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

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.

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.

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.

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.

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

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.

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.