The stomach is an odd hollow organ with thick muscular walls that takes part in digestion process. Stomach performs several functions at once: storage, secretory, digestive, motor, protective, incretory. Stomach malignant lesions are fairly common oncological diseases that occur mainly in adults. This is a whole group of malignant tumors that can affect mucous membrane or other layers of stomach walls.
Unfortunately, diagnosis of stomach cancer is often late, as the disease has no specific symptoms and is disguised as a common disease of gastrointestinal tract. In the early stages, disease is detected, as a rule, during preventive examinations of risk groups or accidentally in diagnosis process for another reason.
Stomach cancer is a serious disease with a serious prognosis, but with timely detection and a competent treatment approach, it is completely curable. The main thing is to find a qualified specialist with experience in application of modern treatment methods of this pathology. Such doctors work in the Oncology Department of Maimonides Multidisciplinary Medical Center. Our clinic closely cooperates with the best Israeli oncology centers. We took Israeli medicine as a model for providing medical services to patients, because it was one of the most effective in the world. All clinical cases are conducted jointly by the attending oncologist, the head of the department – Dr. Iryna Stefanska and responsible experienced oncologist directly from Israel. Thus, without going abroad, patient gets access to modern Israeli medicine advantages.
Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation, so all our patients can receive financial assistance for treatment, because the fight against a malignant tumor is a rather expensive process and not everyone who needs it can afford modern treatment.
Also, an important treatment advantage in our medical center is a participation of a whole multidisciplinary teamin treatment and diagnostic process. Patient is assisted not only by an oncologist, but also by a large number of other narrow specialists – gastroenterologists, general surgeons, radiation therapists, chemotherapists, rehabilitation specialists, psychologists and other doctors as necessary. In their daily practice, they are guided by modern clinical recommendations and global treatment protocols, so patients can be sure of medical services quality and their compliance with international standards.
At the same time, approach to each patient is purely individual. Attending oncologist does not use one examination template or one treatment scheme for everyone, so diagnosis and treatment plan is selected for each individual, taking into account age, sex, main diagnosis, type of tumor, its size and distribution,disease stage, concomitant serious pathologies presence, and patient’s wishes.
The department is equipped with modern medical and diagnostic equipment of an expert class. All doctors have professional psychological skills in communicating with oncology patients. If a certain narrow specialist or rare medical and diagnostic equipment is not available, patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services, where he is guaranteed to receive the full range of necessary medical services.
Stomach cancer causes and symptoms
About 900,000 new cases of stomach cancer are diagnosedannually in the world. It ranks fourth among all malignant neoplasms in adult population. Unfortunately, this cancer type, despite of modern oncology achievements, has a high mortality rate, is on the 2nd place in oncological mortality structure and is the second only to lung cancer.
Among those who fell ill, men predominate. Among development reasons of stomach cancer, infection with H. pylori bacteriahas proven to be an important place today. Chronic stomach diseases, which are accompanied by either increased acidity or, conversely, reduced acidity in stomach cavity (hyperacidic and atrophic gastritis) also contribute to cancer.
Another infectious agent that is associated with an increased incidence of stomach cancer is the Epstein-Barr virus. There is also a hereditary predisposition to development of this disease. If this pathology is present in cases of family history, a mutant gene E-cadherin (CDH-1)will find. It is associated with an increased risk of malignant stomach tumors development.
Among other negative risk factors that contribute to stomach cancer development, the negative effect of nitrates and nitrites on mucous membrane is highlighted. We consume them mainly with vegetables. These harmful compounds are also found in many alcoholic beverages, dried and smoked products, so their regular use is a significant risk factor for stomach cancer.
The initial manifestations of stomach cancer are nonspecific. As a rule, they have symptoms of dyspepsia, which gives reason to suspect an ulcer. Both patients and doctors often ignore symptoms or treat acid-dependent disease without a detailed examination. Later, if the cancer disrupts patency of stomach terminal part or stomach capacity decreases, a feeling of early satiety (fullness after taking a small amount of food) is added. Dysphagia (swallowing disorder) appears with cancer in the area of cardia, when it becomes difficult to get food from esophagus.
Weight loss, loss is often observedare often observed. This usually occurs as a result of restricting food intake due to fear of the symptoms described above returning. Massive bleeding during vomiting and melena appear quite rarely. Anemia development due to hidden blood loss is typical. In some cases, the first symptoms are associated with metastatic process (in particular, jaundice, ascites, pathological bone fractures).
Types of stomach malignant tumors
Stomach malignant tumors are not homogeneous in their histological structure and origin. The following types of stomach cancer are most often encountered:
- Diffuse-infiltrative gastric cancer is a malignant tumor that grows endophytically (not in cavity, but spreads along the walls of stomach and into neighboring organs and tissues). The source of growth are mucous membrane cells, infiltration of submucosal layer of organ, neighboring organs and tissues occurs, and distant metastases develop quickly.
- Glandular squamous cell carcinoma of stomach is a malignant tumor that combines features of squamous cell carcinoma and adenocarcinoma. The disease is aggressive, characterized by early metastasis.
- Gastric carcinoma with ulceration is a malignant tumor consisting of epithelial cells and looks very much like an ulcer. The disease has a very aggressive course, it metastasizes early.
- Carcinosarcoma of stomach is a malignant tumor, it is rare, it mainly affects elderly men.
- Undifferentiated gastric cancer is a malignant tumor consisting of a variety of tumor cells that cannot be classified as a single type.
- Neuroendocrine tumors are a whole group of lesions that occur quite rarely (less than 2% of all stomach tumors). Such tumors development is slow, clinical picture is very diverse, depending on tumor type.
- Low-differentiated adenocarcinoma of stomach is a very aggressive malignant tumor that develops from mucosa glandular cells.
- Ring cell carcinoma is a fairly common form of gastric malignancy. The tumor is very aggressive, grows quickly, metastasizes early, and is difficult to diagnose in the early stages.
- Papillary adenocarcinoma of stomach is a malignant tumor originating from glandular epithelial cells of the stomach.
- Squamous cell cancer of stomach is a rare form of malignant lesion, originating from epithelium cells lining the mucous membrane of stomach, localized mainly in cardiac part of the organ.
- Polypoid gastric cancer is a malignant tumor that has an exophytic growth type (grows into stomach cavity), has a clear base and is limited from surrounding healthy tissues.
- Tubular adenocarcinoma of stomach is a malignant, aggressive tumor that grows from the glandular cells of mucous membrane.
- Choriocarcinoma is a rare malignant tumor of epithelial cells, mostly women are affected. The tumor is prone to early metastasis.
- Gastric carcinoma with partial ulceration is epithelial cells malignant tumor that resembles an ulcer in appearance. The tumor grows rapidly and invades neighboring tissues.
Diagnosing methods of stomach cancer
Timely and accurate diagnosis is the key to successful stomach cancer treatment. At Maimonides Clinic, we use only modern and accurate diagnostic equipment, our doctors have an impeccable command of all examination methods and interpret received data without error. Diagnostic program sets two aims for the doctor – to confirm (or to refute) cancer diagnosis and establish the stage of the disease.
Any examination process begins with a visit to a doctor and consultation. Specialist will ask about all the complaints, determine among them those specific for stomach cancer, then collect medical and life history, single out factors that could have caused malignant tumor development, carefully examine patient in all organs and systems. Based on received data, doctor will make up a further plan for a more detailed diagnosis.
If gastric cancer is suspected, endoscopy (esophagogastroscopy) with multiple biopsy and scraping with a special brush for cytological examination should be performed. In some cases, a biopsy limited to mucous membrane boundaries does not allow to recognize the tumor in its submucosal location.
We send all the materials after the biopsy to pathohistological laboratories of the best oncology centers in the world (Israel, USA, Germany). Thanks to such double checks, we are absolutely sure of diagnosis correctness and subsequent adequate selection of treatment tactics.
Our patients also have access to innovative molecular diagnostics of biopsy specimens (molecular genetic studies). This is a mandatory part of modern oncological diseases diagnosis. As is known, the direct cause of many tumors is a mutation in a certain gene. Thanks to molecular genetic diagnostics, we can find these mutations and choose the most effective treatment regimens, because the response to certain drug effect depends on the type of changes. An example of such modern diagnostics are test systems for molecular genetic testing. Among them are the Foundation One and Caris Molecular Testing
Stomach X-ray examination, especially in double-contrast mode, is informative in tumors diagnosis, but, as a rule, there is a need for a subsequent endoscopy to confirm diagnosis and take a biopsy.
When stomach cancer diagnosis is established, MRI, CT of chest and abdominal cavity are indicated to determine the process prevalence. If during the follow-up examinations metastases are not detected, an Ultrasound involvement. Detected changes determine the treatment scheme and disease prognosis.
Also, in order to detect metastatic lesions of distant organs and tissues, scanning of the whole body can be performed using PET-CT or PET-MRI techniques, bone scintigraphy.
In order to assess patient’s general condition, anemia presence, water and electrolyte balance violations, and possible signs of metastatic liver damage, basic blood tests should be performed, including a complete blood count, electrolytes level assessment, and liver tests. Before and after surgical treatment should be assessed carcinoembryonic antigen level (CAE) in blood and stomach tumors marker.
In high-risk populations (such as Japan), routine endoscopic screening is performed for early detection of the disease.
To detect recurrence after treatment endoscopy and CT scan of chest, abdomen, and pelvis are performed. If initially elevated level of CAE decreased after tumor removal, this indicator dynamics should be evaluated during observation process – an increase indicates a relapse.
Based on obtained data during examination, doctor makes an accurate diagnosis indicating the stage of malignant process and formulates a treatment scheme, according to patient’s individual characteristics and modern clinical recommendations. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Stomach cancer modern treatment
The indisputable treatment advantage Maimonides Medical Center is a comprehensive approach application to each case of malignant stomach tumor. A whole multidisciplinary team works to give all necessary help for patient, all decisions are made in consultation, treatment scheme includes a combination of basic treatment methods (surgical removal, radiation therapy and chemotherapy), as well as innovative or even experimental methods (targeted therapy, treatment with immunobiological agents, etc.).
Treatment tactics choice for stomach cancer depends on tumor stage and patient’s wishes (many people prefer more active treatment).
Radical treatment necessarily includes tumor surgical removal – stomach subtotal resection or gastroectomy with regional lymph nodes removal. This tactic is justified in case when signs of tumor spread beyond the stomach are absent. While metastases presence in regional lymph nodes is permissible (<50% of patients belong to this category).
Adjuvant chemotherapy or a combination of chemotherapy and radiotherapyafter surgery improves treatment results (if the tumor is operable).
In metastases presence or multiple lesions of regional lymph nodes , radical surgeries are not indicated, and, as a rule, palliative interventions are performed. The true extent of tumor spread is difficult to assess before radical intervention is attempted. Palliative operations, as a rule, consist of gastrointestinal anastomosis application in case of stomach terminal part patency violation. Intervention is carried out only when it is expected to improve the patient's quality of life. All our surgeons master the techniques of both radical and palliative interventions for stomach cancer.
In patients not treated with surgery, combination chemotherapy (5-fluorouracil, capecitabine, doxorubicin, mitomycin, cisplatin, oxaliplatin, irinotecan, paclitaxel, docetaxel, or leucovorin in various combinations) may lead to improvement condition and survival.
The effectiveness of radiation therapy is limited, as stomach tumors are not sensitive to ionizing radiation action. It can only be used in combination with chemotherapy before or after surgery to improve the prognosis. At our disposal we have only modern and safe equipment for radiation therapy courses – linear accelerators of the latest generation. Such devices allow us to act in a targeted manner (only in the affected area), while the negative impact on surrounding healthy tissues is minimal. Modern devices make it possible to very clearly program radiation dose, received by the patient, to simulate radiation therapy regimen, which makes it possible to avoid the most common side effects of this treatment method.
In recent years, modern oncology has been actively using targeted therapy in complex treatment (especially in late stages of cancer). The following drugs are most often used: trastuzumab (for tumors that express human epidermal growth factor receptor 2 - HER2+ tumors) and ramucirumab (an inhibitor of vascular endothelial growth factor [VEGF]).
Immunotherapy, particularly with pembrolizumab, is approved for use in patients with programmed cell death ligand 1 (PD-L1)-positive advanced or metastatic gastric cancer. Programmed cell death receptor 1 inhibitors (for instans, nivolumab) are approved to use in patients with advanced gastric cancer.
Thus, for each patient, a decision about a combination of certain stomach cancer treatment methods (which methods to start with, what to add next, at what stage of treatment to perform surgery, when and according to which scheme to apply chemotherapy, or to use targeted drugs or other immunobiological drugs) is accepted consularly by a multidisciplinary team of specialists . Each person and their disease is different, so our specialists, relying on their rich experience in oncological pathologies treatment, often depart from standard protocols, changing the treatment regimen and doses of necessary drugs in order to obtain the best possible results for their patients.