and after surgery to help prevent infections, but they can still occur.

2. Bleeding: Surgery involves cutting and manipulating tissues, which can lead to bleeding. Excessive bleeding may require blood transfusion or additional surgical interventions to control it.

3. Leakage from surgical connections: After the removal of a portion of the stomach, the remaining portions are reconstructed or connected to the esophagus or small intestine. There is a risk of leakage (anastomotic leak) at these connections, which may require additional treatment, such as drainage, stenting, or reoperation.

4. Digestive problems: Following gastric cancer surgery, individuals may experience changes in digestion and absorption of nutrients. This can result in symptoms such as diarrhea, malabsorption, and nutritional deficiencies. Dietary modifications and nutritional supplementation may be necessary.

5. Dumping syndrome: Dumping syndrome is a condition that can occur after gastric surgery, characterized by rapid emptying of stomach contents into the small intestine. It can cause symptoms such as nausea, vomiting, abdominal pain, diarrhea, and lightheadedness after meals.

6. Stricture formation: Scar tissue can develop at the surgical connections, leading to narrowing (strictures) of the gastrointestinal tract. This can cause difficulty swallowing, food getting stuck, or problems with the passage of food through the digestive system.

7. Blood clots: Surgery increases the risk of blood clots forming in the legs (deep vein thrombosis) or traveling to the lungs (pulmonary embolism). Measures are taken to minimize these risks, such as blood-thinning medications, compression stockings, and early mobilization.

8. Respiratory complications: After surgery, individuals may be at risk of respiratory complications, such as pneumonia or lung collapse (atelectasis). Breathing exercises and early mobilization are important in reducing these risks.

9. Adverse reactions to anesthesia: The use of anesthesia during surgery carries its own set of risks, including reactions to medications, breathing difficulties, or adverse effects on the heart or lungs. Anesthesiologists closely monitor patients during surgery to minimize these risks.

10. Long-term effects: Gastric cancer surgery may have long-term effects on digestion, eating habits, and quality of life. Some individuals may experience changes in body weight, appetite, and dietary restrictions.

 

It's important to note that these risks are general considerations, and the actual risks may vary depending on individual factors. The surgical team will thoroughly assess each patient's case and take necessary precautions to minimize risks. The benefits of surgery, including the potential for tumor removal and improved quality of life, are weighed against the risks before making a treatment decision.

 

What are the benefits of gastric cancer surgery?

Gastric cancer surgery, also known as gastrectomy, offers several potential benefits for individuals diagnosed with gastric cancer. The specific benefits can vary depending on factors such as the stage of the cancer, the location and size of the tumor, the overall health of the patient, and individual circumstances. Here are some potential benefits of gastric cancer surgery:

 

1. Tumor removal: The primary goal of gastric cancer surgery is to remove the cancerous tumor from the stomach. Surgery can provide a curative treatment option for localized tumors that have not spread beyond the stomach or nearby lymph nodes. Complete tumor removal increases the chances of long-term survival and potential cure.

2. Improved survival rates: Surgery, particularly when combined with other treatments such as chemotherapy or radiation therapy, can improve long-term survival rates for individuals with gastric cancer. The extent of the cancer, stage, and other factors influence the overall prognosis. Surgery can play a crucial role in removing the tumor and reducing the risk of cancer recurrence.

3. Symptom relief: Gastric cancer can cause various symptoms, including abdominal pain, difficulty swallowing, nausea, vomiting, weight loss, and early satiety. Surgery aims to alleviate these symptoms by removing the tumor, reducing obstruction, and improving the overall functioning of the stomach.

4. Prevention of complications: Gastric cancer can lead to complications such as bleeding, obstruction, or perforation of the stomach. Surgery can help prevent or manage these complications by removing the tumor and restoring normal stomach function.

5. Quality of life improvement: Gastric cancer surgery can enhance the quality of life for individuals by alleviating symptoms and allowing for improved dietary intake. By removing the tumor and reconstructing the digestive system, surgery can help restore or improve the ability to eat and digest food, leading to better nutrition and overall well-being.

6. Individualized treatment approach: Gastric cancer surgery allows for a personalized treatment plan tailored to each individual's specific situation. The surgical approach can be customized based on the location and extent of the tumor, the overall health of the patient, and other factors, ensuring the best possible outcome for the individual.

7. Adjuvant therapy effectiveness: In cases where chemotherapy or radiation therapy is administered after surgery (adjuvant therapy), surgical removal of the tumor can enhance the effectiveness of these treatments. By eliminating the bulk of the tumor, adjuvant therapy can better target any remaining cancer cells and potentially improve outcomes.

It's important to note that the benefits of surgery may vary depending on the stage of the cancer, individual health factors, and the expertise of the surgical team. The healthcare team will assess each patient's case thoroughly and weigh the potential benefits against the risks before recommending surgery as part of the treatment plan. Additionally, post-surgery follow-up care, including surveillance and potential adjuvant treatments, is crucial for long-term management and monitoring of the disease.

 

How should be the follow up, life style and feeding after gastric cancer surgey?

After gastric cancer surgery, follow-up care, adopting a healthy lifestyle, and making appropriate dietary adjustments are essential for optimal recovery and long-term management. Here are some recommendations:

 

1. Follow-up care:

• Regular check-ups: Attend scheduled follow-up appointments with your healthcare team to monitor your recovery, assess any complications, and address any concerns or symptoms that may arise. The frequency of follow-up visits will vary depending on individual factors, but they are typically more frequent in the first year after surgery.
• Surveillance tests: Your healthcare team may recommend regular imaging tests, such as CT scans, endoscopic examinations, or blood tests, to monitor for any signs of cancer recurrence or new developments.
• Adjuvant therapy: If adjuvant treatments, such as chemotherapy or radiation therapy, are part of your treatment plan, follow the recommended schedule and attend all sessions as advised by your healthcare team.
• Emotional support: Coping with a cancer diagnosis and undergoing surgery can be emotionally challenging. Seek support from family, friends, or support groups. Consider joining a support group specifically for gastric cancer survivors.

 

2. Lifestyle modifications:

• Quit smoking: If you smoke, it's highly recommended to quit smoking altogether. Smoking can interfere with the healing process, increase the risk of complications, and potentially contribute to the development of new cancers.
• Limit alcohol consumption: If you consume alcohol, it's advisable to moderate your intake or avoid it completely. Alcohol can irritate the digestive system and may increase the risk of complications.
• Physical activity: Engage in regular physical activity as recommended by your healthcare team. Exercise can help improve overall health, maintain a healthy weight, enhance recovery, and reduce the risk of other chronic diseases.
• Emotional well-being: Pay attention to your emotional well-being and seek support if needed. Going through cancer treatment and surgery can have a significant impact on mental health. Consider counseling or therapy to help cope with any emotional challenges that may arise.

 

3. Feeding and nutrition:

• Gradual diet progression: After surgery, you'll typically start with a liquid or pureed diet and gradually progress to soft foods and eventually a regular diet as tolerated. Follow the dietary guidelines provided by your healthcare team and consult with a registered dietitian for personalized advice.
• Balanced nutrition: Ensure that your diet includes a variety of nutrient-dense foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats. Adequate protein intake is particularly important for wound healing and recovery.
• Portion control and mindful eating: Pay attention to portion sizes and practice mindful eating. Eat slowly, chew food thoroughly, and stop eating when you feel satisfied, rather than overly full.
• Nutritional supplementation: In some cases, nutritional supplements may be recommended to ensure adequate intake of essential nutrients. Consult with a registered dietitian to create a personalized meal plan and discuss appropriate supplementation if needed.

4. Long-term monitoring:

• Regular follow-up visits and surveillance tests will continue for an extended period to monitor for any signs of cancer recurrence or new developments.
• Report any new symptoms or concerns to your healthcare team promptly. Early detection and intervention can improve outcomes.

It's crucial to work closely with your healthcare team, including surgeons, oncologists, dietitians, and other specialists, to develop an individualized plan for follow-up care, lifestyle modifications, and dietary adjustments after gastric cancer surgery. They will provide personalized recommendations based on your specific needs and circumstances.