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Causes, signs, symptoms, and treatment of gastric cancer

Contents:

What is stomach cancer?

Stomach cancer is a malignant degeneration of cells of the gastric epithelium. In disease 71-95% of cases associated with lesions of the walls of the stomach bacteria Helicobacter Pylori and refers to common oncological diseases of people aged from 50 to 70 years. In men stomach cancer is diagnosed at 10-20% more than women of the same age.

Epidemiology

In the structure of Russian cancer gastric cancer takes the leading positions together with malignant lesions of the lung, breast, colon intestine and skin.

The incidence rate of about 17-19 people per 100 thousand people in Russia annually. According to certain data it reaches 30 persons per 100 thousand population. The duration of the preclinical period of the disease – from 11 months to 6 years.

Marked geographical heterogeneity of disease incidence on a global scale:

  • High level – Russia, Japan, South Korea, Finland, Chile, Brazil, Colombia, Iceland.
  • Low level West Europe, USA, Canada, Australia, Indonesia.

The debut of gastric cancer associated with H. Pylori infection and previous pathologies: dysplasia of the mucous membranes, peptic ulcer disease, polyps on the walls of the stomach, gastritis and other diseases. Undoubtedly proven the negative impact of Smoking and strong alcohol on the body, and regular consumption of food colorants, flavors and flavor enhancers.

In countries with a high level of medical care of cancers detected at early stages, so mortality statistics looks quite optimistic. Five-year survival of stomach cancer patients in Japan provided an early diagnosis is about 70-90%.

How I live with stomach cancer?

Patients with gastric cancer, men live on average 12 years and women 15 years less than their peers.

In Russia the structure of the detection and survival of patients looksas follows:

  • I stage of the disease is determined in 10-20% of patients, the survival rate for five years is 60-80 %;
  • II-III stage of lesion of regional lymph nodes determine 30% of patients, the survival rate over five years ranges from 15-45 %;
  • Stage IV with metastases to neighboring organs diagnosed in 50% of cases, survival for five years is not more than 5-7 %.

Active attempts are being made in creating systems objective prediction of the outcome of the disease. As immunohistochemical markers of this form oncologists use a variety of enzyme systems, including MMP-9. The method finds application in clinical Oncology to determine the possibility of surgical treatment.

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Treatment of gastric cancer in "Assuta"

Stomach cancer can develop rapidly, so the success of treatment often depends on rapid diagnosis. Clinic "Assuta"offers a diagnosis of this disease in Israel in the shortest possible time - in just 4-5 days. Examination and treatment is conducted by leading specialists of the country. Among them – Professor of Oncology Moshe Inbar, Baruch Klein and Ilan Ron.

In the clinic"Assuta" a modern endoscopic equipment to perform sparing laparoscopic surgery for cancer of the stomach. Such operations are performed through 3 puncture of the abdominal wall. They do not require lengthy rehabilitation and the risk of complications is considerably less than with open operations. In clinic special methods of rapid postoperative recovery fast track.

Don't fight the trouble by yourself, get acquainted with the program of treatment of gastric cancer in Israel now, click – http://www.assuta-clinic.org/lechenie-raka-v-izraele/lechenie-raka-zheludka-v-izraile/


The symptoms of stomach cancer

Long-term disease manifested clinical signs.

Major diagnostic errors are associated with symptoms that make cancer of the stomach similar to non-cancer pathologies of the heart or the gastrointestinal tract:

  • Similar to heart disease. Localization of the tumor in the cardial part of the stomach is accompanied by chest pain (angina), especially against the background of high blood pressure in people over fifty years.

  • Similar to diseases of the gastrointestinal tract. The localization of the tumor, closer to the intestinal part of the stomach is manifested by symptoms resembling gastritis, peptic ulcer, pancreatitis, cholecystitis. All these diseases are manifested by pain in the abdomen, vomiting, and gastric hemorrhage.

Misdiagnosis can be a long time to hide the underlying disease. Moreover, the cardiologist and gastroenterologist in-depth examinations usually find multiple deviations in patients with advanced age, with obvious signs of cancer there.

The doctor leading the patient should be alerted:

  • The lack of effect after treatment;
  • The patient has a history of chronic diseases of the gastrointestinal tract.

The patient and physician should also subotici subjective feelings (at least two to three), indicating small signs of stomach cancer:

  • Constant discomfort in the abdomen (overflow, severity);
  • Difficulty swallowing food, chest pain that radiates to the back;
  • Pain, not animalsas after a meal and does not respond to medication;
  • Fatigue and chronic weakness after minimal physical exertion;
  • Fast weight loss (10-20 pounds in 6 months with a body weight of 80-90 kg) and a decrease in appetite;
  • Aversion to meat dishes, not previously observed intelligibility in food;
  • Satiation minimal amount of food.

On the basis of clinical studies the regularities of the appearance of signs of disease (at the same time at least two to three of the following), which identifitseerida signs of cancer, namely:

  • Central pain in the epigastric region, it is reported about 60% of patients;
  • Progressive decrease of body weight, according to 50% of patients;
  • Nausea and vomiting after intake of food – about 40% of patients;
  • Nausea and vomiting blood about 25%;
  • Pallor of the mucous membranes is about 40%.

Clinical symptoms has some differences depending on the localization of the tumor in the upper, middle and lower parts of the stomach:

  • The defeat of upper part of the stomach is manifested by cardiac symptoms (pain in the heart area), as well as difficulty when swallowing, even impossible to eat. Develops dehydration, threatening disseminated intravascular coagulation (DIC). It is also dangerous proteinfasting, which aggravated the violation of nitrogen metabolism and lead to critical level of oxidized substances in the blood.
  • Lose the middle part of the stomach is manifested gastrointestinal bleeding and anemia development. In this area there are large vessels. Occult blood is determined by a simple laboratory methods, and massive bleeding is defined as the change in consistency and colour of stool – it becomes black and tarry. The pain is often corded with involvement in carcinogenesis of the pancreas. Other symptoms are General in nature.

  • Lose the lower part of the stomach is manifested by dyspepsia (diarrhea, constipation, vomiting and gastric pain), belching with a smell of rotten eggs.

The very first symptoms of stomach cancer

At the first signs you should pay attention before the symptoms, which characterize stage III-IV stomach cancer. Detection of the disease in the latter stages – almost a sentence.

Should be associated with premalignant pathology following pathology:

  • Chronic (atrophic) gastritis, regardless of cause, is characterized by common signs, well detectable by clinical examination of the patient is nausea and vomiting.
  • Gastric ulcer, regardless of options, is manifested stomach bleeding in the form of bloody vomit, massive or hidden blood loss after bowel movements, persistent or recurrent pain in the stomach. For peptic ulcer disease is characterized by seasonal exacerbation and successful pain relief medication.

  • Polyps of the stomach wall, including the major (adenomatous) and small (hyperplastic). Early stages occur subclinical, benign tumors in traumatic bleeding. Prone to malignancy polyps located initial section of the stomach.

  • Dysplasia, metaplasia. All stages of cell atypia (dysplasia) up to the latest stage IV (cancer in situ) were detected mainly in the laboratory cytological and histological examination. In the last stages are diagnosed with digestive disorders, nausea and vomiting.

Vomiting in gastric cancer

Unmotivated at first glance, the vomit may indicate early signs of cancer. Diagnostic importance of vomiting in combination with other features.

The gag reflex can be triggered by:

  • Narrowing of the digestive tube developed a tumor that creates obstaclemove food (has a diagnostic value in the later stages);
  • The irritation of receptors of the vomiting center in the chemical and mechanical action of the products of the pathogenesis (is of great diagnostic value, including in the early stages).

In the first case, food is thrown out directly after a meal. Vomit contain swallowed food without signs of splitting her gastric juices. The concomitant symptoms pointing to cancer of the digestive tube, are severe weight loss, pale mucous membranes, and changes in stomach wall at the cellular level. Vomiting of undigested food see intoxication in a short period of time. But if it is associated with cancer of the stomach, manifested in a long time.

In the second case the irritation of the vomiting center vomiting occurs, regardless of the meal. It is most commonly associated with intoxication by the products of carcinogenesis.

In a single spasm vomiting contains polypropyrene, multiple – liquid content:

  • Yellow (bile ducts normal);
  • A light color (obstruction of the ducts may metastasize to the liver);
  • Streaks or clots of dark red color (blood vessel damage).

Vomiting and cancer exactly have a relationship when there are two or three additional signs of damage to the digestive tract.

The blood of gastric cancer

The changes observed in the feces (in the form maleny – the so-called "currant jelly"), and in the vomit. Not always gastric bleeding has a relationship with cancer. The combination of bleeding and small signs of stomach cancer (see above) greatly increases the probability of Association with the underlying disease.

Signs of stomach bleeding:

  • Vomit have a dark color, and not foam, it separates the blood from the stomach of pulmonary bleeding;
  • Cal due to the coagulated blood has a black color, liquid consistency, smell the fetid allocated small portions.

Causes of stomach cancer

Transformation of normal cells into malignant one is a multi – stage chain of events.

Following is a simplified vision of carcinogenesis and the phased inclusion of the different reasons:

  • Stimulation and accumulation of mutations under the influence of external and/or internal carcinogens;
  • The development of precancerousdiseases in the walls of the stomach (chronic gastritis, peptic ulcer disease, benign neoplastic education);
  • Stimulation of cancer on the background of pre-cancer and exposure to carcinogens .

The first stage

To occurred mutations, it is necessary carcinogenic effects on the epithelium of the stomach.

External carcinogens (mainly food and beverages), including:

  • Regular consumption of excess salt, food additives marked with "E". For example, meat products and delicacies, which are always (provided by technology) was added sodium nitrate e251 to give the meat a red color, monosodium glutamate or e261 to improve the taste. Contribute stomach cancer also smoked, spicy, pickled, canned and fried foods, hard liquor, tobacco Smoking and use of medication (aspirin, hormones);
  • A deficiency of ascorbic acid (vitamin C), which normalizes the level and quality of hydrochloric acid, reduces bleeding, thus preventing the development of primary irregularities in the walls of the stomach. The detrimental effect low level of vitamin E (tocopherol), which regulates the resistance of the mucous membranes, beta-carotene and some macro-and micronutrients.

Internal carcinogens (infectious, hereditary, immune factors), including:

  • Infectious – negative impact of Helicobacter pylori, micrococci, strepto - and staphylococci, fungi of the genus Candida, Epstein-Barr. The participation of the latter as the cause of gastric cancer conclusively proven by the discovery of herpes-markers in tumor cells some types of tumors;
  • Hereditary – it has been proved that the incidence of some forms of cancer is 20% higher in individuals that inherit A(II) blood group. Moreover, hereditary transmission of a low level of the gene, called E-cadherin is a protein of the epithelium, which in normal conditions suppresses the growth of tumor cells;
  • Immune – decrease the resistance of the epithelium due to the lack of immunoglobulin (Ig) And in the wall of the mucous membranes. Influence of autoimmune processes on the formation of cancer is also proven.

The second stage

Includes the development of diseases prior to cancer, including:

Disease can develop without the participation ofcarcinogens, then the pathogenesis is limited benign course. In case of exposure to disease transformirovalsya malignant.

The third stage

Directly carcinogenesis is triggered when the combination of the two above-mentioned factors and additional unknown causes. The underlying mechanisms of transformation of normal cells to malignant has not been studied. However, it is known that almost 100% of cases gastric cancer is preceded by infection with H. Pylori damage the stomach lining and unconditional participation of carcinogens.


The stages of stomach cancer

The designation of the primary tumor – T with the addition of digits from 1 to 4 and small caps (a, b) to describe the details of carcinogenesis, occurring in the primary tumor. Designation of regional lymph nodes – N with the addition of numbers from 0 to 3 and small capital letters (a, b). To denote distant metastases use Latin letter and digits – 0, 1 to indicate the absence or presence of distant metastases.

Stage 1 stomach cancer

Stage 1 can be encrypted in three ways, namely:

  • stage 1A ( T1 N0 M0 ), the primary tumor the first stage, grow into the mucosal and submucosal layer, without defeat lymph nodes and distant metastases;

  • stage 1B, option 1 ( T1 N1 M0 ), the primary tumor grows in the mucous and submucosa, metastasis in one to six regional lymph nodes, distant metastases absent;

  • stage 1, option 2 (T- 2A/b N0 M0), the primary tumor has invaded the muscle and podserozny layer of lymph node and distant metastasis is not observed.

Stage 2 stomach cancer

Stage 2 can be encrypted in three ways, namely:

  • (T1 N2 M0), the primary tumor grows in the mucous and submucous layer, is the involvement of 7-15 regional lymph nodes, distant metastases absent;

  • (T- 2A/b N1 M0), primary tumor in the muscle and podserozny layer are diagnosed by the involvement of 1-6 regional lymph nodes and absence of distant metastases;

  • (T3 N0 M0), the primary tumor is the serous membrane and the visceral wall without involvement of adjacent organs, lesions of regional lymph nodes and distant metastases were not observed.

Stage 3 stomach cancer

Stage 3 can be encrypted in four variants, namely:

  • stage IIIA, variant 1 (T- 2A/b N2 M0), which means involvement in the pathogenesis of muscle and podserozny layer of the stomach wall, lose 7-15 regional lymph nodes and absence of distant metastases;

  • Stage IIIA, variant 2 (T3 N1 M0 ), means there is damage to all layers of the serous membrane of the stomach without involvement of adjacent organs, lose 1-6 regional lymph nodes and absence of distant metastases;

  • Stage IIIA, tier 3 (T4 N0 M0 ), the tumor has spread to adjacent organs in the absence of involvement of regional lymph nodes and without distant metastases;

  • Stage IIIB, (T3 N2 M0 ), damage to all layers of the serous membrane, lose 7-15 regional lymph nodes, no distant metastases;

Stage 4 stomach cancer

Stage 4 can be encrypted in three versions, namely:

  • (T4 N1, N2, N3, M0 ), the spread of the tumor to adjacent organs, the defeat of regional lymph nodes (1-6 ) –N1, or (7-15) – N2, or (15) – N3, no distant metastases;

  • (T1 T2 T3, N3 M0 ), the defeat of the rectal mucosa and submucosa – T1 or lose muscle and podserozny layer – T2 or the defeat of all layers of the serous membrane, lose more than 15 regional lymph nodes, no distant metastases;

  • (Tany, Nany, M1), the primary tumor of various options for growth, also any options for the defeat of the regional lymph nodes and the obligatory presence of distant metastases.

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Inoperable stomach cancer with metastasis

It refers to the stage of the disease, where it is impossible or impractical to apply the methods of surgical removal (resection) of the stomach and lymph nodes to stop the disease. For inoperable cases do not consider palliative surgery to alleviate the patient's condition.

An inoperable cancer can be:

  • Locally advanced, when damaged a significant portion of the stomach or multiple lesions located mosaic and hurt vital parts of the body (large vessels and the nerve), cells spread lymphokine, contact orimplant;
  • Metastatic when identified lesions of distant organs, usually the liver, lungs, adrenal glands, bones and subcutaneous tissue. Cancer cells spread through the blood stream.

The most positive results are seen in radical radiotherapy for locally advanced common processes. According to some sources, the duration of life after the course of combined treatment can be increased to 20-24 months. While complications from exposure to ionizing radiation is much lower therapeutic effect and the patient gets a chance to prolong life in the absence of pain. Unfortunately, to ensure more in terms of modern medicine is impossible.

The main ways of metastasis are through the lymphatic system, therefore, secondary tumors and metastases the most significant find in the first place, in the lymph nodes.

Metastasis of gastric cancer:

  • In adrectal tissue or in the space near the rectum – Schnitzler's;
  • The navel – sister Marie Joseph;
  • In the left supraclavicular region – Virchow;
  • In the ovary region – Kruckenberg.

These secondary tumors are evidence of the late stages of the disease, when the therapeutic strategy is chosen individually and often is palliative, that is aimed at improving the quality of life of the patient.

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Types of stomach cancer

Stomach cancer is divided into the location and distribution methods – it may be, for example, the extrusion surrounding tissue, or Vice versa, infiltration into the surrounding tissue. A significant impact on the pathogenesis have histological forms of cancer: diffuse or paripoorna.

Perstnevskiy stomach cancer

Diagnosed by cytological and histological examination. This kind of diffuse cancer. The modified area consists of a flat signet ring cells. The disease is an aggressive course.

Histochemical studies have establishedhormonal nature of this tumor. In the tissues of the tumors in women find increased level of estrogen and men have testosterone.

The distinctive feature of this disease:

  • The predominance of women in the structure of patients. The number of women patients – 55% men – 45%. The ratio can vary, but the pattern is confirmed by numerous studies;
  • Peaks of incidence in the age between 40 to 50 years and 60-70 years. In other intervals such a life cancer is diagnosed in significantly lower;
  • In the structure of patients is dominated by people with blood group A(II) – about 45%, with other variants of blood groups is significantly lower.
  • Not, the dependence of the onset of the disease from the presence of prior addictions (alcohol, salted, smoked, pickled foods) and exogenous factors (radiation, chemical manufacturing).
  • This type of gastric cancer more commonly found among urban residents.

Infiltrative gastric cancer

The morphological shape of carcinoma, without clear separation of the boundaries of tumors. The growth of malignant cells occurs mainly in the thickness of the stomach wall.

Features of the disease:

  • It can occur in relatively young people, a marked hereditary predisposition;
  • Small pockets of growth onkokletok are detected at a distance of 5-7 cm from each other;
  • This is one of the most malignant forms of cancer often metastasizes;
  • Pathogenesis clinical stage, accompanied by symptoms related to dyspepsia (chronic vomiting, impaired peristalsis);
  • In the last stages the tumor is in the form of a dense stone-like formation, the stomach is reduced in size.

Poorly differentiated gastric cancer

Normal cells are updated with high speed, after about 3-4 days of generation changes completely. High refresh rate is an important factor in the appearance of defects.

High speed reproduction nizkoeffektivnyj cells is the basis of the aggressiveness of the pathogenesis of cancer. Poorly differentiated gastric cancer is gastric adenocarcinoma, consisting of stem cells.

Features of the disease:

  • High speed growth, the development of inflammatory and necrotic foci around the tumor;
  • The inability to determine the type of change that is covert development of carcinogenesis in the thickness of the stomach wall;
  • The lack of clear boundaries of the tumor growth occurs in the type of diffuseimpregnate the walls of the stomach;
  • The rapid formation of metastases in regional lymph nodes and distant organs: metastasis up to 90% of all cases nizkotemperaturnogo of carcinogenesis.

Diagnosis of gastric cancer

Of particular importance for the early detection of the disease is unconstrained and care of the General practitioner. Diagnosis is carried out in stages and includes physical, instrumental and laboratory methods.

1. Physical methods

Diagnosis begins with clinical inspection, palpation and auscultation.

In the early stages of stomach cancer it helps to identify long-term symptoms on the condition of the skin, color, moisture content, temperature, pain, including in the abdomen.

Auscultation of the heart pain in the chest is a frequent complaint of the patient. To exclude the noise of the stenosis and the splash, is not characteristic of pathologies of the cardiovascular system. Palpation of the abdominal wall in the early stages of the disease there are no changes, and later it is possible to detect seals under the skin in the epigastric region.

2. Instrumental methods

Uses the techniques of contrast radiology and endoscopy.

X-ray diagnostics. Is an indirect method that helps you quickly determine the presence of pathology by the nature of the x-ray shadow.

The radiologist takes account of the following changes to the negative picture, where dense is a light and loose is the dark areas:

  • Local change (thickening, folding) wall;
  • Defects of different sizes in the form of filled contour plots on the inner wall in propovednik forms of cancer of the stomach;
  • Seals, reducing the elasticity of the tissue of the stomach;
  • Niche area of infiltration and the folding of the walls of the mucous membranes;
  • Deformation in the form of sidelining sections of the walls around the tumor or infarction of the tissues of the stomach wall;
  • Decrease peristalsis (defined not by all means).

Modern methods of x-ray indirectly, the nature of blackouts, and to identify up to 85% of changes of the stomach wall. More valuable method of diagnosis of cancer of the stomach endoscopy.

Gastroendoscopy

Value is enhanced when obtaining a biopsy from different parts of the walls of the stomach for histological and cytological studies. Color visualization of the walls of the bodyhelps to identify minimal abnormalities on character color of the inner walls, the thickness of the folds, the presence of peristalsis of the stomach and foci of hemorrhage, in the form of wall defect (raised, saped, in-depth).

Modification of gastroendoscopy:

  • Staining helps identify areas of metaplasia and other early pathologies that are not visible to the naked eye;
  • Treatment with drugs that selectively accumulate in tumor cells, while laser illumination helps identify the changed section for fluorescence.
  • Endoscopy with attachments for optical zoom helps to identify changes to the walls of the stomach at a cellular level;
  • Endoscopes with the ultrasonic nozzles – a combination of ultrasound and imaging;
  • A relatively new technique – introduction into the stomach unmanaged videocapsule, which in real time shows the overview not sighting the image of the stomach wall.

Disadvantages of endoscopy:

  • The discomfort of the patient with the ingestion of relatively large tube diameter. Usually this is accompanied by a reflex gag reflex that prevents with the help of drugs (Diprivan, reglan);
  • The difficulty of differentiating benign and malignant tumors.

Therefore, endoscopy is usually combined with electrocoagulation of tumors on stomach wall.

Morphological method

On the basis of histological and cytological studies in the laboratory with a high degree of reliability is determined by the histological type of the tumor. General pattern: tumors, located closest to the cardiac portion (entrance to stomach), more likely to have the properties of malignancy.

3. Additional methods

Ultrasound diagnostics. Carried out in three main variants:

  • Outside, through the abdominal wall;
  • Outside, after the filling of the stomach degassed liquid;
  • Internal, using an endoscopic probe.

Laparoscopy – second additional method of diagnosis of gastric cancer. This technique is used to determine the operability of the tumor and presence of metastasis. Laboratory testing of biological fluids is used to clarify the patient's condition before surgery. In recent years, used methods of determining cancer using tumor markers.

Differential diagnosis of gastric cancer

The above methodsare used to differentiate cancer from less dangerous or previous cancer disease, including:

  • Atrophic forms of gastritis;
  • Peptic ulcer disease;
  • Various polyps;

  • Infectious diseases with similar symptoms (syphilis, tuberculosis of the stomach, amyloidosis);

  • Diseases of the lower esophagus (narrowing or achalasia incomplete relaxation of the sphincter muscle closer to the stomach).

Treatment of gastric cancer

The choice of treatment is determined by the stage of carcinogenesis and is discussed at the consultation with the specialists of several medical specialties. The main method of treatment of a tumor in the early stages – surgical removal combined with adjuvant chemotherapy and neoadjuvant. Methods of treatment of advanced stages are palliative and symptomatic.

All patients are divided into three groups:

  • The first patients have early stage (patients with carcinoma in situ the first stage);
  • The second – patients with resectable locally common stage (with patients up to stage III);
  • The third – patients with inoperable stage of generalized cancer of the stomach (comparable to stage IV patients with severe associated symptoms or involvement in the guidance of the vital organs and systems).

Sometimes recognized even inoperable patients with early forms of cancer, for example, when a tumor lesion of the vital parts of the body or the inability of the surgery for other reasons.

The greatest chance of full recovery (up to 90% with five-year survival rate) without significant consequences for the organism in the first group of patients. Forecast inside the second group has considerable variation, because of the many nuances of this stage of the disease. Minimally favorable prognosis in patients with recent, third group. In this case, you should talk about extending and improving the quality of life of patients during illness.

Removal (resection) of the stomach for cancer

Patients, with the exception of certain categories before the surgery is indicated laparoscopic diagnosis in order to exclude metastasis to the omentum and in the peritoneum.

Endoscopic resection

Depending on the stage of the disease, clinical condition of the patient and size of the tumor can be scheduled for surgery with minimal dissection of the abdominal wall endoscopic resection.There are several options – the choice of the doctor.

Possible complications of endoscopic resection:

  • Postoperative pain – cropped drugs or dosed irradiation;
  • Perforation (full, partial) of the walls of the stomach – is eliminated by physical methods of influence;
  • Postoperative bleeding is stopped by physical methods and pharmaceutical drugs.

A simplified version of the intervention – moxibustion neoplasms electrothermal or laser action on the stomach wall.

Abdominal surgery

Is conducted in the absence of absolute and relative contraindications. In case of impossibility of resection was the issue of chemotherapy or radiation effects on the tumor to reduce carcinogenesis before further operation.

If the indications for operation, preoperative preparation is conducted, which consists of a series of manipulations, aimed at stabilizing the patient's condition.

The scheduling algorithm operation includes a choice of:

  • Access to the tumor during the operation;
  • Volume of surgical intervention in the body;
  • Tactics removal of packets of lymph nodes;
  • The method of reconstruction of the body.

An important stage of treatment is post-operative recovery, including the imposition of drainage tubes to drain the fluid. Patients with no complications allow to sit in the first day, and walk – on the second day after surgery.

Contraindications to abdominal surgery for cancer of stomach disorders are:

  • Hemodynamics in the form of instability of blood pressure and disseminated intravascular coagulation syndrome;
  • The rhythm of breathing (respiratory arrhythmia).

Planned post-operative events:

  • Postoperative analgesia, from the first day;
  • Stimulation of intestinal peristalsis, on the third day;
  • Enteral (through a tube and if it is necessary) meals, special mixtures, from the first day;
  • Antibiotic therapy in the form of four - or six-day course;
  • Introduction of medicinal substances that reduce the viscosity of the blood (according to indications).

All manipulations are carried out under the supervision of a physician. There are limitations and contraindications. The need for additional remedial measures are determined individually. Removal of stitches is not earlier than 7 days after the intervention.

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Chemotherapy for stomach cancer

Surgical intervention for complete cure of cancer of the stomach is usually not enough. The patient for a long period of time to determine clinical dynamics. During this period, prescribe chemotherapy to eliminate hidden local centers of secondary carcinogenesis.

Chemotherapy has a General negative impact on the body. Its use is justified only when the real possibility of increasing the chances of recovery or at least improve the quality of life of the patient.

Adjuvant chemotherapy: the term "adjuvant" means an increase or addition. That is, this type is used after surgery, in contrast to neoadjuvant chemotherapy, which is used before the procedure to reduce the tumor size before surgery. In recent years relative to adjuvant effects was changed. Previously, the method of chemotherapy gastric cancer was considered not effective.

This treatment is in the form of chemotherapy (exposure to multiple drugs) two or three courses with different intervals. Apply pharmaceutical drugs in various combinations: Doxorubicin, Etoposide, Cisplatin, Fluorouracil, Mitomycin, Cisplatin, and others.

Palliative chemotherapy. Another type of therapy, which is used when it is impossible the partial or total removal of the stomach and lymph nodes.

Complications after chemotherapy is unavoidable. Cytostatics inhibit the growth of malignant cells.

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However, it is develop side effects in the form of toxicosis, accompanied by:

  • Restoring hair loss;
  • Toxic liver;
  • A violation of hematopoiesis;
  • The suppression of the cooperation of humoral and cellular immunity.

Usually these phenomena are eliminated in the course of rehabilitation treatment.

Learn more: Chemotherapy in gastric cancer


Juice for stomach cancer

The disease is accompanied by loss of body large amounts of fluid from repeated vomiting and gastric bleeding. In cancer patients complain of loss of appetite due to the loss of gustatory and olfactory sensations, and painother reasons.

Juices, especially with pulp, is almost always useful for patients, especially if they do not exist swelling. Recommended fluid intake to 2 liters per day. Besides juices you can drink milk, dairy products, teas, fruit drinks, fruit drinks.

Juices is advisable consumed fresh squeezed, with pulp, from:

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As raw material for the production of juices it is better to use local fruit, which is the usual for a sick set of nutrients.

The value of juices:

  • Sour to raise the acidity, as the stomach wall to reduce secretion of hydrochloric acid, and reduce the need for salt and to raise the threshold of the gag reflex. Sweet and sour juices possess a better toning effect;
  • Sweet – they must saturate the body with vitamins, minerals, indigestible fiber contained in the pulp is needed to improve peristalsis. Too sweet juices it is best to dilute with water;
  • Slightly bitter, cabbage, turnips or grapefruit for appetite stimulation and motility.

After consultation with the attending physician, the amount of liquids, especially in the form of a refreshing juice and dairy beverages:

  • increase during the course of receiving chemotherapy drugs in the course of dehydration, diarrhea and vomiting;
  • reduce swelling, accumulation of ascitic fluid in the pleural and abdominal cavity.

After a course of treatment of stomach cancer chemotherapy some patients are shown instead of juice, take before meals 20-30 ml of table wine. A small amount of wine has a stimulating and tonic effect, increases immunity and soothes.

The fluid necessary for human excretion products of metabolism from the body, improve tissue nutrition, improve health and improve immunity.


Diet for stomach cancer

Therapeutic diet for stomach cancer performs the following tasks:

  • Prevents the loss of body weight through a balanced diet;
  • Increases the tolerance of aggressive antitumor treatment and reduces the risk of postoperative complications;
  • Normalizes metabolism and minimize its violation;
  • Boosts and supports the body's resistance to physical stress;
  • Supports the immune system, prevents infection, including slow developing on the background of immunodeficiency;
  • Accelerates the regenerative activity of the tissues after partial or total gastric resection;
  • Improves the quality of life.

The principles of therapeutic nutrition in cancer of the stomach:

  • Cooking techniques – boiling, baking, braising;
  • The mode of nutrition of patients is four to six times a day;
  • Personalised nutrition – energy cost and metabolic properties introduction to the diet protein, including animal origin, fats, carbohydrates and liquids is produced gradually.
  • Power correction, based on the stages of treatment – is carried out with the aim of reducing side effects of cancer therapy.

Offered three options diet for patients with stomach cancer with consideration of the peculiarities of metabolism and body mass.

The first option

– organization of supply the patient with normal body weight in the absence of obvious violations of metabolism:

  • The energy value is not higher than 2400 kilocalories per day;
  • The total amount of protein – 90 grams including animal – 45 grams;
  • The total number of fats – 80 grams, including plant – 30 grams;
  • The total number of carbs – 330 grams.

The second option

– organization of supply the patient with severe underweight, emaciation, visible metabolic disorders, and after surgery, chemotherapy or radiation therapy:

  • Energy value – not above 3,600 calories a day;
  • The total number of protein – 140 grams including animal – 70 grams;
  • The total amount of fat, 120 grams, including plant – 40 grams;
  • The total amount of carbohydrate is 500 grams.

The third option

for patients with extreme weight loss and laboratory-confirmed violation of the excretory functionkidney and liver:

  • The energy value is not higher than 2650 kcal per day;
  • The total amount of protein – 60 grams including animal – 30 grams;
  • The total amount of fat is 90 grams, including plant – 30 grams;
  • The total number of carbs – 400 grams.

Find out more: Food in stomach cancer


Prevention of gastric cancer

Work includes General activities: improving health knowledge of the population, informing about the causes of stomach cancer.

General activities

Dialogue with the population:

  • Clarification of the risk of cancer and improving the alertness of the people;
  • Description of algorithm of actions in case of detection of the first signs of stomach cancer;

  • Promotion of healthy lifestyle.

Medical interventions

Work in this direction is carried out in high-risk groups. It consists of measures for the prevention and treatment of precancerous diseases.

It should be the therapy against Helicobacter pylori before the development of precancerous changes in the body. This type of bacteria, is the etiological factor in 71-95% of all cases of gastric cancer.

At risk include people with a history of:

Find out more: Prevention of gastric cancer

  • Genetic predisposition;
  • Carriage Of H. Pylori;
  • Resection of the stomach;
  • A long period of work in hazardous and chemical industries;
  • Chronic deficiency in production of hydrochloric acid in the stomach;

  • Pernicious anemia;

  • Autoimmune atrophic gastritis;

  • Extensive atrophic gastritis with reduced secretion of hydrochloric acid;

  • Adenoma of the stomach.


ykov, Yevgeny Pavlovich, doctor-oncologist