Stomach cancer treatment
Gastric cancer is a common malignant disease developing inside the stomach walls. Helicobacter pylori, gastritis, alcohol consumption, smoking and age are among the factors that cause the disease. However, there are effective treatment options: surgery, chemotherapy, local chemotherapy, radiotherapy, immunotherapy, and target and proton therapy.
Stomach (also called gastric) cancer refers to tumours originating in the stomach lining. This process can occur and spread to any part of the organ. But most often, cancer affects the central and the largest portion - the stomach body.
There are several types of gastric cancer, depending on which cells are affected:
- Adenocarcinoma - is the most common form (95% of all cases). It develops from the secretory cells of the stomach;
- Gastrointestinal stromal tumours (GISTs) - a rare type of gastric cancer from interstitial cells;
- Neuroendocrine tumours - a malignant process of cells that perform nerve and endocrine functions in the stomach;
- A lymphoma - is a rare form which progresses from cells of the gastric immune system.
Malignant tumour in the stomach is a common condition and ranks fifth in the world among all malignancies. The mean age at onset is around 72 for men and 75 for women. Men are affected slightly more often. More than 800,000 new stomach cancer cases are registered annually worldwide. The highest incidence rate in Japan is 90 people per hundred thousand yearly.
On the other hand, the lowest incidence rate is noted in the USA. Only 5-6 people per hundred thousand people get sick a year. In Europe, the incidence among men is 11-12 per hundred thousand per year and 6-7 per 100 thousand among women.
Best hospitals for Stomach cancer Worldwide
University Hospital Rechts der Isar Munich
Department of internal medicine (gastroenterology, endocrinology, diabetology, infectiology, hepatology)
Department of haematology and oncology
Department of general, abdominal, thoracic, oncosurgery and endocrine surgery
Anadolu Medical Centre
University Hospital Ludwig-Maximilians Munich
Department of general, abdominal and transplant surgery
Department of gastroenterology and hepatology
Department of oncology
University Hospital Charite Berlin
University Hospital Frankfurt am Main of Goethe-University
Department of internal medicine (gastroenterology, hepatology, endocrinology, diabetology, nutritional medicine)
Department of haematology oncology
Department of general, visceral, transplant and thoracic surgery
Best doctors for Stomach cancer Worldwide
Reasons for stomach malignancy
There is an association between damage to the genetic material of gastric tissue (DNA) and the development of stomach cancer. DNA is responsible for adequate cell growth. Therefore, gastric cells grow uncontrollably and form a tumour due to their damage.
Scientists cannot name the exact cause of DNA damage. But there are some risk factors leading to cancer:
- Features of nutrition (excessive use of salt, spices, pickled, fried, spicy food, consumption of such products as bacon, sausages, ham, and canned products);
- The presence of Helicobacter pylori infection;
- Presence of stomach cancer in close relatives;
- Operations, resection (removal of a part) of the stomach increases the risk of cancer by 1.5-3 times;
- It more commonly affects people of Asian and African descent;
- The presence of polyps on the mucous membrane of the stomach;
- Cigarette smoke contains many chemical compounds that cause cancer. One such substance is benzene. It is a toxic and carcinogenic substance, one of the reasons for the appearance and reproduction of cancer cells;
- Occupational hazards: coal mining, metal processing, rubber production.
Warning signs of gastric neoplasm
In its early stages, the disease causes few or no symptoms. The disease is often only discovered when the tumour has already progressed. If there are symptoms, they are often very unspecific and do not necessarily suggest stomach malignancy. Patients feel discomfort in the abdomen area and do not suspect the presence of severe pathology.
The most common signs include:
- Difficult swallowing;
- Frequent vomiting;
- Loss of appetite;
- Unclear weight loss;
- Blood in stool, black-coloured stool;
- Unclear anaemia.
Specific symptoms appear in the late stages (difficulty swallowing, vomiting, dark-coloured stools) when metastases form in nearby organs (oesophagus, pancreas, spleen), and the treatment prognosis is disappointing.
Symptoms of stomach malignancy in men and women appear the same. Children may be moody and tearful, aloof and withdrawn. Frequent fever can be an early sign in children. As a result of the malignant process, a white, grey or yellow coating may form on the tongue, and white spots and bumps may appear.
How is gastric cancer diagnosed?
To diagnose a stomach disease, however, it is usually necessary to look inside the organ. In endoscopic ultrasound (endosonography), an ultrasound head is inserted into the stomach. With this examination, it is possible to determine precisely how far the tumour has already penetrated the stomach wall.
Tumour markers can point to oncology in the early stages. These are proteins that are formed by cancer cells. Stomach carcinomas also occasionally produce such substances in the blood. So, doctors can easily detect them during regular check-ups.
Tumours that have grown through the entire stomach wall can spread directly through the peritoneum to the whole abdomen. Therefore, an endoscopic examination of the abdominal cavity (laparoscopy) may also be necessary to confirm cancer spread.
Positron emission tomography (PET-CT scan) is a technique that can be used to visualize tumours and search for metastases. This technique detects small cancer spreading in the liver, lungs or lymph nodes distant from the primary tumour. MRI scan clarifies suspicious findings in the stomach that are revealed by ultrasound or CT scan.
A gastroscopy is a golden standard for any stomach tumours. Doctors check the stomach from the inside with a special probe and a camera at the end. If there are noticeable changes in the gastric mucosa at one point, tissue samples can be taken (biopsy). They are later examined under the microscope for cancer cells.
The stages of gastric cancer:
- Stage I refers to a tumour limited to the uppermost layer of the gastric mucosa and has not grown into the deeper layers.
- In stage II, the tumour has developed further into the gastric mucosa, but there's an absence of metastases.
- Stage III is characterized by cancer growing deeper into the underlying tissue and muscle layers or even beyond the stomach wall into the surrounding tissue.
- Stage IV is classified as having distant metastases, regardless of tumour size or the number of lymph nodes involved.
Many patients are referred to specialized oncological centres with a basic diagnosis. However, modern cancer treatment requires a complete examination before treatment starts. Therefore, the staging process in oncology is essential for better treatment outcomes.
The treatment range for stomach cancer
The first and the most crucial procedure to treat gastric cancer is surgery. The operation aims to remove the tumour and thus permanently cure the disease. The process can be endoscopic (resection without incision) and open (with incision of the abdominal wall). Surgical treatment can also be a partial or total (complete) gastrectomy. Whether the surgeons can save part of the stomach or remove the entire stomach depends on the tumour's location, how it is growing, and its size.
If surgical treatment is not a solution to particular cancer, systemic treatment can be indicated. For example, chemotherapy can kill cancer cells - even those that have broken away from the original tumour and spread throughout the body. Usually, chemotherapy is an additional option to surgical treatment to improve the chances of recovery. In addition, many patients might have chemotherpay courses before the surgery, so-called neoadjuvant chemotherapy.
Oncology treatment can include antibodies (called immune checkpoint inhibitors ) that can remove the blockage of the immune system by malignant cells. Immunotherapy enables the body's defence cells to attack and destroy tumour cells again. In addition, some patients can be candidates for target therapy - modern anti-cancer drugs aim at cancerous cells and tissues. That means only the tumour is damaged, and healthy surrounding tissues are safe.
Modern stomach cancer treatment includes many local (targeted options) to focus on the tumour itself without any effect on the whole body. For example, transarterial chemoembolization is a combination of chemotherapy and closure of tumour vessels. Chemo drugs are carried out through the arteries directly on the malignant neoplasm. That makes it possible to have a treatment with a high dose of medication. The modification of embolization is transarterial chemoperfusion. It is a cancer therapy characterized by the local introduction of chemo drugs into arteries supplying the tumour. In this way, the medications are directed through the formation and therefore have less impact on the body.
Radiation therapy (radiotherapy) is sometimes used for stomach cancer when a patient cannot have surgery or the tumour is not responding to chemotherapy. In addition, radiation has proven effective in the case of bone metastases, which can cause pain and, under certain circumstances, bone fractures. One of the modern radiotherapy options is proton beams. It uses high-powered energy on the tumour. Proton therapy is safer than using conventional radiotherapy for stomach cancer treatment.
The leading cancer clinics provide:
- Comprehensive treatment for gastric cancer;
- Combining laparoscopic surgery with chemoradiotherapy;
- Immunotherapy and targeted therapy;
- Locally advanced targeted treatment.
It's important to note that treatment strategy is made considering molecular and genetic features of cancerous cells. This approach allows oncologists to achieve the maximum effect in treating stomach cancer.
What if the gastric cancer prognosis?
The survival rate in individual cases depends on the stage of cancer. In the early stages, when the tumour is still limited to the mucous, the chances of recovery are very high. However, if the tumour cannot be removed entirely due to its size or has already metastasized, the chances of survival decrease significantly.
90 - 95% of patients with stage I gastric cancer live five years after diagnosis. If it is stage II, the five-year survival rate drops to 70%. In tumour stage III, the five-year survival rate is still 30%, and in stage IV - only 5%. The survival rate for stomach cancer is highest if the pathology is detected in the early stages, so it is necessary to visit a doctor as soon as possible.
FAQ
What are the first signs of stomach cancer?
In the first stage, the tumour develops in the muscle layer and penetrates into one or two nearby lymph nodes. Symptoms of stage I include discomfort after eating, loss of appetite, and weakness. In the second stage, malignant cells penetrate the outer layer of the stomach wall and affect the adjacent lymph nodes causing heartburn, nausea and flatulence.
Is stomach cancer a curable disease?
The answer depends on the stage of cancer. The chances of recovery from stomach cancer are good if the doctor detects the tumour early. But even if the disease is already far advanced and there is no longer any hope of healing, medicine offers a wide range of options for tumour control.
Is stomach malignancy fast-growing?
Gastric cancer is a slow-growing disease that usually develops over a year or even longer. It can take 10-15 years, from the time of formation of a tumour to the appearance of the first symptoms. The disease may progress to stage three or four when cancer symptoms appear. It is crucial to detect stomach cancer early, so a gastroenterologist should regularly examine people in the risk group.
Terminal stomach cancer what to expect?
In some cases, stomach cancer has progressed so far that a cure is no longer possible (end-stage gastric cancer). At this stage, treatment aims to relieve the symptoms. Chemotherapy or radiation therapy is used if the general condition is sufficiently good. However, many people suffer from severe pain in the advanced stage of gastric cancer. Painkillers then help to improve the quality of life significantly.
Is stomach cancer common?
Although the frequency of gastric cancer has decreased in recent years, it is still a common disease. A malignant tumour in the stomach is the 5th most common and one of the leading causes of death from oncology. In addition, men are affected almost twice as often as women.
Where can I get Stomach cancer treatment?
What are the best clinics for Stomach cancer treatment?
Who are the best doctors for Stomach cancer?
Prof. Dr. med. Roland M. Schmid from University Hospital Rechts der Isar Munich
Prof. Dr. med. Florian Bassermann from University Hospital Rechts der Isar Munich
Prof. Dr. med. Helmut Friess from University Hospital Rechts der Isar Munich
Prof. Dr. med. Jens Werner from University Hospital Ludwig-Maximilians Munich
Prof. Dr. med. Julia Mayerle from University Hospital Ludwig-Maximilians Munich