Contents
What is stomach cancer?
Stomach cancer is a malignant transformation of the cells of the gastric epithelium. In the disease, 71-95% of cases are associated with damage to the walls of the stomach by Helicobacter Pylori bacteria and are common cancers in people aged 50 to 70 years. In men, stomach cancer is diagnosed 10-20% more often than in women of the same age.
Epidemiology
In the structure of oncological diseases in Russia, gastric cancer occupies a leading position along with malignant lesions of the lung, breast, large intestine and skin.
The incidence rate is 17-19 people per 100 thousand inhabitants of Russia per year. According to some reports, it reaches 30 people per 100 people. The duration of the preclinical period of the disease is from 11 months to 6 years.
There is a geographical heterogeneity in the incidence rate on a global scale:
High level – Russia, Japan, South Korea, Finland, Chile, Brazil, Colombia, Iceland.
Low level – Western Europe, USA, Canada, Australia, Indonesia.
The debut of gastric cancer is associated with H. Pylori and previous pathologies: dysplasia of the mucous membranes, peptic ulcer, polyps on the walls of the stomach, gastritis and other diseases. Of course, the negative impact of smoking and strong alcohol on the body, as well as the regular use of food colors, flavors and flavor enhancers, has been proven.
In countries with a high level of medical care, cancer is detected at an early stage, so the mortality statistics look quite optimistic. The five-year survival rate for patients with gastric cancer in Japan, provided early diagnosis, is about 70-90%.
How long do people live with stomach cancer?
Men with stomach cancer live an average of 12 years, and women are 15 years less than their peers.
In Russia, the structure of detection and survival of patients is as follows:
Stage I of the disease is determined in 10-20% of patients, survival for five years is 60-80%;
Stage II-III with damage to regional lymph nodes is determined in 30% of patients, survival for five years fluctuates at the level of 15-45%;
Stage IV with metastases to neighboring organs is diagnosed in 50% of patients, the survival rate for five years is no more than 5-7%.
Active attempts are being made to create systems for objective prediction of the outcome of the disease. Oncologists use various enzyme systems, including MMP-9, as immunohistochemical markers of this form. The method is used in clinical oncology to determine the possibility of surgical treatment.
Symptoms of stomach cancer
The disease does not show clinical signs for a long time.
The main diagnostic errors are associated with symptoms that make stomach cancer look like non-cancer pathologies of the heart or gastrointestinal tract:
Similar to heart disease. Localization of the tumor in the cardial part of the stomach is accompanied by retrosternal pain (angina pectoris), especially against the background of high blood pressure in people over fifty.
Similar to diseases of the gastrointestinal tract. Localization of the tumor closer to the intestinal part of the stomach is manifested by signs resembling gastritis, peptic ulcer, pancreatitis, cholecystitis. All these diseases are manifested by pain in the abdomen, vomiting and stomach bleeding.
An erroneous diagnosis can hide the underlying disease for a long time. Moreover, a cardiologist and a gastroenterologist, during an in-depth examination, usually find multiple deviations in patients of solid age, while there are no obvious signs of oncology.
The doctor leading the patient should alert:
No effect after the course of treatment;
The patient has a history of chronic diseases of the gastrointestinal tract.
The patient and the doctor should also be concerned about subjective sensations (at least two or three) indicating signs of small stomach cancer:
Constant discomfort in the abdomen (fullness, heaviness);
Difficulty swallowing food, retrosternal pain that radiates to the back;
Pain that does not subside after eating and is not relieved by taking medications;
Fatigue and chronic weakness after minimal physical exertion;
Rapid weight loss (by 10-20 kg in 6 months with a body weight of 80-90 kg) and loss of appetite;
Aversion to meat dishes, not previously observed pickiness in food;
Fast satiety with a minimum amount of food.
Based on clinical studies, regularities have been established for the appearance of signs of the disease (at least two or three of the following at the same time), which are further identified as signs of oncology, namely:
Pain in the central region of the epigastrium, about 60% of patients report this;
Progressive weight loss reported by about 50% of patients;
Nausea and vomiting after eating – about 40% of patients;
Nausea and vomiting with blood – about 25%;
Paleness of mucous membranes – about 40%.
Clinical symptoms have some differences depending on the localization of the tumor in the upper, middle and lower parts of the stomach:
The defeat of the upper part of the stomach is manifested by cardiological symptoms (pain in the region of the heart), as well as difficulty in swallowing, up to the inability to eat. Dehydration develops, threatening the syndrome of disseminated intravascular coagulation (DIC). Protein starvation is also dangerous, which exacerbates nitrogen metabolism disorders and leads to a critical level of under-oxidized substances in the blood.
The defeat of the middle part of the stomach is manifested by gastric bleeding and the development of anemia. Large vessels are located in this zone. Latent bleeding is determined by simple laboratory methods, and massive bleeding is determined by a change in the consistency and color of the feces – it becomes black and tarry. Pain is most often associated with involvement in pancreatic carcinogenesis. Other symptoms are general.
The defeat of the lower part of the stomach is manifested by dyspepsia (diarrhea, constipation, vomiting and stomach pain), belching with the smell of rotten eggs.
The earliest symptoms of stomach cancer
The first signs should be paid attention to long before the symptoms that characterize stage III-IV of gastric cancer. Identification of the disease in the last stages is almost a sentence to the patient.
The following pathologies should be associated with precancerous diseases:
Chronic (atrophic) gastritis, regardless of the causes, is characterized by common signs that are well detected during the clinical examination of the patient – this is nausea and vomiting.
A stomach ulcer, regardless of the options, is manifested by gastric bleeding in the form of bloody vomiting, massive or hidden blood loss during defecation, constant or periodic pain in the stomach. Peptic ulcer disease is characterized by seasonal exacerbations and successful pain relief by taking medications.
Polyps of the walls of the stomach, including large (adenomatous) and small (hyperplastic). The early stages proceed subclinically, benign neoplasms bleed when traumatized. Polyps located in the initial part of the stomach are prone to malignancy.
Dysplasia, metaplasia. All stages of cellular atypia (dysplasia) up to the last stage IV (cancer in situ) are detected mainly by laboratory methods in cytological and histological examination. In the last stages, digestive disorders, nausea and vomiting are diagnosed.
Vomiting in stomach cancer
Unmotivated, at first glance, vomiting may indicate early signs of oncology. Vomiting in combination with other symptoms is of diagnostic value.
The gag reflex can be triggered by:
Narrowing of the digestive tube by a developed tumor that creates an obstacle to the advancement of food (has diagnostic value in the later stages);
Irritation of the receptors of the vomiting center during the chemical and mechanical effects of pathogenesis products (it is of great diagnostic value, including in the early stages).
In the first case food is thrown out immediately after eating. Vomit contains swallowed food without signs of splitting it with gastric juice. Accompanying symptoms indicating cancer of the digestive tube are dramatic weight loss, pallor of the mucous membranes, and changes in the walls of the stomach at the cellular level. Vomiting of undigested food is observed during intoxication in a short period of time. But if it is associated with stomach cancer, it manifests itself for a long time.
Second case when the vomiting center is irritated, vomiting occurs regardless of food intake. Most often, it is associated with intoxication of the body with carcinogenesis products.
With a single spasm, vomiting contains semi-digested, with multiple – liquid contents:
Yellow color (bile ducts are normal);
Light color (obstruction of the ducts, possible metastasis to the liver);
Dark red streaks or clots (damage to blood vessels).
Vomiting and cancer are definitely related in the presence of two or three additional signs of damage to the digestive tract.
Blood in stomach cancer
Changes are observed in feces (in the form of melena – the so-called “currant jelly”), as well as in vomit. Not always gastric bleeding is associated with cancer. The combination of bleeding and small signs of gastric cancer (see above) greatly increases the likelihood of an association with an underlying disease.
Signs of stomach bleeding:
The vomit is dark in color and does not foam, which distinguishes blood from the stomach from pulmonary bleeding;
Feces due to clotted blood are black in color, the consistency is liquid, the smell is fetid, it is excreted in small portions.
Causes of stomach cancer
The transformation of normal cells into malignant cells is a multi-stage chain of events.
The following is a simplified view of carcinogenesis and a step-by-step inclusion of a variety of causes:
Stimulation and accumulation of mutations under the influence of external and / or internal carcinogens;
The development of precancerous diseases in the walls of the stomach (chronic gastritis, peptic ulcer, benign neoplastic formations);
Stimulation of the development of oncology against the background of precancer and exposure to carcinogens.
The first stage
For mutations to occur, a carcinogenic effect on the epithelium of the stomach is necessary.
External carcinogens (primarily food and drink), including:
Excessive regular consumption of table salt, nutritional supplements labeled “E”. For example, meat products and delicacies, in which sodium nitrate E251 is always (provided by technology) added to give the meat a red color, monosodium glutamate or E261 to improve the taste. Smoked, spicy, pickled, canned and fried foods, strong alcohol, tobacco smoking, drug use (aspirin, hormones) also contribute to stomach cancer;
Lack of ascorbic acid (vitamin C), which normalizes the level and quality of hydrochloric acid, reduces bleeding, thereby preventing the development of primary disorders in the walls of the stomach. The low level of vitamin E (tocopherol), which regulates the resistance of mucous membranes, beta-carotene and some macro and microelements, also has a detrimental effect.
Internal carcinogens (infectious, hereditary, immune factors), including:
Infectious – the negative impact of Helicobacter pylori, micrococci, strepto- and staphylococci, fungi of the genus Candida, Epstein-Barr virus. The participation of the latter as a cause of gastric cancer has been unconditionally proven by the detection of herpes markers in tumor cells of certain types of tumors;
Hereditary – it has been proven that the incidence of certain forms of cancer is 20% higher in people who inherit the A (II) blood group. Also confirmed is the hereditary transmission of a low level of a gene called E-cadherin, an epithelial protein that under normal conditions inhibits the growth of tumor cells;
Immune – a decrease in the resistance of the epithelium due to a lack of immunoglobulin (Ig) A in the wall of the mucous membranes. The influence of autoimmune processes on the formation of cancer has also been proven.
The second stage
Includes the development of diseases that precede cancer, including:
Chronic gastritis;
stomach ulcers;
Polyps of the walls of the stomach;
Resection of the stomach and other operations on the stomach;
Dysplasia and metaplasia of the walls of the stomach.
Diseases can develop without the participation of carcinogens, then the pathogenesis is limited to a benign course. In the case of their impact, the disease is transformed into a malignant one.
The third stage
Carcinogenesis is directly triggered by a combination of the above two factors and unknown additional causes. The underlying mechanisms of transformation of normal cells into malignant ones are not fully understood. However, it is known that in almost 100% of cases, gastric cancer is preceded by infection with H. Pylori, damage to the walls of the stomach and the unconditional participation of carcinogens.
Stages of stomach cancer
The designation of the primary tumor is T with the addition of numbers from 1 to 4 and small capital letters (a, b) to describe the details of carcinogenesis occurring in the primary tumor. The designation of the defeat of regional lymph nodes is N with the addition of numbers from 0 to 3 and small capital letters (a, b). To designate distant metastases, the Latin letter – M and the numbers – 0, 1 are used 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 ), a primary tumor of the first stage, grows into the mucous and submucosal layer, without damage to the lymph nodes and distant metastases;
stage 1B, option 1 (T1 N1 M0 ), the primary tumor grows into the mucous and submucosal layers, metastases in one to six regional lymph nodes, there are no distant metastases;
stage 1 B, option 2 (T2а/b N0 M0), the primary tumor has grown into the muscular and subserosal layers, no lesions of the lymph nodes and distant metastases are observed.
stage 2 stomach cancer
Stage 2 can be encrypted in three ways, namely:
(T1 N2 M0), the primary tumor grows into the mucous and submucosal layers, 7-15 regional lymph nodes are involved, there are no distant metastases;
(T2а/b N1 M0), a primary tumor in the muscular and subserosal layers, the involvement of 1-6 regional lymph nodes and the absence of distant metastases are diagnosed;
(T3 N0 M0), the primary tumor is located in the serous membrane and visceral wall without involvement of neighboring organs, lesions of regional lymph nodes and distant metastases are not observed.
stage 3 stomach cancer
Stage 3 can be encrypted in four ways, namely:
Stage IIIA, option 1 (T2а/b N2 M0), which means involvement in the pathogenesis of the muscular and subserous layer of the stomach wall, damage to 7-15 regional lymph nodes and the absence of distant metastases;
Stage IIIA, option 2 (T3 N1 M0 ), means damage to all layers of the serous membrane of the stomach without involving neighboring organs, damage to 1-6 regional lymph nodes and the absence of distant metastases;
Stage IIIA, option 3 (T4 N0 M0 ), the tumor has spread to neighboring organs in the absence of damage to regional lymph nodes and without distant metastases;
Stage IIIB, (T3 N2 M0), damage to all layers of the serous membrane, damage to 7-15 regional lymph nodes, absence of distant metastases;
stage 4 stomach cancer
Stage 4 can be encrypted in three main variants, namely:
(T4 N1, N2, N3, M0 ), spread of the tumor to neighboring organs, damage to regional lymph nodes (1-6) -N1, or (7-15) – N2, or (more than 15) – N3, absence of distant metastases;
(T1 T2 T3,N3 M0 ), damage to the mucous and submucosal layer – T1 or damage to the muscular and subserosal layer – T2 or the defeat of all layers of the serous membrane, the defeat of more than 15 regional lymph nodes, the absence of distant metastases;
(TAny, Nany, M1), a primary tumor of various growth variants, as well as any variants of damage to regional lymph nodes and the obligatory presence of distant metastases.
Inoperable gastric cancer with metastases
This is the stage of the disease at which it is impossible or inappropriate to apply 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 surgery in order 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 arranged in a mosaic pattern and affect vital parts of the body (large vessels, nerve nodes), cells spread by lymphogenous, contact or 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 reports, life expectancy after a course of combined treatment can be increased up to 20-24 months. At the same time, complications from exposure to ionizing radiation are much lower than the therapeutic effect, and the patient gets a chance to prolong life in the absence of pain. Unfortunately, it is impossible to guarantee more in the conditions of modern medicine.
The main metastasis pathways pass through the lymphatic system, so secondary neoplasms and the most significant metastases are found primarily in the lymph nodes.
Metastases of stomach cancer:
In pararectal tissue or in the space near the rectum – Schnitzler;
In the navel area – sisters Marie Joseph;
In the left supraclavicular region – Virchow;
In the region of the ovaries – Krukkenberg.
These secondary tumors are evidence of the 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.
Types of stomach cancer
Gastric cancer is divided according to the place of localization and methods of spread – it can be, for example, squeezing out the surrounding tissues or vice versa, infiltration into the surrounding tissues. Significant influence on the pathogenesis is exerted by histological forms of cancer: diffuse or polypoid.
Ring cell carcinoma of the stomach
It is diagnosed by cytological and histological examination. This is a type of diffuse cancer. the altered area consists of flat cricoid cells. The disease is characterized by an aggressive course.
Histochemical studies established the hormonal nature of this tumor. In the tissues of neoplasms in women, an increase in the level of estrogen is found, and in men – testosterone.
A distinctive feature of this type of disease:
The predominance of women in the structure of patients. The number of sick women – 55%, men – 45%. The ratio may vary, but the pattern has been confirmed by numerous studies;
Peaks of incidence in age intervals from 40 to 50 years and 60-70 years. In other intervals of life, such cancer is diagnosed significantly lower;
The structure of patients is dominated by people with blood group A (II) – about 45%, with other variants of blood groups is significantly lower.
The dependence of the onset of the disease on the presence of previous bad habits (alcohol, salty, smoked, pickled food) and exogenous factors (work with radiation, in chemical production) has not been established.
This type of stomach cancer is more often found in urban residents.
Infiltrative gastric cancer
Morphological form of carcinoma, without a clear definition of the boundaries of the neoplasm. 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 hereditary predisposition is noticeable;
Small foci of cancer cell growth are found at a distance of 5-7 cm from each other;
This is one of the most malignant forms of cancer, often gives metastases;
The pathogenesis of the clinical stage is accompanied by symptoms associated with dyspeptic symptoms (chronic vomiting, impaired peristalsis);
In the last stages, the tumor is defined as a dense stone-like formation, the stomach decreases in size.
Poorly differentiated stomach cancer
Normal epithelial cells are updated at a high rate, after about 3-4 days the generation is completely replaced. A high update rate is an important factor in the appearance of defects.
The high rate of reproduction of poorly differentiated cells underlies the aggressiveness of cancer pathogenesis. Poorly differentiated gastric cancer is a form of gastric adenocarcinoma composed of stem cells.
Features of the disease:
High growth rate, development of inflammatory and necrotic foci around the tumor;
The inability to determine the type of changes is the latent development of carcinogenesis in the thickness of the stomach wall;
The absence of clear boundaries of the tumor, growth occurs according to the type of diffuse impregnation of the walls of the stomach;
Rapid formation of metastases in regional lymph nodes and distant organs: metastasis reaches 90% of all cases of low-grade oncogenesis.
Diagnosis of gastric cancer
Of particular importance for the early detection of the disease is the alertness and attentiveness of the general practitioner. Diagnosis is carried out in stages and includes physical, instrumental and laboratory methods.
1. Physical methods
Diagnosis begins with a clinical examination, palpation and auscultation.
In the early stages of gastric cancer, it allows you to identify distant signs of the disease by the condition of the skin, color, humidity, temperature, pain, including in the abdomen.
On auscultation of the heart, chest pain is a common complaint of the patient. Stenosis and splashing noises that are not characteristic of pathologies of the cardiovascular system should be excluded. On palpation of the abdominal wall in the early stages of the disease, there are no changes, and in the later stages it is possible to detect seals under the skin in the epigastric region.
2. Instrumental methods
Contrast X-ray diagnostic methods, as well as endoscopy, are used.
X-ray diagnostics. It is an indirect method, it helps to quickly determine the presence of pathology by the nature of the x-ray shadow.
The radiologist takes into account the following changes in the negative image, where dense are light areas, and loose are dark areas:
Local change (thickening, folding) of the wall;
Defects of various sizes in the form of filled areas on the contour of the inner wall in polypoid forms of gastric cancer;
Seals, decreased elasticity of the stomach tissue;
Niches with a zone of infiltration and folding of the walls of the mucous membranes;
Deformations in the form of pushing sections of the walls around the tumor or impregnation of the tissues of the walls of the stomach;
Decreased peristalsis (not determined by all methods).
Modern methods of X-ray diagnostics allow indirectly, by the nature of blackouts, to identify up to 85% of changes in the walls of the stomach. A more valuable method for diagnosing gastric oncology is endoscopy.
Gastroendoscopy
The value increases when obtaining a biopsy from various parts of the stomach wall for histological and cytological examination. Color visualization of the organ walls helps to identify minimal deviations from the norm in terms of the color of the inner walls, the thickness of the folds, the presence of gastric peristalsis and foci of bleeding, and the shape of the wall defect (raised, undermined, deepened).
Modifications of gastroendoscopy:
Staining helps to identify areas of metaplasia and other early pathologies not visible to the naked eye;
Treatment with drugs that selectively accumulate in tumor cells under laser illumination helps to determine the altered area by fluorescence;
Endoscopy with nozzles for optical magnification helps to determine changes in the walls of the stomach at the cellular level;
Endoscopes with ultrasonic tips – a combination of ultrasound and imaging;
A relatively new method is the introduction of an unguided video capsule into the stomach, which in real time shows an overview of the non-targeted picture of the stomach wall.
Disadvantages of endoscopy:
Unpleasant sensations in the patient when swallowing a tube of a relatively large diameter. This is usually accompanied by a reflex gag reflex, which is prevented with the help of drugs (Deprivan, Cerucal);
Difficulty in differentiating between benign and malignant tumors.
Therefore, endoscopy is usually combined with electrocoagulation of neoplasms on the walls of the stomach.
Morphological method
Based on histological and cytological studies in the laboratory, the histological type of the tumor is determined with a high degree of certainty. General pattern: tumors located closer to the cardial part (entrance to the stomach) are more likely to have malignant properties.
3. Additional methods
Ultrasound diagnostics. It is carried out in three main variants:
Outside, through the abdominal wall;
Outside, after filling the stomach with a degassed liquid;
From the inside, using an endoscopic probe.
Laparoscopy is the second additional method for diagnosing stomach cancer. This technique is used to determine the operability of the tumor and the presence of metastases. A laboratory study of biological fluids is used to clarify the patient’s condition before surgery. In recent years, methods for determining oncological disease using oncomarkers have been used.
Differential diagnosis of stomach cancer
The above methods are used to differentiate cancer from less dangerous or cancer-precursor diseases, including:
Atrophic forms of gastritis;
peptic ulcer;
Various polyps;
Infectious diseases with similar symptoms (syphilis, stomach tuberculosis, amyloidosis);
Diseases of the lower esophagus (narrowing, achalasia – incomplete relaxation of the sphincter closer to the stomach).
Stomach Cancer Treatment
The choice of treatment tactics is determined by the stage of carcinogenesis and is discussed at a consultation with the participation of specialists from several medical specialties. The main treatment for early-stage tumors is surgical removal combined with adjuvant and non-adjuvant chemotherapy. Late stage treatments are palliative and symptomatic.
All patients are conditionally divided into three groups:
First – patients have early stages (patients with carcinoma in situ and the first stage);
The second – patients with an operable locally advanced stage (patients up to stage III correspond);
The third is patients with inoperable stage of generalized gastric cancer (patients of stage IV, who have severe concomitant symptoms or involvement of vital organs and systems in the oncological process, correspond).
Sometimes even patients with early forms of oncology are recognized as inoperable, for example, when a tumor affects vital parts of the body or it is impossible to perform an operation for other reasons.
The highest probability of complete recovery (up to 90% with a five-year survival rate) without significant consequences for the body in the first group of patients. The prognosis within the second group has a significant variation, due to the many nuances of this stage of the disease. A minimally favorable prognosis in patients of the last, third group. In this case, we should talk about prolonging and improving the quality of life of patients during the period of illness.
Removal (resection) of the stomach for cancer
Patients, with the exception of some categories, are shown laparoscopic diagnostics before surgery in order to exclude metastasis on the omentum and in the peritoneum.
Endoscopic resection
Depending on the stage of the disease, the clinical condition of the patient and the size of the tumor, an operation with a minimal opening of the abdominal wall can be prescribed – endoscopic resection. There are several options – the choice is up to the doctor.
Possible complications of endoscopic resection:
Postoperative pain – stopped by drugs or dosed radiation;
Perforation (complete, partial) of the walls of the stomach – is eliminated by physical methods of exposure;
Postoperative bleeding – stopped by physical methods and pharmaceuticals.
A simplified version of the intervention is cauterization of neoplasms by electrothermal or laser exposure to the walls of the stomach.
Abdominal surgery
It is carried out in the absence of absolute and relative contraindications. If it is impossible to perform resection, the issue of chemotherapy or radiation exposure of the tumor is decided in order to reduce carcinogenesis before further surgery.
With indications for surgery, preoperative preparation is carried out, which consists of a series of manipulations aimed at stabilizing the patient’s condition.
The planning of the operation algorithm includes the choice of:
Access to the tumor during the operation;
The volume of surgical intervention in the organ;
Tactics for removing packs of lymph nodes;
method of organ reconstruction.
An important stage of treatment is postoperative recovery, which includes the application of drainage tubes to drain exudate. Patients in the absence of complications are allowed to sit down on the first day, and walk on the second day after the operation.
Contraindications to abdominal surgery for stomach cancer are violations:
Hemodynamics in the form of instability of blood pressure and DIC;
Rhythm of breathing (respiratory arrhythmias).
Planned postoperative measures:
Postoperative pain relief, from the first days;
Stimulation of intestinal peristalsis, on the third day;
Enteral (through a tube and if necessary) nutrition with special mixtures, from the first days;
Antibiotic therapy in the form of a four- or six-day course;
The introduction of drugs that reduce blood viscosity (according to indications).
All manipulations are carried out under the supervision of a doctor. There are restrictions and contraindications. The need for additional therapeutic measures is determined individually. Removal of sutures – not earlier than 7 days after the intervention.
Chemotherapy for stomach cancer
Surgery is usually not enough to completely cure stomach cancer. The patient is observed for a long time in order to determine the clinical dynamics. During this period, chemotherapy is prescribed to eliminate hidden local foci of secondary carcinogenesis.
Chemotherapy has a general negative effect on the body. Its use is justified only if there is a real possibility of increasing the chances of recovery or at least improving the patient’s quality of life.
Adjuvant Chemotherapy: The term “adjuvant” means enhancement or addition. That is, this type is used after surgery, as opposed to non-adjuvant chemotherapy, which is used before surgery in order to reduce the size of the tumor before surgery. In recent years, attitudes towards adjuvant exposure have changed. Previously, this method of chemotherapy for stomach cancer was considered ineffective.
Such treatment is carried out in the form of polychemotherapy (exposure to several drugs) in two or three courses at different intervals. Pharmaceutical cytostatics are used in various combinations: Doxorubicin, Etoposide, Cisplatin, Fluorouracil, Mitomycin, Cisplatin and others.
palliative chemotherapy. Another type of therapy that is used when partial or total removal of the stomach and affected lymph nodes is not possible.
Complications after chemotherapy are inevitable. Cytostatics inhibit the growth of malignant cells.
But at the same time, side effects develop in the form of toxicosis, accompanied by:
Recoverable hair loss;
Toxic damage to the liver;
Violation of hematopoiesis;
Suppression of cooperation of humoral and cellular immunity.
Usually these phenomena are completely eliminated during rehabilitation treatment.
Juices for stomach cancer
The disease is accompanied by the loss of large volumes of fluid by the body after repeated vomiting and stomach bleeding. With cancer, patients complain of a decrease in appetite due to loss of taste and smell sensations, pain and other reasons.
Juices, especially with pulp, are almost always useful for patients, especially if there are no edema. The recommended fluid intake is up to 2 liters per day. In addition to juices, you can drink milk, dairy products, teas, compotes, fruit drinks.
It is advisable to use juices freshly squeezed, with pulp, from:
vegetables (carrots, beets, tomatoes, cabbage, celery, bell peppers, lettuce leaves);
fruits (apples, pears);
berries (currant, cherry, cranberry).
As a raw material for the preparation of juices, it is better to use local fruits that have a set of nutrients familiar to the patient.
Meaning of juices:
Acidic – increase acidity, since the walls of the stomach reduce the production of hydrochloric acid, as well as reduce the need for salt and increase the threshold of the gag reflex. Sweet and sour juices have the best tonic effect;
Sweet – they should saturate the body with vitamins, minerals, indigestible fiber, which is contained in the pulp and is necessary to improve peristalsis. Too sweet juices are best diluted with water;
Slightly bitter – for example, from cabbage, turnips or grapefruit to stimulate appetite and peristalsis.
After agreement with the attending physician, the amount of liquids, especially in the form of refreshing juices and fermented milk drinks:
increase during the course of taking chemotherapeutic agents, with dehydration, diarrhea and vomiting;
reduce with edema, accumulation of ascitic fluid in the pleural and abdominal cavity.
After a course of gastric cancer treatment with chemotherapy, some patients are shown to take up to 20-30 ml of table wine before meals instead of juice. A small amount of wine has a stimulating and tonic effect, improves immunity and soothes.
Liquid is necessary for a person to remove metabolic products from the body, improve tissue nutrition, improve well-being and increase immunity.
Diet for stomach cancer
Therapeutic dietary nutrition for stomach cancer performs the following tasks:
Prevents weight loss through a balanced diet;
Increases the tolerability of aggressive anticancer 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 regenerative activity of body tissues after partial or total resection of the stomach;
Improves the quality of life.
Principles of therapeutic nutrition for stomach cancer:
Cooking methods – boiling, baking, stewing;
The diet of patients – four to six times a day;
An 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.
Correction of nutrition, taking into account the stages of treatment – is carried out in order to reduce the side effects of anticancer therapy.
Three diet options for patients with stomach cancer are proposed, taking into account the characteristics of metabolism and body weight.
First option
– organization of nutrition of a patient with normal body weight in the absence of pronounced metabolic disorders:
Energy value – no more than 2400 kilocalories per day;
The total amount of protein – 90 grams, including animal – 45 grams;
The total amount of fats is 80 grams, including vegetable fats – 30 grams;
The total amount of carbohydrates is 330 grams.
The second option
– organization of nutrition of a patient with severe underweight, malnutrition, with visible metabolic disorders, as well as after surgery, chemotherapy or radiation therapy:
Energy value – no more than 3600 kilocalories per day;
The total amount of protein – 140 grams, including animal – 70 grams;
The total amount of fats is 120 grams, including vegetable fats – 40 grams;
The total amount of carbohydrates is 500 grams.
Third Embodiment
– for patients with a critical decrease in body weight and a laboratory-confirmed violation of the excretory function of the kidneys and liver:
Energy value – no more than 2650 kilocalories per day;
The total amount of protein – 60 grams, including animal – 30 grams;
The total amount of fats is 90 grams, including vegetable fats – 30 grams;
The total amount of carbohydrates is 400 grams.
Prevention of stomach cancer
They carry out work that includes general activities: increasing the level of medical knowledge of the population, informing about the causes of stomach cancer.
General events
Dialogue with the public:
Explaining the dangers of cancer and increasing people’s alertness;
Description of the algorithm of actions in case of detection of the first signs of stomach cancer;
Promoting a healthy lifestyle.
Medical events
Work in this direction is carried out in risk groups. It consists of measures for the prevention and treatment of precancerous diseases.
The risk group includes people with a history of:
genetic predisposition;
Carriage of H. Pylori;
Resection of the stomach;
Long period of work in hazardous and chemical industries;
Chronic insufficiency of the 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.