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Gastric Cancer

Gastric Cancer

About Gastric Cancer

Gastric cancer is the fifth most common cancer in the world and the third leading cause of cancer death in both sexes worldwide. Stomach cancer is more common in men than in women.

Risk Factors

  • H Pylori infection
  • High salt , nitrate consumption and smoked foods
  • Smoking
  • Menetrier disease
  • Chronic atropic gastritis
  • Gastric adenomatous poyps
  • Li Fraumeni syndrome

Common Signs and Symptoms

  • Unexplained loss of weight
  • Early fullness after meals
  • Persistent vomiting sometime after food
  • Persistent black stools or vomiting of blood
  • Lump in the abdomen
Gastric Cancer

Diagnosis of Gastric Cancer

Your doctor will examine you to look for any signs of spread of the cancer .Routine blood tests will indicate if you are anaemic of other systems are affected.

The specific tests include

  • Upper GI endoscopy- a camera is passed into the stomach to look at the tumor and a biopsy is taken. The extent an location of the tumor is noted.
  • Endoscopic ultrasound- this is done in early tumors 
  • CT Scan / PET CT Scan- this cross sectional imaging helps stage the disease and assess the extent of spread and plan the treatment. A PET scan is not routinely advised but may be done if there is a doubt of distant spread.
  • Staging laparoscopy- it is recommended in bulky or locally advanced cases for accurate staging prior to chemotherapy.
Gastric Cancer

Treatment Options

The planning of treatment will depend on the extent and type of cancer, degree of spread and the age and general condition of the patient. Most patients are nutritionally depleted and will need support and advice on diet.

The treatment is usually multimodality and the sequencing is decided based on the stage.

Surgery

Surgery is the main line of treatment and the only curative option in gastric cancer. Based on the location , the surgeon will decide on either a subtotal gastrectomy ( where a part of the stomach is removed) or a total gastrectomy ( where the entire stomach is removed) The surgery also involves a complete lymph node clearance of the affected area which is called a D2 Lymphadenectomy. Some of these surgeries can be done by laparoscopy or robotic technique but it is usually only for very early stage tumors.

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Chemotherapy

Gastric cancer is quite a chemo responsive disease and the newer regimens have very promising outcomes in gastric cancer . Chemotherapy maybe given prior to surgery to downstage the cancer before surgery or after the surgery to reduce the chances of recurrence.

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Radiation

Radiation has a role in the post operative setting when the margins are positive or when a large number of lymph nodes are positive or when a complete lymph node clearance is not done.

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Prevention and maintaining a healthy lifestyle
  • Small and frequent meals
  • Avoid late night meals or immediately before going to bed
  • Treat H pylori infections promptly and completely
  • Avoid outside food / water which can cause H Pylori infection
  • Maintain healthy weight
  • Adequate physical activity and exercise
  • Limit alcohol consumption
  • Smoking cessation
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Surgery For Gastric Cancer

Surgery is the main treatment and the only curative option in gastric cancer.

Subtotal Gastrectomy

Gastric cancers which are located in the distal part of the stomach will be eligible for a subtotal gastrectomy . This involves removal of the later 2/3 of the stomach. It is important to have a margin of 5 cm from the tumor . The remaining part of the stomach is joined with a loop of small intestine to restore the continuity.

Gastric Cancer

Total Gastrectomy


Tumors which involve the proximal part of the stomach or the entire stomach will need a a total gastrectomywhere the entire stomach is removed. The end of the esophagus (food pipe) is joined to the loop of small intestine to restore continuity. Usually, the omentum (fat layer arising from the stomach) is completely removed as part of the resection.

D2 Lymphadenectomy

The surgery also involves a complete lymph node clearance of the affected area which is called a D2 Lymphadenectomy. This is one of the key steps in ensuring a complete resection and reduces risk of recurrence.

Some of these surgeries can be done by laparoscopy or robotic technique but it is usually only for very early stage tumors. Complete and radical surgery is the only way to ensure a good outcome in gastric cancer.

This surgery is usually well tolerated. Patients may need to adjust their meals to small frequent portions and take vitamin supplements.  

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Related FAQ's
1. How can gastric cancer be diagnosed early?

Gastric cancer is indolent cancer with vague symptoms and hence many patients present late. Any loss of weight with loss of appetite, persistent indigestion or gastric bloating, or vomiting must be promptly investigated.

2. Can I function normally if my stomach is removed?

Yes. Most patient's liver is near-normal lives after a gastrectomy. Some alterations in lifestyle like the inability to take in a large meal at one time will need some coping. Small frequent meals are advised.

3. I have been diagnosed with gastric cancer? Is there a risk of transmission to my family members?

Not at all. No cancer is transmitted from one person to another. Patients need all the love and care they can get from their family members and friends in order to fight this disease.

4. What are my survival chances after surgery for gastric cancer?

Survival after gastric cancer depends on the stage of the disease as per the histopathology report. Node-negative patients do better than node-positive ones. Early gastric cancer has a survival of more than 65% at 5 years with a complete and appropriate radical surgery while locally advanced gastric cancers have a 25% 5-years survival in spite of multimodality treatment.

5. How often should I follow up after my treatment is completed?

You must follow up at 6 monthly intervals up to 5 years after completing treatment for gastric cancer. The usual tests area CBC, B12 levels, chest Xray and ultrasonography or CT scan of the abdomen.

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