Stomach and duodenal cancer. Stomach cancer - first symptoms

Gastric cancer is the uncontrolled proliferation of epithelial cells in the gastric mucosa. At the same time, intracellular structural changes occur in the gastric mucosa, which lead to changes in the functions inherent in healthy cells.

Malignant degeneration first covers the mucous layer of the organ walls, then moves deeper. Metastasis from cancer of the stomach occurs in more than 80% of patients, and therefore the pathology has a rather severe course.

What is stomach cancer?

Gastric cancer is an oncological disease accompanied by the appearance of a malignant tumor formation formed on the basis of the epithelium of the gastric mucosa.

Stomach cancer is prone to rapid metastasis to the organs of the digestive tract, often grows into neighboring tissues and organs through the stomach wall (into the pancreas, small intestine), and is often complicated by necrosis and bleeding. Through the bloodstream it metastasizes mainly to the lungs and liver; through the vessels of the lymphatic system - into the lymph nodes.

The stomach wall consists of five layers:

• the inner layer, or lining (mucosa). In most cases, stomach cancer begins in this layer;
• submucosa is the support for the tissue of the inner layer;
• muscle layer - muscles in this layer mix and grind food;
• connective tissue (subserosa) is the tissue support for the outer layer;
• outer layer (serous) - it covers the stomach and supports the abdomen.

In almost 90% of cases When a cancerous tumor is detected in the stomach, a bacterium such as Helicobacter Pylori is also found, which suggests its certain participation in the degeneration of normal cells into atypical ones.

It occurs slightly more often in men than in women. In addition, the risk of encountering this pathology is higher among representatives of the Negroid race and among the poor. Regarding age: the peak incidence of stomach cancer is between 65 and 79 years old. However, the disease is often detected in people aged 50-55 years.

Classification

According to histological type, stomach cancer is divided into the following types:

• Adenocarcinoma. Detected in almost 95% of cases. The tumor develops from the secretory cells of the mucous layer.
• Squamous. A tumor of this type is the result of cancerous degeneration of epithelial cells.
• Signet ring cell. The tumor begins to form from goblet cells responsible for producing mucus.
• Glandular cancer. The reason for the formation of this type of cancer is an atypical transformation of ordinary glandular cells.

Differs in growth form:

• Polypoid - resembles a mushroom on a stalk, growing into the lumen of the stomach, the slowest growing form;
• Saucer-shaped - has the appearance of a clearly limited ulcer, bordered by a high shaft along the periphery, gives late metastasis;
• Infiltrative-ulcerative - the edges of the ulcerative lesion are blurred, cancer cells diffusely spread deep into the wall of the stomach;
• Infiltrating - the cancer focus has no visible boundaries.

The last two types are especially malignant: quickly affects the entire thickness of the gastric wall, actively metastasizes at an early stage, scattering metastases throughout the peritoneum.

The classification of stomach cancer according to its forms does not end there; a separate part of it is based on the specific part in which the tumor developed; the following types of cancer are distinguished:

• Cardiac. This form of cancer develops in the upper part of the stomach organ, specifically in the place where it “joins” the esophagus.
• Body of the stomach. In this form, the cancer affects the middle part of the organ.
• Small curvature. Covers the area of ​​the right gastric wall.
• Gatekeeper (pyloric department). In this variant, cancer develops from the side from which the anatomical transition of the organ to the duodenum occurs.

The first signs of manifestation

The earliest signs of stomach cancer are so vague and inexpressive that treatment, if they occur, is started in extremely rare cases and, as a rule, is not appropriate to the disease. After all, most diseases of the gastrointestinal tract have similar manifestations, and it is extremely difficult to diagnose cancer using them.

If the patient is concerned about the following points, then you should pay attention to them, as these may be the first signs of stomach cancer:

• deterioration of appetite or its complete loss, which entails a complete aversion to food;
• a sharp deterioration in the patient’s condition, which occurs over 2-3 weeks, and is accompanied by weakness, loss of strength and fatigue;
• there is discomfort in the intestines, pain, a feeling of fullness and, in some cases, nausea and vomiting;
• unreasonable weight loss.

The precancerous condition of this disease sometimes lasts 10-20 years. At this time, only if the first symptoms of the stomach are present in the early stages, an experienced doctor will be able to suspect cancer. Often, oncology of the stomach is detected already in the later stages:

• First, a person gets sick, which, in the absence of suitable treatment, becomes chronic.
• Then comes atrophy of the gastric mucosa, the formation of atypical and cancer cells.

In those who lead a healthy lifestyle, cancer develops more slowly than in people who use tobacco, alcohol, overcooked and too hot food.

Causes

Oncological disease, caused by the formation of a malignant tumor from cells of the gastric mucosa, ranks 4th among cancer diseases. It often affects people in Asia. A malignant tumor can develop in any part of the stomach.

In about 90% of cases, the tumor is malignant, and approximately 95% of these malignant tumors are carcinomas. Gastric carcinoma in men is diagnosed mainly between the ages of 50 and 75 years.

Factors that provoke the development of stomach cancer:

• the bacterium Helicobacter pylori, the presence of which in the human body, according to statistics, increases the risk of damage to the mucous membrane, and as a result, the occurrence of cancer by 2.5 times;
• genetics (more frequent occurrence of the disease is noted in people with blood type A (II), as well as in those who suffer from hereditary pernicious anemia;
• negative environmental situation;
• poor quality nutrition: consumption of unhealthy foods (spicy, sour, canned, dried, fast food);
• alcohol abuse, smoking;
• previous injuries, gastric resection;
• immunodeficiency states;
• hazardous working conditions: working with chemicals and radioactive substances.

There are so-called precancerous diseases that adversely affect the mucous membrane, causing the appearance of unusual epithelium:

• polypous growths;
• B12-deficiency anemia (vitamin deficiency impairs the formation of the gastrointestinal epithelium);
• some subtypes of chronic gastritis (in particular atrophic gastritis, leading to the death of stomach cells);
• Menetrier pathology, which contributes to abnormal growth of the mucous membrane;

It is worth noting that most often cancer occurs in the antrum (lower part of the stomach). One of the reasons is the occurrence of duodenogastric in patients, in which the contents of the duodenum are able to flow back into the stomach (retrograde movement of food) and leads to gastritis.

Stages of development + photo

The development of the disease includes 4 main stages. They show how much and how quickly stomach cancer develops:

1. The early stages are manifested by small formations in the layers of the stomach.
2. Stage two: the tumor enlarges, deepens, and spreads to nearby lymph nodes. Indigestion occurs.
3. The tumor grows into the wall of the organ and spreads to adjacent tissues.
4. Metastasis – cancer cells spread to different parts of the body, disrupting the functioning of systems.

Stage 4 is divided into 3 phases:

• Phase 4A denotes a process that has spread through the visceral peritoneum to neighboring organs and any number of lymph nodes.
• Phase 4B is a tumor of any size that has not invaded other organs, but has metastases in more than 15 lymph node groups.
• The most complex and final stage of stomach cancer is 4B., in which metastases spread through lymph and blood and create secondary tumor foci in different organs. Absolutely any organ can be damaged, regardless of proximity to the stomach: bones, liver, pancreas, lymph nodes (more than 15), lungs and even the brain.

Symptoms of stomach cancer in adults

The main symptoms and first signs of stomach cancer are not always the same in different patients. Depending on the location of the tumor and its histological type, symptoms can vary significantly.

• The location of the tumor in the cardiac part of the stomach (the part adjacent to the esophagus) is primarily indicated by difficulties in swallowing rough food or large pieces of it, and increased salivation.
• As the tumor grows, the symptoms become more pronounced. After some time, other signs of a tumor develop: vomiting, a feeling of heaviness in the chest, between the shoulder blades or in the heart area, pain.

When the tumor grows into the blood vessels, gastric bleeding may occur. Consequences of cancer:

• decreased nutrition,
• Cancer intoxication leads to the development of general weakness and high fatigue.

The presence of any of the above symptoms is not sufficient to diagnose stomach cancer; other diseases of the stomach and digestive organs may also manifest themselves.

General symptoms of the cancer process

As mentioned above, there are a number of symptoms inherent in almost all cancers. These include:

• sudden weight loss;
• lack of appetite;
• apathy, constant fatigue;
• increased fatigue;
• anemic skin color.

The above symptoms are typical for any cancerous tumor. That is why, for the purpose of early detection of stomach cancer (in the absence of other clinical symptoms), scientists dealing with oncology of the stomach and the entire gastrointestinal tract have proposed using a set of symptoms called “small sign syndrome” in the diagnostic process.

Minor trait syndrome includes:

• Feeling of constant discomfort in the upper abdomen.
• Bloating () after eating.
• Unreasonable loss of appetite, and subsequently weight.
• Feeling of nausea and light drooling accompanying it.
• Heartburn. Perhaps one of the symptoms of cancer when the tumor is localized in the upper half of the stomach.

As the disease progresses and the tumor grows, new symptoms may appear:

• Abnormal stool.
• Discomfort in the upper abdomen.
• Fast saturation.
• Increase in abdominal size.
• Vomiting with blood.

All of the above signs most often indicate stomach cancer. Symptoms and manifestations of the disease are not a sufficient condition to confirm the diagnosis, as they may indicate other gastrointestinal pathologies. It is extremely important to undergo a detailed examination.

When symptoms appear, be sure to see a specialist. There is no need to engage in self-diagnosis, because... this is fraught with serious consequences for the body.

Diagnostics

When dealing with complaints of gastrointestinal dysfunction, a specialist performs an external examination of the patient with palpation of the abdominal cavity (on the left, right side, back, in a standing position). The tumor detected by this method of examination is painless, can be dense or soft with uneven, bumpy edges.

Next, the doctor collects the patient’s medical history (cases of stomach pathologies in the family, dietary habits, the presence or absence of bad habits, chronic diseases), prescribes laboratory and instrumental diagnostic methods.

Laboratory research methods include checking blood (general and biochemical tests), urine, coprogram, as well as determining the concentration of tumor markers.

It is impossible to diagnose stomach cancer using blood tests alone, and the patient is sent to take a blood test for cancer antigen, that is, for the presence of proteins (tumor markers) in the blood that are secreted only by cancer cells.

Instrumental diagnostics:

1. Endoscopy of the stomach: Using a thin flexible tube with a light, the doctor can examine the entire gastrointestinal tract. If a suspicious area is found, a biopsy is taken from it in order to perform a microscopic examination.
2. Ultrasound: the peculiarity of the technique is that a sound wave is used to determine the diagnosis; ultrasound is performed together with a specialized probe inserted through the oral cavity. This will allow you to find out how much the neoplasm has spread within the gastrointestinal tract, surrounding tissues, and lymph nodes.
3. Computed tomography (CT)- is aimed mainly at clarifying ultrasound data regarding the presence of metastases in internal organs located in the abdominal cavity. By imaging the stomach and its tissues from different angles, CT helps oncologists more accurately determine the stage of stomach cancer.
4. MRI uses a safe magnetic field rather than X-rays to produce images. MRI diagnostics provides a clear “picture” of almost all tissues and organs.
5. Diagnostic laparoscopy. This is an operation performed under intravenous anesthesia through punctures in the abdominal wall, where a camera is inserted to examine the abdominal organs. The study is used in unclear cases, as well as to detect tumor growth into surrounding tissues, metastases to the liver and peritoneum, and to take a biopsy.
6. X-ray with contrast agent. This is an x-ray of the esophagus, stomach and first part of the intestine. The patient drinks barium, which outlines the abdomen on the x-ray. This helps the doctor, using special imaging equipment, find possible tumors or other abnormal areas.

Treatment

The tactics of therapeutic measures depend on the stage of development of stomach cancer, the size of the tumor, germination into neighboring areas, the degree of colonization of lymph nodes by malignant cells, metastasis of other organs, the general condition of the body, concomitant diseases of organs and systems.

The success of treatment for stomach cancer directly depends on the size and spread of the tumor to neighboring organs and tissues, as well as on metastasis. Very often, diagnostic laparoscopy is performed before surgery to exclude metastases in the peritoneum.

Operation

The main method of treatment is surgical, which involves removing the tumor along with the stomach (gastrectomy) or part of it. If radical surgery is not possible, preoperative radiation or chemotherapy may be performed to reduce the size and growth of the tumor.

Surgical treatment of stomach cancer involves a preliminary examination - the patient undergoes laparoscopic diagnostics to identify possible metastases in the abdominal cavity and omentum for preliminary planning of the scope of surgical intervention.

Depending on the degree of tumor damage to the body, two types of surgical intervention are used - endoscopic resection or intracavitary surgery. In the first case, the intervention is minimal.

Chemotherapy

Better results with a lasting positive effect can be obtained by supplementing surgery with chemotherapy. This therapy involves the introduction of chemicals into the body to suppress tumor cells remaining after surgery - invisible local areas of the tumor and foci of secondary damage in the form of distant metastases. The duration of chemotherapy is determined depending on the dynamics of events.

How long do people live with cancer at different stages: prognosis

Doctors can give a positive prognosis if they are able to diagnose the development of cancer cells in the stomach at the initial stage of the disease. In this case, the treatment result will be effective in 90% of cases. When metastases spread to neighboring organs, the chance of recovery is reduced, but it still exists and primarily depends on the number of widespread metastases.

In conclusion, it should be noted that today stomach cancer is being diagnosed more and more often. Symptoms and manifestations of this disease should be a reason for consultation with a specialist. The sooner the doctor confirms the pathology and prescribes appropriate treatment, the higher the chances of a favorable prognosis.

Be sure to undergo examination by a gastroenterologist several times a year, get tested on time and start treatment if you have gastrointestinal diseases. Take care of your body and be healthy!

The gastrointestinal tract is by far the most cancer-prone system in our body. A tumor can develop anywhere in this organ. At the same time, all gastrointestinal cancer pathologies are dangerous and have the same feature: in the early stages, there are practically no signs of the disease.

stomach and pancreas

For example, cancer in the pancreas is often not detected until it reaches a stage when it is already difficult to treat (the tumor has enlarged and begun to spread).

Externally, the symptoms of cancer are manifested by the patient's jaundice, weight loss, abdominal pain, nausea, and the presence of fat in the stool. If the tumor has blocked the bile duct into the intestine, the stool loses its brown color and becomes pale, and the urine, on the contrary, darkens.

By the way, cancer is detected earlier than in oncopathology of other areas.

Colon cancer: symptoms

Cancer (colorectal) ranks second in the country in terms of the number of cases. Like pathologies in other parts of the gastrointestinal tract, there are no specific symptoms that belong only to it. Blood in the stool or black stools, constant constipation or diarrhea, unexplained weight loss in the stomach, bloating - these are not only symptoms of cancer, but also manifestations of other diseases.

Method for early diagnosis of cancer

Based on the above, one of the most effective methods for timely diagnosis of oncopathology is colonoscopy (a complete visual examination of the walls of the large intestine using a probe).

This procedure allows not only to determine the condition of the intestinal mucosa, but also to painlessly take, if necessary, small fragments of tissue for laboratory analysis during the examination. If small polyps are detected, they can be removed immediately.

If there is a hereditary tendency to cancer in the family, such an examination should be done for everyone who has reached the age of forty and repeated examinations should be carried out regularly: once every 4-5 years.

What manifestations should you be wary of?

In order not to miss the early symptoms of cancer, you need to be attentive to the condition of your body. Thus, frequent changes in bowel function (constipation, diarrhea) and detection of traces of blood in the stool should alert you and force you to immediately consult a doctor.

At later stages of tumor development, patients also develop a feeling of incomplete emptying and also an alarming sign that requires mandatory consultation with a specialist may be pain during bowel movements, false urges to defecate, and, of course, pain in the rectum.

When is colorectal cancer most likely to develop?

There are risk factors that make the development of cancer most likely. This:

• ulcerative colitis (the presence of inflammation and ulcers of the intestine);
• congenital familial polyposis (with the formation of polyps on the lining of the colon);
• love of fatty foods (regular consumption of foods high in fat but low in fiber).

Don't wait until cancer symptoms are completely undeniable! As a rule, this occurs in the later stages of the disease. Don't take risks and be healthy!

The gastrointestinal tract systems, especially the stomach, are dangerous because the organ quickly loses the ability to efficiently absorb food.

In addition, the stomach is surrounded by other vital organs - targets for mutated metastatic cells. With early diagnosis, the chances of survival are quite high. But often this type of oncopathology is detected at later stages.

Reasons for the development of the disease

The reasons for the development of a pathological process in the tissues of the stomach lie largely in violation of the rules of healthy eating and inattention to one’s own health.

All causes of gastric carcinoma can be divided into the following groups:

• Food habits - abuse of goodies and harmful foods from the fatty, smoked, pickled series. This causes damage to the mucous membrane lining the stomach. Substances that contribute to the development of the oncological process are absorbed into injured tissue areas.
• Smoking and alcoholic drinks.
• The presence of chronic pathological processes affecting the mucous membrane. The culprit of ulcers, colitis, and other inflammatory diseases of the gastrointestinal tract is most often a bacterium
• . It can exist in the stomach and intestines for years; gastric juice is not dangerous for it. During its activity, this pathogen destroys areas of the gastric mucosa, provoking the development of gastritis and areas of necrosis. So, for example, the atrophic form of gastritis is considered a precancerous condition.
• Hereditary history - if there are cases of carcinoma of the gastrointestinal tract in the family, then there is a risk of developing oncopathology.
• Endocrine and hormonal factor.

Classification of gastric cancer

Stomach cancer is a dangerous disease

The classification of organ carcinomas is based on the location of the tumor in the parts of the stomach. Types of gastric cancer pathologies:

1. cardiac section - entrance to the stomach from the esophagus;
2. tumors of the lower esophagus;
3. carcinoma of the body of the stomach;
4. cancer of the outlet or antrum of the organ;
5. angle of the stomach - the area between the organ and the duodenum;
6. multiple tissue damage in infiltrative forms of carcinoma.

Based on their shape, there are 2 types of malignant neoplasms affecting the esophagus-stomach system. The classification is based on the form of the tumor process. Highlight:

• exophytic type of neoplasm - a voluminous tumor, resembles a polyp or inflorescence, ulceration;
• infiltrative - altered tissues spread over the surface of the mucous membrane lining the internal cavity of the stomach.

Treatment tactics for different types of malignant neoplasms in the gastrointestinal tract will vary.

Stages and symptoms of the pathological process

Diagnosis of stomach cancer - MRI

The basis for the division into stages is the degree of damage to the tissues of the stomach, surrounding organs, the presence of secondary tumors in nearby organs, and lymph nodes.

• Stage 0 or cancer on the way. An area of ​​mutated cells is detected. The tumor does not extend beyond the gastric mucosa. No metastases were found.
• Stage 1: In substage 1A, the carcinoma involves only the mucosa. There is no metastasis. In substage 1B, the tumor has spread beyond the stomach. Metastases in 1–2 nearest lymphatic collectors.
• Stage 2. All layers and tissues of the stomach are affected. Metastases in nearby lymph nodes and blood vessels.
• Stage 3. Increase in the size of malignant tissue. More than 15 lymphatic collectors are affected.
• Stage 4. Multiple metastases in the bones, brain, pancreas, lymph nodes.
• Thermal stage. Symptoms depend on the stage of the malignant process and concomitant pathologies in nearby organs.

Signs of stomach cancer:

1. At stage zero there are no symptoms.
2. At stage 1, there are no specific signs of pathology. A blood test shows a decrease in hemoglobin levels. The patient complains of fatigue, belching, and early satiety.
3. At stage 2 - increased body temperature, refusal of any food, discomfort when eating.
4. Stage 3 – pain, sudden weight loss, anorexia, and vomiting with blood or stagnant contents, impaired bowel movements. The blood test showed a sharp decrease in hemoglobin.
5. Stage 4 – severe pain, refusal to eat, ascites due to the accumulation of fluid in the abdominal cavity. There is jaundice due to liver damage.

If suspicious symptoms appear, you should immediately contact a gastroenterologist. If you experience vomiting with blood or black mucus, you should immediately call an ambulance.

Diagnostic measures

Stomach cancer is not asymptomatic

The gold standard for diagnosis in cases of suspected malignant formations of the gastrointestinal tract or other pathologies of inflammatory origin is gastroscopy.

How does differential analysis work:

• Physical examination, analysis of patient complaints.
• Videoesophagogastroduodenoscopy. The procedure is carried out using an endoscope and allows you to carefully examine all parts of the stomach. During the study, tissue can be taken for histological examination to determine the nature of the neoplasm. If necessary, excision of a suspicious area of ​​tissue is possible. The manipulation is well tolerated; intravenous anesthesia is indicated when taking a biopsy or excision of a section of mucous membrane.
• - safe and non-invasive procedure. Allows you to evaluate the functionality of the organ. Indispensable for suspected relapse of the disease and for diagnosing infiltrative forms of malignant neoplasms, since often with this form of cancer the biopsy will be negative.
• abdominal cavity - determination of carcinoma by indirect signs. The procedure is indicated for examining the epigastric organs for secondary carcinomas.
• CT or MRI - help to establish an accurate diagnosis, detail the location and size of the pathogenic tissue.
• Endoscopic ultrasound is indicated for suspected carcinomas located in the thickness of the stomach wall under the mucous layer. The examination helps determine the extent of invasion into the wall of the organ and into neighboring systems.
• – indicated in controversial cases, when metastasis to the liver or pancreas is suspected.
• – these protein compounds produce only malignant tissues. They are absent in a healthy body. For early diagnosis of metastasis in cancer in remission, tumor markers Ca 19.9, CEA, Ca 72.4 are used. As a primary diagnostic tool, these studies are not very informative.

Treatment strategy and tactics

Stomach cancer: surgery

The list of treatment measures depends on the stage of the disease. The choice of treatment methods is the prerogative of the oncologist.

What modern medicine can offer:

1. Stage 0 – surgical resection of 80% of the stomach tissue. Chemotherapy and radiation are not indicated.
2. Stage 1 – surgical treatment is combined with chemotherapy and radiotherapy to prevent metastasis. Some techniques use chemotherapy drugs and radiation sessions before surgery. This increases the patient's chances.
3. Stage 2 - at this stage of development of the malignant process, treatment tactics are selected based on the operability of the tumor. If the tumor can be removed, then total gastrectomy is used. At this stage, a course of chemotherapy, radiation, and hormone therapy is additionally indicated. If the carcinoma is inoperable, then only conservative methods are used.
4. At the third stage, most patients are inoperable. Therefore, radiotherapy, aggressive chemicals, and hormone therapy are used. If the doctor believes that surgery will improve the patient's condition, then it should be performed.
5. At stage 4, a large number of secondary tumors are observed in various tissues and systems. At this stage, all methods of therapy are aimed at maintaining life, reducing pain, and reducing secondary malignant foci. Operative treatment is inexpedient. Palliative therapy is chemotherapy and radiotherapy. carried out to stop bleeding and eliminate stenosis of the esophagus or parts of the stomach.

Forecasts

The prognosis depends on the stage of cancer diagnosis

Survival prognosis for patients with gastric malignancy depends on the patient’s age, stage of the disease, the presence of metastases, other individual characteristics of the body and its response to treatment.

What medical statistics say:

• At stage 0 after resection, the five-year survival rate is 90% of patients.
• At stage 1 - even with secondary tumors in nearby nodes after surgical and drug treatment - 80% of patients survive for 5 years.
• At stage 2 - provided that the tumor is operable or the body responds well to chemotherapy drugs, radio irradiation - only 50% of patients cross the five-year barrier.
• Stage 3 - the chances are low - about 37% of patients live for 5 years.
• Stage 4 - no more than 5% of patients survive.

Even if the forecast is disappointing, then you should not give up.

Preventive actions

Prevention of cancer is the best way, if not to avoid it, then to diagnose it in time and increase the chances of recovery.

Those who have a family history of cancer of any organ should be especially careful about their own health.

1. Change the diet - remove fatty and heavy, spicy and pickled dishes. Change the way of cooking, replace fried meat with baked. Forget about junk food, minimize communication with semi-finished products.
2. Smoking has never made anyone healthier. Ethanol and nicotine affect the entire digestive tract - from the esophagus to the liver and pancreas.
3. Timely and high-quality treatment of diseases of the gastrointestinal tract. Any neoplasms - growths - must be removed in a timely manner, since the probability of their degeneration is 50%.

Cancer of any organ is a difficult test for the patient and his family. Even if you have been given such a diagnosis, do not give up. Forecasts are forecasts, but the desire to live and recover contributes to a good response of the body to treatment and increases the chances of overcoming the disease.

Maximum information about oncology is in the video:

is a malignant degeneration of gastric epithelial cells. In 71-95% of cases, the disease is associated with damage to the stomach walls by Helicobacter Pylori bacteria and is a common cancer in people aged 50 to 70 years. Men are diagnosed with stomach cancer 10-20% more often than women of the same age.

Epidemiology

In the structure of cancer diseases in Russia, stomach 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 information, it reaches 30 people per 100 thousand population. The duration of the preclinical period of the disease is from 11 months to 6 years.

There is geographic heterogeneity in incidence rates on a global scale:

High level - Russia, Japan, South Korea, Finland, Chile, Brazil, Colombia, Iceland.

Low level - Western Europe, USA, Canada, Australia, Indonesia.

The onset of stomach cancer is associated with H. Pylori and previous pathologies: mucous membranes, peptic ulcers, polyps on the walls of the stomach, gastritis and other diseases. The negative effects of smoking and strong alcohol on the body, as well as regular consumption of food dyes, flavors and flavor enhancers, have certainly been proven.

In countries with a high level of medical care, cancer is detected at an early stage, so mortality statistics look quite optimistic. The five-year survival rate for patients with stomach cancer in Japan, if diagnosed early, is about 70-90%.

How long do you live with stomach cancer?

Men with stomach cancer live on average 12 years, and women 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 rate for five years is 60-80%;

Stage II-III with involvement of regional lymph nodes is determined in 30% of patients, survival rate over five years ranges from 15-45%;

Stage IV with metastases to neighboring organs is diagnosed in 50% of patients; survival rate for five years is no more than 5-7%.

Active attempts are being made to create systems for objectively predicting 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.

The disease does not manifest clinical signs for a long time.

The main diagnostic errors are associated with symptoms that make stomach cancer similar to non-oncological pathologies of the heart or gastrointestinal tract:

Similar to heart diseases. Localization of the tumor in the cardiac part of the stomach is accompanied by chest pain (angina), especially in people over fifty years of age.

Similar to diseases of the gastrointestinal tract. Localization of the tumor closer to the intestinal part of the stomach is manifested by signs reminiscent of gastritis, peptic ulcer, cholecystitis. All these diseases are manifested by abdominal pain, vomiting and gastric bleeding.

An erroneous diagnosis can hide the underlying disease for a long time. Moreover, during an in-depth examination, a cardiologist and gastroenterologist usually find multiple abnormalities in elderly patients, but there are no obvious signs of oncology.

The doctor caring for the patient should be alert to:

Lack of effect after a 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 abdominal area (fullness, heaviness);

Difficulty swallowing food, chest 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 activity;

Rapid weight loss (10-20 kg in 6 months with a body weight of 80-90 kg) and loss of appetite;

Aversion to meat dishes, previously unobserved pickiness in food;

Quick satiation with a minimum amount of food.

Based on clinical studies, patterns of appearance of signs of the disease (at least two or three of the following at the same time) have been established, which are further identified as signs of oncology, namely:

Pain in the central epigastric region, reported by about 60% of patients;

Progressive weight loss is reported by about 50% of patients;

Nausea and vomiting after eating – about 40% of patients;

Nausea and vomiting with blood – about 25%;

Paleness of the mucous membranes – about 40%.

Clinical symptoms have some differences depending on the location of the tumor in the upper, middle and lower parts of the stomach:

Damage to the upper part of the stomach is manifested by cardiac symptoms (pain in the heart area), as well as difficulty swallowing, up to the inability to eat. Dehydration develops, threatening disseminated intravascular coagulation syndrome (DIC syndrome). Protein starvation is also dangerous, as it aggravates nitrogen metabolism disorders and leads to a critical level of under-oxidized substances in the blood.

Damage to the middle part of the stomach is manifested by gastric bleeding and the development of anemia. Large vessels are located in this zone. Hidden bleeding is determined by simple laboratory methods, and massive bleeding is determined by a change in the consistency and color of stool - it becomes black and tarry. Pain is most often associated with involvement in pancreatic carcinogenesis. Other symptoms are general.

Damage to the lower part of the stomach is manifested by dyspepsia (diarrhea, constipation, vomiting and stomach pain), belching with the smell of rotten eggs.

The very first symptoms of stomach cancer

The first signs should be paid attention to long before the symptoms characterizing stages III-IV of stomach cancer. Detection of the disease in its final stages is almost a death sentence for the patient.

The following pathologies should be associated with precancerous diseases:

Chronic (atrophic) gastritis, regardless of the cause, is characterized by common signs that are clearly identified during a clinical examination of the patient - nausea and vomiting.

A gastric ulcer, regardless of the variants, is manifested by gastric bleeding in the form of bloody vomiting, massive or hidden blood loss during bowel movements, 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 stomach walls, including large (adenomatous) and small (hyperplastic). The early stages are subclinical; 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 during cytological and histological examination. In the final stages, digestive disorders, nausea and vomiting are diagnosed.

Vomiting with stomach cancer

Vomiting that seems unmotivated at first glance may indicate early signs of cancer. Vomiting in combination with other signs has diagnostic significance.

The gag reflex can be triggered by:

Narrowing of the digestive tube by a developed tumor, creating an obstacle to the movement of food (has diagnostic value in the later stages);

Irritation of the receptors of the vomiting center under the chemical and mechanical influence of pathogenesis products (has great diagnostic significance, including in the early stages).

In the first case, food is thrown out immediately after eating. Vomit contains swallowed food without signs of digestion by gastric juice. Associated symptoms indicating cancer of the digestive tube are sudden weight loss, pallor of the mucous membranes, as well as changes in the walls of the stomach at the cellular level. Vomiting of undigested food is observed during intoxication for a short period of time. But if it is associated with stomach cancer, it manifests itself over a long period of time.

In the second case when the vomiting center is irritated, vomiting occurs regardless of food intake. Most often it is associated with intoxication of the body by products of carcinogenesis.

With a single spasm, vomit contains semi-digested, with multiple spasms - liquid contents:

Yellow color (bile ducts are normal);

Light color (obstruction of ducts, possible metastasis to the liver);

Streaks or clots of a dark red color (damage to blood vessels).

Vomiting and cancer are definitely connected if there are two or three additional signs of damage to the digestive tract.

Blood for stomach cancer

Changes are observed in feces (in the form of melena - the so-called “currant jelly”), as well as in vomit. Gastric bleeding is not always associated with cancer. The combination of bleeding and minor signs of stomach cancer (see above) significantly increases the likelihood of a connection with the underlying disease.

Signs of stomach bleeding:

Vomit is dark in color and does not foam; this distinguishes blood from the stomach from pulmonary hemorrhage;

Due to coagulated blood, feces are black in color, have a liquid consistency, have a foul odor, and are excreted in small portions.

The transformation of normal cells into malignant cells is a multi-step chain of events.

Below is a simplified vision of carcinogenesis and a step-by-step inclusion of various causes:

Stimulation and accumulation of mutations under the influence of external and/or internal carcinogens;

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.

First stage

For mutations to occur, a carcinogenic effect on the gastric epithelium is necessary.

External carcinogens (primarily food and drink), including:

Excessive regular consumption of table salt, food additives labeled “E”. For example, meat products and delicacies, to which sodium nitrate E251 is always added (provided for by technology) to give the meat a red color, monosodium glutamate or E261 to improve the taste. Smoked, spicy, pickled, canned and fried foods, strong alcohol, smoking tobacco, taking medications (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. Low levels of vitamin E (tocopherol), which regulates the resistance of mucous membranes, beta-carotene and some macro and microelements, also have a detrimental effect.

Internal carcinogens (infectious, hereditary, immune factors), including:

Infectious – 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 stomach cancer is certainly proven by the discovery of herpes markers in the tumor cells of some types of tumors;

Hereditary - it has been proven that the incidence of certain forms of cancer is 20% higher in individuals inheriting blood type A (II). Hereditary transmission of a low level of a gene called E-cadherin has also been confirmed - this is an epithelial protein that under normal conditions suppresses the growth of tumor cells;

Immune - decreased epithelial resistance due to 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.

Second phase

Includes the development of diseases that precede cancer, including:

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.

Third stage

Carcinogenesis itself is triggered by a combination of the two above 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, stomach cancer is preceded by infection with H. Pylori, damage to the walls of the stomach and the unconditional involvement of carcinogens.

The designation of the primary tumor is T with the addition of numbers 1 to 4 and small capital letters (a, b) to describe the details of carcinogenesis occurring in the primary tumor. The designation of damage to regional lymph nodes is N with the addition of numbers from 0 to 3 and small capital letters (a, b). To designate distant metastases, use the Latin letter - M and numbers - 0, 1 to indicate the absence or presence of distant metastases.

Stage 1 stomach cancer

Stage 1 can be encrypted in three ways, namely:

stage 1A (T 1 N 0 M 0), primary tumor of the first stage, grows into the mucous and submucosal layer, without affecting the lymph nodes and distant metastases;

stage 1B, option 1 (T 1 N 1 M 0), the primary tumor grows into the mucous and submucosal layer, metastases in one to six regional lymph nodes, no distant metastases;

stage 1 B, option 2 (T 2a/b N 0 M 0), the primary tumor has grown into the muscular and subserosal layer, there is no damage to the lymph nodes or distant metastases.

Stage 2 stomach cancer

Stage 2 can be encrypted in three ways, namely:

(T 1 N 2 M 0), the primary tumor grows into the mucous and submucosal layer, 7-15 regional lymph nodes are involved, there are no distant metastases;

(T 2a/b N 1 M 0), primary tumor in the muscular and subserosal layer, involvement of 1-6 regional lymph nodes and the absence of distant metastases is diagnosed;

(T 3 N 0 M 0), 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 (T 2a/b N 2 M 0), which means involvement of the muscular and subserosal layer of the stomach wall in the pathogenesis, damage to 7-15 regional lymph nodes and the absence of distant metastases;

Stage IIIA, option 2 (T 3 N 1 M 0), means damage to all layers of the serous membrane of the stomach without involvement of neighboring organs, damage to 1-6 regional lymph nodes and the absence of distant metastases;

Stage IIIA, option 3 (T 4 N 0 M 0), has spread to neighboring organs in the absence of damage to regional lymph nodes and without distant metastases;

Stage IIIB, (T 3 N 2 M 0), 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 options, namely:

(T 4 N 1, N 2, N 3, M 0), tumor spread to neighboring organs, damage to regional lymph nodes (1-6) – N 1, or (7-15) – N 2, or (more than 15) – N 3, absence of distant metastases;

(T 1 T 2 T 3, N 3 M 0), damage to the mucous and submucosal layer - T 1 or damage to the muscular and subserosal layer - T 2 or damage to all layers of the serous membrane, damage to more than 15 regional lymph nodes, absence of distant metastases;

(T any, N any, M 1), 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 designates the stage of the disease at which it is impossible or impractical to use 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 operations 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 located in a mosaic pattern and affect vital parts of the body (large vessels, nerve nodes), cells spread lymphogenously, by contact or by 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 data, life expectancy after a course of combined treatment can be increased to 20-24 months. At the same time, complications from exposure to ionizing radiation are significantly lower than the therapeutic effect, and the patient gets a chance to prolong life without pain. Unfortunately, it is impossible to guarantee more in the conditions of modern medicine.

The main routes of metastasis pass through the lymphatic system, therefore 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's;

In the area of ​​the ovaries - Krukkenberg.

These secondary tumors are evidence of 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.

Stomach cancer is divided according to location and methods of spread - this could be, for example, squeezing out surrounding tissue or, conversely, infiltration into surrounding tissue. Histological forms of cancer: diffuse or polyp-like have a significant influence on the pathogenesis.

Signet ring cell cancer of the stomach

Diagnosed by cytological and histological examination. This is a type of diffuse cancer. The changed area consists of flat signet ring cells. The disease has an aggressive course.

Histochemical studies have established the hormonal nature of this tumor. In the tissues of the neoplasm in women, an increase in the level of estrogen is found, and in men - testosterone.

Distinctive features of this type of disease:

Predominance of women in the structure of patients. The number of sick women is 55%, men are 45%. The ratio may vary, but the pattern has been confirmed by numerous studies;

Peaks of incidence in the age intervals from 40 to 50 years and 60-70 years. At 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 significantly lower.

The dependence of the onset of the disease on the presence of previous bad habits (drinking alcohol, salted, smoked, pickled foods) and exogenous factors (working with radiation, in chemical production) has not been established.

This type of stomach cancer is more often found in urban residents.

Infiltrative stomach cancer

Morphological form of carcinoma, without clearly delineating the boundaries of the neoplasm. The growth of malignant cells occurs mainly in the thickness of the stomach wall.

Features of the disease:

May occur in relatively young people, 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 and often metastasizes;

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 gastric cancer

Normal epithelial cells renew themselves at a high rate; after about 3-4 days, a generation is completely replaced. High update speed is an important factor in the occurrence 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 hidden development of carcinogenesis in the thickness of the stomach wall;

The absence of clear boundaries of the tumor, growth occurs as a 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 tumorigenesis.

Diagnosis of stomach cancer

Of particular importance for the early detection of the disease is the oncological alertness and attentiveness of the general practitioner. Diagnosis is carried out in stages and includes physical, instrumental and laboratory methods.

Diagnosis begins with a clinical examination, palpation and auscultation.

In the early stages of stomach cancer, it allows you to identify distant signs of the disease by the condition of the skin, color, humidity, temperature, pain, including in the abdominal area.

When auscultating the heart, pain in the chest is a common complaint of the patient. Noises and splashing that are not characteristic of pathologies of the cardiovascular system should be excluded. When palpating the abdominal wall in the early stages of the disease, there are no changes, but in the later stages, compactions can be detected under the skin in the epigastric area.

2. Instrumental methods

Contrast X-ray diagnostic methods are used, as well as endoscopy.

X-ray diagnostics. It is an indirect method that 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 the dense are the light areas, and the loose are the 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 stomach tissue;

Niches with an infiltration zone 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 diagnostic method for gastric oncologists 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, with 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 attachments – a combination of ultrasound and visualization;

A relatively new method is the introduction of an uncontrolled 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 medications (Deprivan, Cerucal);

Difficulty in differentiating between benign and malignant tumors.

Therefore, endoscopy is usually combined with electrocoagulation of tumors on the walls of the stomach.

Morphological method

Based on histological and cytological examination in the laboratory, the histological type of the tumor is determined with a high degree of certainty. General pattern: tumors located closer to the cardiac part (entrance to the stomach) are more likely to have malignant properties.

3. Additional methods

Ultrasound diagnostics. Carry out in three main options:

Outside, through the abdominal wall;

Externally, after filling the stomach with 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. Laboratory testing of biological fluids is used to clarify the patient’s condition before surgery. In recent years, methods have been used to determine cancer using tumor markers.

Differential diagnosis of stomach cancer

The above methods are used to differentiate cancer from less dangerous or pre-cancer diseases, including:

Atrophic forms of gastritis;

Peptic ulcer;

Various polyps;

Infectious diseases with similar symptoms (stomach tuberculosis);

Diseases of the lower parts of the esophagus (narrowing, achalasia - incomplete relaxation of the sphincter closer to the stomach).

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 method for early stage tumors is surgical removal in combination with adjuvant and non-adjuvant chemotherapy. Treatment methods for late stages are palliative and symptomatic.

All patients are conditionally divided into three groups:

The first is that patients have early stages (patients with carcinoma in situ and the first stage);

The second is patients with an operable locally advanced stage (patients up to stage III correspond);

The third group is patients with an inoperable stage of generalized gastric cancer (patients of stage IV with severe accompanying symptoms or involvement of vital organs and systems in the cancer process correspond).

Sometimes even patients with early forms of oncology are considered inoperable, for example, when the tumor affects vital parts of the body or it is impossible to perform surgery for other reasons.

The highest probability of complete recovery (up to 90% with a five-year survival rate) without significant consequences for the body is in the first group of patients. The prognosis within the second group has significant variability due to the many nuances of this stage of the disease. The prognosis for patients in the last, third group is minimally favorable. In this case, we should talk about prolonging and improving the quality of life of patients during illness.

Removal (resection) of the stomach for cancer

For patients, with the exception of some categories, laparoscopic diagnosis is indicated before surgery in order to exclude metastasis on the omentum and 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 minimal opening of the abdominal wall - endoscopic resection - may be prescribed. There are several options - the choice is up to the doctor.

Possible complications of endoscopic resection:

Postoperative pain - relieved with medications or dosed radiation;

Perforation (full, partial) of the walls of the stomach - eliminated by physical methods of influence;

Postoperative bleeding can be controlled with physical methods and pharmaceuticals.

A simplified version of the intervention is cauterization of tumors using electrothermal or laser effects on the walls of the stomach.

Abdominal operation

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 to the tumor is decided to reduce carcinogenesis before further surgery.

If there are indications for surgery, preoperative preparation is carried out, which consists of a number of manipulations aimed at stabilizing the patient’s condition.

Planning an operation algorithm includes choosing:

Access to the tumor during surgery;

The volume of surgical intervention in the organ;

Tactics for removing lymph node packages;

Method of organ reconstruction.

An important stage of treatment is postoperative recovery, which includes the application of drainage tubes to drain exudate. In the absence of complications, patients are allowed to sit down on the first day and walk on the second day after surgery.

Contraindications to abdominal surgery for gastric cancer are the following:

Hemodynamics in the form of instability of blood pressure and disseminated intravascular coagulation syndrome;

Breathing rhythm (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;

Administration of drugs that reduce blood viscosity (as indicated).

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. Sutures are removed no 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 to determine clinical dynamics. During this period, chemotherapy is prescribed to eliminate hidden local foci of secondary carcinogenesis.

Chemotherapy has overall negative effects 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 intensification or addition. That is, this type is used after surgery, as opposed to non-adjuvant chemotherapy, which is used before surgery to reduce the size of the tumor before surgery. In recent years, attitudes towards adjuvant treatment have changed. Previously, this method of chemotherapy for stomach cancer was considered ineffective.

This treatment is carried out in the form of polychemotherapy (exposure to several drugs) in two or three courses at various 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 impossible.

Complications after chemotherapy are inevitable. Cytostatics suppress the growth of malignant cells.

But at the same time, side effects develop in the form of toxicoses, accompanied by:

Recoverable hair loss;

Toxic liver damage;

Hematopoietic disorders;

Suppression of cooperation between humoral and cellular immunity.

Usually these phenomena are completely eliminated during rehabilitation treatment.

Juices for stomach cancer

The disease is accompanied by the body losing large volumes of fluid after repeated vomiting and stomach bleeding. With cancer, patients complain of decreased appetite due to loss of taste and smell, pain and other reasons.

Meaning of juices:

Sour - increase acidity, since the walls of the stomach reduce the production of hydrochloric acid, as well as reduce the need for table 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, and indigestible fiber, which is contained in the pulp and is necessary to improve peristalsis. It is better to dilute juices that are too sweet with water;

Slightly bitter - for example, from cabbage, turnip or grapefruit to stimulate appetite and peristalsis.

After consultation with your doctor, the amount of liquids, especially in the form of refreshing juices and fermented milk drinks:

increase during a course of chemotherapy, with dehydration, diarrhea and vomiting;

reduced in case of edema, accumulation of ascites fluid in the pleural and abdominal cavities.

After a course of treatment for stomach cancer with chemotherapy, some patients are advised 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 calms.

Liquid is necessary for a person to remove metabolic products from the body, improve tissue nutrition, improve well-being and enhance immunity.

Therapeutic dietary nutrition for stomach cancer performs the following tasks:

Prevents weight loss through a balanced diet;

Increases the tolerability of aggressive antitumor 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 restoration activity of body tissues after partial or total resection of the stomach;

Improves quality of life.

Principles of therapeutic nutrition for stomach cancer:

Cooking methods - boiling, baking, stewing;

The diet of patients is four to six times a day;

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.

Nutrition correction taking into account the stages of treatment is carried out in order to reduce the side effects of antitumor therapy.

Three diet options have been proposed for patients with stomach cancer, taking into account the characteristics of metabolism and body weight.

First option

– organization of nutrition for a patient with normal body weight in the absence of pronounced metabolic disorders:

Energy value – no higher than 2400 kilocalories per day;

The total amount of protein is 90 grams, including animal protein – 45 grams;

The total amount of fat is 80 grams, including vegetable fats – 30 grams;

Total carbohydrates: 330 grams.

Second option

– organizing nutrition for a patient with severe underweight, exhaustion, with visible metabolic disorders, as well as after surgery, chemotherapy or radiation therapy:

Energy value – not higher than 3600 kilocalories per day;

The total amount of protein is 140 grams, including animal protein – 70 grams;

The total amount of fat is 120 grams, including vegetable fats – 40 grams;

The total amount of carbohydrates is 500 grams.

Third option

– for patients with critical loss of body weight and laboratory confirmed impairment of the excretory function of the kidneys and liver:

Energy value – not higher than 2650 kilocalories per day;

The total amount of protein is 60 grams, including animal protein – 30 grams;

The total amount of fat is 90 grams, including vegetable fats – 30 grams;

The total amount of carbohydrates is 400 grams.

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 population:

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.

It is necessary to carry out therapy against Helicobacter pylori bacteria before the development of precancerous changes in the body. This type of bacteria is the etiological factor in 71-95% of all cases of stomach cancer.

The risk group includes people with a history of:

Genetic predisposition;

Carriage of H. Pylori;

Gastric resection;

Long period of work in hazardous and chemical industries;

Successful treatment of oncology depends on the stage of the disease. You should know and promptly recognize the symptoms of gastrointestinal cancer.

How does the disease manifest itself at the initial stage?

You should consult a doctor if you have the following clinical signs:

1. Loss of appetite. It’s not just an isolated incident that should alert you, but a persistent reluctance to eat. If food disgusts you, or you have to force yourself to eat it for three or more days, you should consult a doctor.
2. Weakness appears and performance decreases, even after rest.
3. Gastric discomfort occurs. We are talking about symptoms that the patient has never experienced before - for example, if after a small amount of food a feeling of overeating occurs. Vomiting and nausea, if they are not associated with poisoning, can be symptoms of gastrointestinal cancer.
4. Weight loss with a normal diet should also be of concern.
5. The appearance of uncharacteristic depressive states in a person. Reluctance to do anything, detachment from other people and from the world in general.
6. Heartburn, gas formation, regurgitation.
7. Anemia.

The disease can occur in three forms:

1. Latent. Cancer is discovered by chance on x-rays or during an examination with a doctor. The disease is asymptomatic.
2. Painless form.
3. The appearance of unpleasant sensations. Patients complain of pain in the upper abdomen. Often the suffering continues all day, and intensifies with movement. Pain can radiate to the back when the tumor grows deeply. Many tumors of the gastrointestinal tract have no symptoms at the initial stage. Oncologists divide all clinical signs into 2 groups: general and local. Patients often complain of pain with this disease. Unpleasant sensations appear after eating, sometimes from fatty foods.

A characteristic feature of malignant tumors is that the pain is not severe, but dull.

Cases have been recorded where the sensations are strong.
Doctors are alarmed by the symptom when a peptic ulcer is accompanied by weight loss and general weakness. Depending on where the tumor is located, clinical signs also change.

With duodenal carcinoma, there may be symptoms such as:

• constipation;
• diarrhea;
• stomach ache;
• nausea;
• heartburn;
• vomit;
• jaundice.

Symptoms of small intestinal carcinoma include:

• weight loss;
• nausea;
• vomit;
• weakness and fatigue;
• diarrhea;
• stomach ache.

For rectal carcinoma, the symptoms are as follows:

• constipation;
• blood in stool;
• pain.

Colon carcinoma has the following symptoms:

• weight loss;
• abdominal pain.

In gastrointestinal oncology, symptoms have common features with other diseases. Diagnosing cancer at an early stage is very important. You should undergo regular screening for early detection of the disease.

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