Stomach Cancer. Gastric Cancer

Over the past 60 years have been truly amazing, and obtained encouraging results in reducing the incidence of gastric cancer in Western countries, and this trend continues. In the U.S., for example, for the period from 50's to the 80-ies mortality from cancer of this localization decreased by 59% among men and by 65% among women. Nevertheless, he still ranks sixth on the frequency of cancer among both men and women, with a 2-fold more common in men and is more common among the elderly.
Causes

There is some evidence that the main causes of stomach cancer associated with the environment. This assumption is clearly confirmed by the results of studies on migrants: the population had moved from his native country in some other, over the life of one generation are roughly equally at risk of stomach cancer, as well as the indigenous population of the host country. Reducing the incidence of stomach cancer for nearly all of our century can apparently be attributed to the high incidence of refrigerators for storing food. In those parts of the world, which still adhere to traditional methods of storing food, stomach cancer is much higher and reaches maximum values in Japan (78 cases per 100,000 population, compared with 10 per 100000 in the U.S.) in Eastern Europe and South America it is also very high.

The diet should include plenty of fresh fruits and vegetables and rich in fiber, may well have a protective effect and reduce the risk of stomach cancer. Smoked, marinated and pickled products, which are believed to be linked to its origin, it is likely to consume in moderation.

It is likely some connection between the levels of nitrates in drinking water and stomach cancer, but its development is obviously in no way connected with the consumption of alcohol.

People with a condition known as pernicious anemia, in which the thinner mucosa of the stomach and reduces acid output, as well as an insufficiency of vitamin B12, subject is known to be at increased risk of developing the disease. However, data proving the existence of a connection between him and a gastric ulcer, no.
Manifestations

The most common symptom of stomach cancer is a disorder of the digestive system. Other symptoms include discomfort or feeling of heaviness in the upper abdomen after eating, with possible nausea and vomiting: loss of appetite, weight loss, and sometimes blood in the vomit or stool. Many of these symptoms are similar to those observed in more light and very common conditions, such as indigestion, and even more severe symptoms associated with benign gastric ulcer.

Ambiguous and non-specific nature of these symptoms indicates that early diagnosis is difficult to place. Just as in cancer, gastric cancer is likely to be cured, if detected at an early stage. Unfortunately, however, the tumor may develop in the stomach for some time before you get to these or other symptoms, and people with these symptoms the general practitioner may first appoint a treatment for indigestion or stomach ulcers, thereby delaying further research. This means that in many cases of cancer diagnosed this localization already at an advanced stage, when the probability of cure is low.

In Japan, where stomach cancer is common, anyone with even the most mild symptoms immediately sent for medical examination, so in most cases of gastric cancer can identify at an early stage and long-term survival rates are much higher than in Western countries. Studies in these countries, studies have shown that through the surveys in the event of the first signs of digestive disorders can identify a large number of cases of gastric cancer. However, there is a serious problem: dyspepsia and peptic ulcer are still the most common causes of these symptoms, and therefore difficult to determine what further research is needed in the digestive disorder. However, anyone over the age of 45 years, who is a disorder of an ongoing nature, of course, should consult a doctor and be screened to prevent ulcers and verify the absence of stomach cancer.
Research

The first step is probably a study with barium suspension that constitutes a form of X-ray examination. For this patient suggest to drink a liquid containing barium, which becomes visible under X-rays. Filling the stomach, barium outlines its contours, and as a result of the stomach is readily apparent on the screen of X-ray machine. This couch, which has a patient, you can slightly raise a few places to barium has penetrated into all parts of the stomach. On the screen you can see all the anomalies of the stomach and almost always determine what education looks benign, but some are suspicious.

The only way to make an exact diagnosis is to study a certain amount of tissue under a microscope, so a more thorough examination of any suspicious areas should be made gastroscopy. This procedure involves the introduction of a long flexible tube through the pharynx and esophagus into the stomach. Through the tube the doctor can examine its interior space. Thus it is possible to take pictures and take samples of cells (biopsy) for histological examination.

Before performing this procedure, the patient is usually given a sedative, and the back of the throat is treated with an aerosol anesthetic to avoid the discomfort and vomiting during the introduction of the tube.

If you can definitely talk about cancer, is usually performed CT scan to determine whether the affected local lymph glands and liver, and the surgeon could determine whether operable tumor. Another way to study the stomach, liver and lymph glands is an ultrasound scan, which can take the place of CT scanning, to obtain similar information by a surgeon.

Treatment

Surgery
Surgery is the most common and effective way to cure stomach cancer. Usually you can remove only a portion of the stomach (partial gastrectomy). As a rule, simultaneously removed and local lymph nodes. If a partial gastrectomy can not produce a complete gastrectomy, ie remove the entire stomach with the lower part of the esophagus and the spleen. In this case, the esophagus connects directly to the small intestine.

If the patient is removed the entire stomach or part of it, after healing scars they usually recommend eating several times a day, small portions and often because they have a sense of saturation occurs very rapidly. For this reason, it is probably better to take a drink separately from other foods. Most people need some time, so that by trial and error to find them suitable for power supply circuit and suitable food. However, it is very important to maintain adequate diet, because many patients with gastric cancer strongly lose weight, but for recovery, they need to restore body weight to normal levels. They may be required, at least initially, to introduce additional foods into the diet drinks, which can be obtained by prescription or purchased at a pharmacy. Prior to discharge the hospital nutritionist to give them advice on diet.

In persons who underwent gastrectomy, is likely to experience lack of the chemical, known as intrinsic factor, produced in the stomach and of great importance for the absorption of vitamin B12. Therefore, such patients usually every three months injected this vitamin to prevent its failure.

Chemotherapy
Even if the tumor and local lymph glands are removed surgically, there is some likelihood of spread of cancer cells and the formation of metastases, which are too small to see them on the scanning image, but can cause a relapse of cancer in the future. The risk increases if the affected lymph nodes themselves. Conducted in Japanese studies showed that chemotherapy to prevent recurrence of cancer in the presence of its high-risk (adjuvant chemotherapy) leads to increased rates of survival. However, in studies conducted in Western countries, this increase was not recorded, so adjuvant chemotherapy is currently still at an experimental stage.

Also conducted pilot studies whose aim - to establish whether you can reduce the size of the tumor by chemotherapy before surgery, facilitating, thus, its removal during the operation. Individuals with advanced disease, which has resulted in the germination of cancer cells to other parts of the body, can be subjected to chemotherapy to reduce the cancer lesion and curb its growth for some time, although recovery in this case is not yet possible.

Most chemotherapy regimens involves the use of 5-fluorouracil (5-FU), sometimes in combination with other drugs such as cisplatin and adriamycin. Side effects may include nausea and vomiting (which can be successfully controlled with the help of a new generation antiemetic drugs), diarrhea, stomatitis and hair loss (using adriamycin).

Radiotherapy
Radiotherapy of gastric cancer are not widely used, because due to irradiation may be damaged other organs adjacent to the stomach. If the disease is at an advanced stage and is accompanied by agonizing or painful symptoms, radiotherapy can give a very good effect in terms of their relief.
Forecast

If gastric cancer is diagnosed at an early stage, the prospects for cure by surgery is fairly good (50%). However, about 80-90% of cases of gastric cancer identified only at advanced stages, when the pathological process involved lymph glands and other organs, and in such cases, the survival rate is more than 5 years are below.

Thus, although the actual number of patients with gastric cancer has declined and is declining, it is an obvious need of research in three areas: improvement of diagnosis of the disease, improving the efficiency of adjuvant chemotherapy and further improvement of methods of containment of the disease and prolong life.
Rare tumors of the stomach

Leyomiosarkomy
Leyomiosarkomy represent smooth muscle tumors of the stomach and vary widely in the degree of proliferation of cancer cells. They account for less than 1% of all cases of stomach cancer. In most cases, treatment is surgical methods and provides for the removal of the tumor. Also resorted to chemotherapy, but its role is still the subject of experimental studies.

Non-Hodgkin's lymphoma
These tumors are characterized by similar reactions to treatment. The share of gastric lymphoma accounts for less than 1% of all cancers of the localization.

First-line treatment usually involves surgical removal of the stomach with subsequent chemotherapy. A rare subtype of these tumors, known as associated with the mucous membrane of T-cell lymphoma (Astle), at an early stage in some cases is treatable with antibiotics, used in the presence of infection with the bacterium Helicobacter.