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Gastric Cancer Treatment in India

Gastric Cancer

Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Stomach cancer, also called gastric cancer, is a cancer that starts in the stomach, the disease usually grows slowly over many years. Men are more likely to suffer from stomach cancer as compared to women. This cancer has also been seen in older people who are above 55 years of age.

Types of stomach cancers

Different types of stomach cancer include:

Adenocarcinoma

About 90% to 95% of cancers of the stomach are adenocarcinomas. When the term stomach cancer or gastric cancer is used, it almost always refers to an adenocarcinoma. These cancers develop from the cells that form the innermost lining of the stomach (known as the mucosa).

Lymphoma

These are cancers of the immune system tissue that are sometimes found in the wall of the stomach. About 4% of stomach cancers are lymphomas. The treatment and outlook depend on the type of lymphoma.

Gastrointestinal stromal tumor (GIST)

These are rare tumors that start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal. Some of these tumors are non-cancerous (benign); others are cancerous. Although GISTs can be found anywhere in the digestive tract, most are found in the stomach.

Carcinoid tumor

These are tumors that start in hormone-making cells of the stomach. Most of these tumors do not spread to other organs. About 3% of stomach cancers are carcinoid tumors.

Other cancers

Other types of cancer, such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, can also start in the stomach, but these cancers are very rare.

Causes of stomach cancer

  • Smoking
  • Being overweight or obese
  • A diet high in smoked, pickled, or salty foods
  • Stomach surgery for an ulcer
  • Type-A blood
  • Epstein-Barr virus infection
  • Certain genes
  • Working in coal, metal, timber, or rubber industries
  • Exposure to asbestos

Symptoms

Early on, stomach cancer may cause:

As stomach tumors grow, you may have more serious symptoms, such as:

Stages of Stomach Cancer

Stage 0: Tis, N0, M0

This is stomach cancer in its earliest stage. It has not grown beyond the inner layer of cells that line the stomach (Tis). The cancer has not spread to any lymph nodes (N0) or anywhere else (M0). This stage is also known as carcinoma in situ.

Stage IA: T1, N0, M0

The cancer has grown beneath the top layer of cells in the mucosa into tissue below, such as the connective tissue (lamina propria), the thin muscle layer (muscularis mucosa), or the submucosa (T1). The cancer has not spread to any lymph nodes (N0) or anywhere else (M0).

Stage IB: Any of the following:

T1, N1, M0: The cancer has grown into the layer of connective tissue (lamina propria), and may have grown into the thin layer of muscle beneath it (muscularis mucosa) or deeper into the submucosa (T1). Cancer has also spread to 1 or 2 lymph nodes near the stomach (N1), but not to any distant tissues or organs (M0).

OR

T2, N0, M0: The cancer has grown into the main muscle layer of the stomach wall, called the muscularis propria (T2). It has not spread to nearby lymph nodes (N0) or to any distant tissues or organs (M0).

Stage IIA: Any of the following:

T1, N2, M0: The cancer has grown beneath the top layer of cells of the mucosa into the layer of connective tissue (lamina propria), thin muscle layer (muscularis mucosa), or the submucosa (T1). It has spread to 3 to 6 nearby lymph nodes (N2). It has not spread to distant sites (M0).

OR

T2, N1, M0: The cancer has grown into the main muscle layer of the stomach called the muscularis propria (T2). It has spread to 1 or 2 nearby lymph nodes (N1), but has not spread to distant sites (M0).

OR

T3, N0, M0: The cancer has grown through the main muscle layer into the subserosa, but has not grown through all the layers to the outside the stomach (T3). It has not spread to any nearby lymph nodes (N0) or to distant tissues or organs (M0).

Stage IIB: Any of the following:

T1, N3, M0: The cancer has grown beneath the top layer of cells of the mucosa into the layer of connective tissue (lamina propria), the thin muscle layer, or the submucosa (T1). It has spread to 7 or more nearby lymph nodes (N3). It has not spread to distant tissues or organs (M0).

OR

T2, N2, M0: The cancer has grown into the main muscle layer, called the muscularis propria (T2). It has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant tissues or organs (M0).

OR

T3, N1, M0: The cancer has grown into the subserosa layer, but not through all the layers to the outside of the stomach (T3). It has spread to 1 or 2 nearby lymph nodes (N1), but has not spread to distant tissues or organs (M0).

OR

T4a, N0, M0: The cancer has grown completely through all the layers of stomach wall into the outer covering of the stomach (the serosa), but it has not grown into nearby organs or tissues, such as the spleen, intestines, kidneys, or pancreas (T4a). It has not spread to any nearby lymph nodes (N0) or distant sites (M0).

Stage IIIA: Any of the following:

T2, N3, M0: The cancer has grown into the main muscle layer, called the muscularis propria (T2). It has spread to 7 or more nearby lymph nodes (N3), but has not spread to distant tissues or organs (M0).

OR

T3, N2, M0: The cancer has grown into the subserosa layer, but not through all the layers to the outside of the stomach (T3). It has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant tissues or organs (M0).

OR

T4a, N1, M0: The cancer has grown completely through all the layers of the stomach wall into the outer covering of the stomach (the serosa), but it has not grown into nearby organs or tissues (T4a). It has spread to 1 or 2 nearby lymph nodes (N1), but it has not spread to distant sites (M0).

Stage IIIB: Any of the following:

T3, N3, M0: The cancer has grown into the subserosa layer, but not through all the layers to the outside of the stomach (T3). It has spread to 7 or more nearby lymph nodes (N2), but it has not spread to distant sites (M0).

OR

T4a, N2, M0: The cancer has grown completely through all the layers of the stomach wall into the serosa (the outer covering of the stomach), but it has not grown into nearby organs or tissues (T4a). It has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant sites (M0).

OR

T4b, N0 or N1, M0: The cancer has grown through the stomach wall and into nearby organs or structures such as the spleen, intestines, liver, pancreas, or major blood vessels (T4b). It may also have spread to up to 2 nearby lymph nodes (N0 or N1). It has not spread to distant sites (M0).

Stage IIIC: Any of the following:

T4a, N3, M0: The cancer has grown completely through all the layers of the stomach wall into the serosa, but it has not grown into nearby organs or tissues (T4a). It has spread to 7 or more nearby lymph nodes (N3), but it has not spread to distant sites (M0).

OR

T4b, N2 or N3, M0: The cancer has grown through the stomach wall and into nearby organs or structures such as the spleen, intestines, liver, pancreas, or major blood vessels (T4b). It has spread to 3 or more nearby lymph nodes (N2 or N3). It has not spread to distant sites (M0).

Stage IV: Any T, any N, M1

The cancer has spread to distant organs such as the liver, lungs, brain, or bones (M1)

Diagnosis of Stomach Cancer

  • Blood tests to look for signs of cancer in your body.
  • Upper endoscopy. Your doctor will put a thin, flexible tube with a small camera down your throat to look into your stomach.
  • Upper GI series test. You’ll drink a chalky liquid with a substance called barium. The fluid coats your stomach and makes it show up more clearly on X-rays.
  • CT scan . This is a powerful X-ray that makes detailed pictures of the inside of your body.
  • Biopsy . Your doctor takes a small piece of tissue from your stomach to look at under a microscope for signs of cancer cells. He might do this during an endoscopy.

Treatment for Stomach Cancer

The main treatments for stomach cancer are:

Surgery is part of the treatment for many different stages of stomach cancer if it can be done. If a patient has a stage 0, I, II, or III cancer and is healthy enough, surgery (often along with other treatments) offers the only realistic chance for cure at this time. The type of operation usually depends on what part of the stomach the cancer is in and how much cancer is in the surrounding tissue. Different kinds of surgery can be used to treat stomach cancer:

Endoscopic resection

Endoscopic mucosal resection and endoscopic submucosal resection can be used only to treat some very early-stage cancers, where the chance of spread to the lymph nodes is very low.

These procedures do not require a cut (incision) in the skin. Instead, the surgeon passes an endoscope (a long, flexible tube with a small video camera on the end) down the throat and into the stomach. Surgical tools can be passed through the endoscope to remove the tumor and part of the normal stomach wall around it.

Subtotal (partial) gastrectomy

This operation is often recommended if the cancer is only in the lower part of the stomach. It is also sometimes used for cancers that are only in the upper part of the stomach.

Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine (the duodenum)

Total gastrectomy

This operation is done if the cancer has spread throughout the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus.

The surgeon removes the entire stomach, nearby lymph nodes, and omentum, and may remove the spleen and parts of the esophagus, intestines, pancreas, or other nearby organs. The end of the esophagus is then attached to part of the small intestine. This allows food to move down the intestinal tract. But people who have had their stomach removed can only eat a small amount of food at a time. Because of this, they must eat more often.

Lymph node removal

In either a subtotal or total gastrectomy, the nearby lymph nodes are removed. This is a very important part of the operation. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes.

Chemotherapy

Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond where it started.

Radiation therapy

Radiation therapy uses high-energy rays or particles to kill cancer cells in a specific area of the body. External beam radiation therapy is the type of radiation therapy often used to treat stomach cancer. This treatment focuses radiation on the cancer from a machine outside the body.