The accumulation of atypical cells on the inner walls of the stomach forms stomach cancer. Over time, the malignant process can invade deep into the organ. Also, the tumor can grow into the outer layers of the stomach and nearby organs (liver, pancreas, esophagus and intestines).
Stomach cancer cells, breaking away from the original tumor, tend to spread into the blood and lymphatic vessels, from which they enter any tissue of the organ.
At the initial stages, when the malignant process has not affected other organs, surgical treatment is used. Depending on the stage, the method involves removing part of the organ or the entire stomach.
In order to avoid the spread of the tumor at any period of treatment, chemicals, radiation and targeted therapy are used.
After surgery for stomach cancer: deterioration
Unfortunately, the surgical method of therapy does not always provide one hundred percent certainty of cure. Therefore, patients with gastric cancer require further monitoring and periodic laboratory tests. Most doctors recommend that patients undergo health exams every 3 and 6 months for the first few years. after stomach cancer surgery.
The patient’s well-being after gastric cancer surgery is significantly influenced by the person’s lifestyle. Therefore, it is important to visit a nutritionist to determine changes in eating habits, and also strictly adhere to the prescribed special diet.
People who have undergone an intermediate or total gastrectomy (removal of the upper part of the stomach) need to monitor their blood vitamin levels. They should be checked regularly and possibly receive vitamin supplements, which necessarily include injections of B 12. This measure is necessary because this type of vitamin is not absorbed at all during surgical excision of the upper part of the stomach.
It may be accompanied by a number of complications that arise for the following reasons:
- Stomach cancer has spread to distant sites.
- Aggressive treatment methods (radiation or chemotherapy) have a negative effect on healthy cells in the body, preventing them from dividing.
Stomach cancer after surgery: symptoms of deterioration, its causes and elimination
- Bloating and abdominal pain:
In this condition, it is possible for stomach cancer to spread to other organs of the body or in the abdominal cavity (ascites). Treatment varies depending on the cause.
- Back pain:
Often indicates an enlarged tumor and compression of the nerves surrounding the organ. Oncological lesions are often observed in the lumbosacral junction, which causes radiculitis. The condition worsens after eating or lying down. Treatment involves the use of analgesics and/or opiates.
- Bone pain:
Cancers can metastasize to bone tissue. Biphosphorate may be useful.
Important to know:
- Cachexia(global muscle loss):
A sign of the presence of metastases. It is difficult to treat. There is minimal benefit from taking dietary supplements.
Important to know:
- Thrombophlebitis(vein inflammation and blood clotting problems):
This is the body's response to cancer spreading into the blood vessels. Prescribing anticoagulants prevents the formation of blood clots.
Gastric cancer after surgery: metastasis
The emergence of gastric cancer after resection signals a new stage of malignant lesion and, unfortunately, a decrease in the chances of survival.
A recurrent malignant process affects the following organs:
Stomach: With partial excision, metastases may occur in other parts of the organ (the anastomosis, or the place where the small intestine connects to the rest of the stomach). Symptoms include: black stools consisting of altered blood, upset stomach, weight loss or early satiety.
Lungs: Leads to shortness of breath, chest pain and cough.
Liver: stomach in this organ is a common occurrence. The deterioration may be asymptomatic or cause minor discomfort in the form of bruises on the body or jaundice, which indicate poor blood clotting.
Stomach cancer after surgery: treatment and elimination of deterioration
Patients with advanced gastric cancer are offered several treatment options, which are determined with the help of oncologists, surgeons, gastroenterologists and nutritionists:
- Chemotherapy:
Is the main treatment method for patients who have stomach cancer after surgery. New drugs have been developed specifically for patients with recurrent cancer.
- Targeted therapy:
Anticipates the use of drugs to prevent further spread of cancer. In this regard, oncology suggests that it is advisable to use a protein called HER2 (human epidermal growth receptor 2). In case of metastatic gastric cancer, positive results are observed from the drug “Targeting”. It is known as Herceptin (trastuzumab). It is often used in combination with chemotherapy and can prolong survival in patients with advanced disease and HER2 positive tests.
Also, targeted treatments for stomach cancer after surgery include additional agents. Among them, it is worth highlighting such as Tykerb (“Lapatinib”), and drugs that are intended for other types of tumors (“Avastin”, the active substance is bevacizumab, and “Afinitor” with the main substance everolimus).
Serves as an indication for surgical intervention.
The decision about surgery is made based on the stage of the disease, the presence of secondary lesions and a number of other factors associated with the pathology. You should not refuse surgical treatment, since timely surgery significantly prolongs a person’s life and shortens the overall recovery time.
Indications and contraindications
A direct indication for gastric surgery is a malignant lesion of this organ.
Removing the stomach, part of it, and nearby organs and groups of lymph nodes allows you to remove most of the cancer cells from the body, and this reduces the risk of further spread of cancer.
Of great importance in complete recovery is the postoperative diet, chemotherapy and radiation sessions before and after surgery.
But surgery for stomach cancer cannot always be prescribed; the following are considered contraindications to its implementation:
- Metastases identified in the ovaries, pouch of Douglas, supraclavicular.
- Damage to lymph nodes located away from the stomach.
- Cancerous peritonitis.
- Severe damage to the cardiovascular system and kidneys.
- Hemophilia.
The operation is performed in the absence of contraindications, regardless of the patient’s age. Sometimes chemotherapy is required first, which leads to a shrinkage of the tumor and the possibility of its removal.
Diagnosis before resection
Before any type of gastric surgery, patients with cancer of this organ must be prescribed a series of medications.
They are necessary to determine the functioning of vital organs, to accurately determine the location of the tumor in the stomach, and to identify all secondary foci.
Prescribed:
- . This research method detects all changes on the walls of the stomach; during it, a biopsy is also performed, that is, the affected tissue is separated for histological examination.
- . This study shows the size of the tumor, its distribution throughout all layers of the organ walls, and damage to nearby organs and lymph nodes.
- scanning is necessary to identify secondary lesions. The abdominal organs, pelvic organs, and chest are examined.
- . According to blood parameters, one can judge the activity of the inflammatory process; they are also necessary to assess the functioning of the liver, heart, and blood coagulation system.
- An ECG examination is performed to detect changes in the functioning of the heart. For certain disorders, appropriate treatment is required before surgery.
- Chest X-ray.
Preparation measures
Before surgery to remove a malignant tumor in the stomach, patient preparation is necessary. Preoperative measures are carried out with the aim of improving the functioning of the most important organs, and with the aim of improving the overall well-being of a person.
The patient needs to be explained the advisability of following a special diet. Food several weeks before surgery should be consumed mainly in pureed, easily digestible form. The food should be fortified, it is better to eat in small portions.
The psychological preparation of the patient is also important. Not all doctors are inclined to immediately inform their patient about a malignant lesion. Usually the patient is told about a stomach ulcer, which must be urgently operated on to avoid complications.
The patient must be determined to have a favorable outcome from the surgical intervention; his relatives can also be of great help in this regard.
Medical preparation of patients with gastric cancer before surgical treatment consists of:
- In taking vitamin complexes and products that improve the performance of the digestive system.
- The use of sedatives to improve sleep and overall well-being.
- In the transfusion of protein drugs and plasma when severe anemia is detected in a patient.
- In the prescription of drugs that improve the functioning of the liver, kidneys, and heart.
- In treatment with antibiotics when an increasing inflammatory reaction and elevated temperature are detected.
If signs of bleeding are detected, hemostatic drugs are prescribed. Patients undergoing oncological operations are often prescribed a course of Methyluracil before surgery; this drug has anti-inflammatory properties, improves metabolic processes and liver function.
For stomach cancer, chemotherapy drugs are often prescribed before surgery; their use helps stop the spread of cancer cells throughout the body and stops tumor growth.
Correctly carried out preoperative preparation of patients with gastric cancer should reduce the negative impact of the pathology on the functioning of all organs, increase the functioning of the immune system and psychological preparation of the person.
Types of gastric surgery for cancer
In oncology, several types of operations are used during surgery.
They are selected based on the location of the tumor, the degree of its spread, and the age of the patient and the presence of nearby metastases are also taken into account.
- Resection, that is, removal of one of the parts of the stomach with a tumor.
- Gastrectomy– complete cutting off of an organ, in which parts of the intestines, esophagus and other structures are removed.
- Lymph dissection– cutting off lymph nodes and vessels along with the surrounding adipose tissue. Removal of lymph nodes is essentially part of a complete gastrectomy or gastrectomy.
- Palliative surgery. This type of surgery is prescribed to alleviate the disease in patients with inoperable types of stomach cancer. Various surgical techniques are used.
The decision on the type of surgical intervention is made after the doctor receives all the results of the examination of his patient.
Complete resection
Complete resection or total gastrectomy is the cutting off of the entire organ during surgery. It is prescribed if the cancer grows from the middle part of the organ or affects all its parts. In addition to the stomach, the following is also removed:
- Part of the omentum is a fold of peritoneum that holds the stomach.
- The entire pancreas or the part of the organ affected by metastases.
- Spleen.
- Lymph nodes located near the stomach.
After the stomach is removed, the upper part of the intestine is connected to the esophagus. The distal part of the duodenum 12 is also supplied to the intestine, which is necessary for the supply of enzymes that facilitate the digestion of food.
A total gastrectomy is a difficult operation, and after it is performed, the patient must adhere to the nutritional principles recommended by the doctor. How a person will feel in the future and how the recovery period will proceed depends on adherence to a postoperative diet.
Laparoscopic gastrectomy
Laparoscopic surgery is minimal intervention surgery. Currently, such treatment is also possible for gastric cancer.
First, the surgeon makes a small incision on the patient's abdominal wall, through which he inserts an endoscope; with its help, he examines the stomach itself and the structures nearby. After the examination, several more incisions are made to insert surgical instruments.
Laparoscopic intervention can be performed for stomach cancer, both for partial removal of the organ and for its complete gastrectomy.
Removal of the stomach, parts of it, lymph nodes, and affected organs are cut off using a special surgical knife. Expansion of the abdominal cavity and better visibility of all internal parts of the body are ensured by the introduction of carbon dioxide during laparoscopic intervention.
Thanks to the camera on the endoscope, the image is displayed on a large screen; the surgeon chooses to enlarge the image, which allows him to see all the changes and perform the operation with high precision.
Laparoscopic gastrectomy has fewer complications than conventional surgery.
After such an intervention, the patient tolerates the rehabilitation period more easily. But laparoscopy cannot always be prescribed, and in approximately three percent of cases when it is performed, due to a number of identified changes, it is necessary to proceed to conventional surgical intervention.
Partial proximal
Partial proximal gastrectomy is prescribed when the tumor is located in the upper part of the organ.
It is rarely performed, since the identified tumor must meet certain conditions, these are:
- The size of the neoplasm should not exceed 4 cm.
- Tumor growth must be exophytic.
- There should be no growth of cancer into the serous membrane.
Proximal resection involves not only cutting off the upper part of the organ, about 5 cm of the esophagus and lymph nodes are also removed. The operation is completed by forming an anastomosis connecting the remaining stump of the stomach with the severed esophagus.
Partial distal
Partial distal resection is chosen when a malignant tumor is diagnosed in the lower part of the stomach.
At the same time, lymph nodes, tumor-affected tissue and, if necessary, part of the duodenum are removed. The distal resection ends with the formation of a gastroenteroanastomosis, that is, the remaining part of the stomach is sutured to a loop of the jejunum.
Removal of lymph nodes
Regardless of what kind of surgery is performed for stomach cancer, removal of the lymph nodes is also considered a prerequisite. Cancer cells accumulate and develop in the lymph nodes, from where they can spread to distant organs and tissues.
Today, oncologist surgeons suggest removing at least 15 lymph nodes, which increases the success rate of surgical intervention and prolongs the patient’s life. But you need to know that cutting off lymph nodes also leads to a lot of complications, which only a person in good physical shape can cope with.
Palliative care
The term palliative surgery refers to surgery performed to relieve the symptoms of cancer.
Some types of such operations are carried out to reduce the size of the cancer, which also leads to a decrease in intoxication and allows great success to be achieved using chemotherapy and radiation.
Palliative operations for stomach cancer are divided into two types:
- The first surgical option involves creating a bypass between the small intestine and the stomach. This improves the patient’s nutrition, which has a positive effect on his well-being and allows him to better tolerate further treatment. With this type of operation, the stomach can be removed, but the lymph nodes and cancerous tissues of nearby organs are not touched.
- The second option involves complete excision of the tumor, this is necessary to enhance the effect of radiotherapy and chemotherapy.
Palliative surgery is prescribed in advanced cases, and it can somewhat prolong the patient’s life. There are also contraindications to palliative operations, this is the involvement of the skeletal system, mesentery, peritoneum, lungs, and brain in the oncological process.
What is lymph node dissection?
Lymph node dissection for gastric cancer is the cutting off of lymph nodes and vessels located near the organ along with the surrounding adipose tissue.
Lymph dissection varies in the extent of removal, which depends on the stage of the malignant lesion.
There are the following types of lymph node cutting:
- D0 - lymph nodes are not removed during surgery.
- D1 - cutting off nodes located along the near and greater curvature, next to the greater and lesser omentum.
- D2 - removal of the lymph nodes listed above and nodes belonging to the second level.
- D3 - lymph nodes located along the celiac trunk are additionally cut off.
- D4 - in addition to those listed, para-aortic nodes are cut off.
- Dn – removal of not only lymph nodes, but also cancer-affected organs located near the stomach.
The above options for removing lymph nodes are usually referred to as D1 lymph node dissection. There is also another option, referred to as D2 lymph node dissection, which also involves resection of groups of lymph nodes located near the main blood vessels of the stomach.
This surgical intervention is considered more complex in terms of its technique, but relapses of the disease occur less frequently.
Rehabilitation
The minimum rehabilitation period after removal of a part of the stomach or organ due to a cancerous tumor is at least three months. At this time, it is very important to strictly adhere to all the doctor’s recommendations; the person’s lifestyle in the future depends on this.
During the recovery period in the first weeks you should not:
- Visit baths and saunas.
- Stay under the sun for a long time.
- Resort to physiotherapy.
- Eat as usual.
The question about is the most important for patients with stomach cancer. Since after the operation the size of the organ is reduced or anastomoses are created, you need to adhere to certain rules in choosing dishes.
For the first two to three postoperative weeks, a person should eat baby food - adapted formulas and purees. In the future, regular food is consumed, but it must be pureed, and the volume of the dish at a time should not exceed 300 grams.
Chemical irritants, such as spicy, smoked, pickled foods, too salty foods, and alcohol are excluded. They gradually switch to their usual diet after about a year, but subject to normal restoration of digestive function. But the operated person should always know what is forbidden to him and completely exclude it from his diet.
During the rehabilitation period, control examinations are periodically carried out to allow timely detection of a relapse of the disease.
Should include: diet therapy, replacement therapy, vitamin therapy, treatment and prevention of anemia and psychotherapy. In an uncomplicated condition, the patient must eat every 3 hours (on average 6 times every 8 days), always taking gastric juice and pancreatin. Treatment with vitamins should be carried out periodically.
after surgery may be complicated by various conditions. This may be tumor recurrence, metastasis and non-oncological complications of gastric cancer after surgery, which include dumping syndrome due to the rapid evacuation of food from the stomach stump down the intestinal loop and exclusion of the duodenum from digestion. Nausea, vomiting, less often of a spastic nature 10-30 minutes after eating are clinical manifestations of this condition. They usually last about 2 hours. Another group of symptoms is of a vasomotor nature - immediately after eating there is a feeling of heat, palpitations, sweating, dizziness to the point of fainting, severe weakness to such an extent that the patient must lie down. Sometimes these symptoms occur while eating and last for 30-50 minutes, gradually subsiding. The severity of these symptoms varies from the onset of one symptom after eating a large amount of food containing carbohydrates (mild) to more severe symptoms that wax and wane periodically (moderate) to the constant presence and severity of all symptoms (severe). .
Hypoglycemic syndrome in stomach cancer after surgery is manifested on an empty stomach by severe weakness, dizziness, hunger, trembling, cold sweat, pain in the epigastric region, fainting, even collapse.
Afferent loop syndrome in gastric cancer after surgery is in some cases associated with atony of the afferent loop of the jejunum, which is manifested by a constant unpleasant sensation in the right hypochondrium and epigastric region, nausea, dizziness, several months after surgery. Partial obstruction in afferent loop syndrome (stenosis, bending, fusion) with impaired evacuation of bile and pancreatic juice is manifested by an attack of severe pain, profuse vomiting mixed with a large amount of bile. After this, the pain subsides.
All patients with stomach cancer after surgery should be under constant medical supervision and treatment. The diet for dumping syndrome should contain a small amount of carbohydrates and consist of high-calorie protein and fat foods. In severe cases, carbohydrates should be limited to 100 g per day. The patient should eat 6 times a day and rest 30-40 minutes after meals or eat in a semi-horizontal position. In some cases, it is necessary to limit fluids to the point of dry eating. It is advisable to prescribe novocaine (30-50 ml of 2% solution) or anesthesin (0.5 g) 10-15 minutes before meals, which relieve the severity of clinical symptoms. It is also possible to use vagosympathetic blockades. If afferent loop syndrome is suspected, the patient must be hospitalized for examination in a hospital, and in some cases even operated on.
In addition to these complications, stomach cancer after surgery may be accompanied by general disorders, which are expressed in poor condition, upset stool, weakness, catastrophic weight loss, and sometimes development. Along with this, there may be an occurrence associated with the absence of the stomach, which develops according to the type of iron deficiency or B12 deficiency. The patient's nutritional status can be assessed by height and weight.
In case of gastric cancer after surgery, as a result of regurgitation in the esophagus and in the area of the anastomosis, anastomositis and esophagitis develop, which can reach extreme degrees, up to the development of ulcerative forms. They are characterized by the presence of pain behind the sternum of varying intensity with irradiation upward, to the shoulder girdle, to the interscapular region, a burning sensation in the esophagus, pain when food passes through it, vomiting, regurgitation of bile. In the case of prolonged existence of reflux esophagitis, the development of cicatricial narrowing of the anastomoses is possible. The clinical symptom of this process is dysphagia, which is variable in nature, either weakening or intensifying depending on the severity of the accompanying inflammatory changes.
If there is anemia in a patient with stomach cancer after surgery, it is recommended to administer vitamin B1 100 mcg daily, Campolon, antianamine, iron supplements, and repeated blood transfusions.
Patients with stomach cancer who have developed anastomositis or reflux esophagitis in the immediate period after surgery are prescribed a diet based on the principle of maximum mechanical sparing with the exclusion of pure milk and limiting table salt. Meals should be taken frequently and should consist of liquid or semi-liquid dishes. The use of astringent and enveloping medications is recommended. To reduce inflammation and better passage of food through the esophagus, the patient should be advised to drink a tablespoon of sunflower or Provençal oil before meals. For persistent and severe pain, it is recommended to take 0.3-0.5 g of anesthesin or 30 ml of novocaine solution 30 minutes before meals. For the spastic component, which is almost always observed in esophagitis, papaverine, platiphylline, and no-spa are prescribed. Paravertebral blockade with 200-250 ml of 0.25% novocaine solution is possible. For erosive and ulcerative esophagitis, the use of
Hereditary diffuse gastric cancer is a type of cancer that is sometimes caused by a mutation in the CDH1 gene. Cancer cells are widespread or scattered throughout the stomach, making it difficult to detect at an early stage. To prevent the development of an aggressive form of stomach cancer, a gastrectomy (complete removal of the organ) is performed. If it is necessary to remove the stomach due to cancer, life expectancy largely depends on the qualifications of the surgeon, the absence of complications and adherence to diet after surgery.
The recommended treatment to prevent the development of an aggressive form of stomach cancer is gastrectomy (complete removal of the organ). It is also performed to treat some non-cancerous conditions. People with other types of stomach cancer may also have a gastrectomy.
Surgeries for stomach cancer
Learn about the different types of surgery for stomach cancer. The type of surgery depends on where in the organ the cancer is located. Stomach surgery for cancer is a serious treatment method. It is done under general anesthesia. The patient does not feel anything. The stomach may be partially or completely removed. The patient will not need an ostomy.
In the early stages of 1A cancer, the surgeon may remove the stomach lining. He removes the mucous using a long flexible tube (endoscope). The procedure is called endoscopic gastrectomy - this is the removal of part of an organ or mucous membrane. As a rule, the lower half of the stomach is removed, the remaining part is connected to the intestines.
Gastrectomy before and after
The portion of the small intestine that is first cut at the lower end of the duodenum is extended straight up to meet the esophagus. The end of the duodenum is reconnected to the small intestine. The entire procedure usually takes 4-5 hours, after which the patient's stay in the hospital is 7-14 days.
Often, patients are advised to avoid food and drink for the first 3-5 days, and tampons are moistened to relieve dry lips and mouth. The new digestive system can be fatal if the connection between the rectum and esophagus remains leaky.
An x-ray test is often used to check for leaks before resuming drinking and eating. The first 2-4 weeks after surgery will be challenging. It may be uncomfortable or painful to eat, but this is a normal part of the healing process. Some surgeons insert feeding tubes to supplement nutrition for a period of time after surgery—something to discuss before surgery.
Removal of part of the stomach
Up to 2/3 of the stomach is removed if the cancer is in the lower abdomen. How much is removed depends on the spread of the cancer. The surgeon will also remove some of the tissue that holds the organ in place. As a result, the patient will have a smaller organ.
Removal of the stomach and part of the esophagus
This operation is performed if the cancer is in the area where the stomach connects to the esophagus. In this case, the surgeon removes the organ and part of the esophagus.
Removal of lymph nodes
During the operation, the surgeon examines the organ and the surrounding space. If necessary, remove all lymph nodes located near the stomach and along major blood vessels if they contain cancer cells. Removing nodes reduces the risk of cancer returning. There are cases when the cancer comes back after surgery, then chemotherapy is required or, if possible, a second operation.
Types of surgery
Open surgery
The type of surgery depends on where the cancer is in the stomach. Removal of the stomach for cancer is usually done by open surgery.
- Subtotal gastrectomy is an operation through an incision in the abdomen.
- A total gastrectomy with reconstruction, where the surgeon makes one incision in the abdomen to remove the entire stomach and all omentums. The surgeon attaches the esophagus to the duodenum.
- Thoracoabdominal gastrectomy – the stomach and esophagus are removed through an incision in the abdomen and chest.
Laparoscopic surgery
This is an operation without the need for a large incision in the abdomen. Keyhole surgery may be required to remove the stomach. This type of surgery is done in specialized centers by specially trained surgeons. The surgeon makes 4 to 6 small cuts in the abdomen. A long tube called a laparoscope is used.
The laparoscope is connected to a fiber-optic camera, which displays photographs of the inside of the body on a video screen. Using a laparoscope and other instruments, the surgeon removes part or all of the stomach. Then the remaining organ is connected to the intestines, or the esophagus is connected to the intestines if the entire organ is removed. Laparoscopic surgery takes 30 to 60 minutes.
The most common way to remove a major organ is open surgery.
Less invasive procedures include:
- treatment and blood tests to monitor indicators;
- dietary nutrition;
- light exercise;
- consultation with an oncologist and nutritionist.
At home after surgery, it is necessary to work towards regulating nutrition, allowing the body to adapt to the loss of the stomach. At the same time, it is important to consume as many calories as possible to minimize rapid weight loss during the first few months after surgery, as well as take in the nutrients the body needs to help with the healing process.
Possible complications after stomach removal
As with any type of surgery, the operation carries a risk of complications. Problems may arise due to changes in the way food is digested. There may be the following main complications: weight loss, dumping syndrome, blockage of the small intestine, vitamin deficiency and others. Some complications can be treated with medication, otherwise another operation will be required.
One of the functions of the stomach is to absorb vitamins in food (especially B12, C and D). If the organ is removed, the person may not be able to get all the vitamins, which can lead to anemia and vulnerability to infection. Vitamin C helps strengthen the immune system (the body's natural defense against infection and disease).
If the body does not have enough vitamin C, frequent infections may develop. Wounds or burns will also take longer to heal. As a result of vitamin D deficiency, bone osteoporosis can develop.
Immediately after surgery, the patient may experience discomfort when eating. People who have a gastrectomy must adapt to the effects of the operation and change their diet. A nutritionist can give advice on how to increase your weight with an unusual digestive system. Dumping syndrome is a set of symptoms that can affect people after surgery.
The amount of water gradually increases to 1.5 liters per day. Most of the extra water is taken from the blood, which means a possible drop in blood pressure.
A decrease in blood pressure causes symptoms: nausea, hyperhidrosis, rapid heartbeat. In this state you need to lie down.
Excess water in the body causes symptoms: flatulence, stomach rumbling, nausea, upset, diarrhea.
If you have dumping syndrome, resting for 30 minutes after eating may help. In order to alleviate the symptoms of dumping syndrome, you need to:
- eat slowly;
- avoid sweet foods;
- gradually add more fiber to your diet;
- eat less, in more frequent meals.
Removal of the stomach for cancer - 65% of people overcome the lifespan of 5 years. In the final stages, 34% survive to the five-year mark. If a person applies at the last stage, after diagnosis he can live only six months.
Informative video
– re-development of a malignant tumor in the remaining part (stump) of the stomach after radical surgery. The clinical picture is similar to primary gastric cancer. There is a deterioration in the general condition, dyspepsia and disturbances in the patency of the gastrointestinal tract. Distinctive features of recurrent gastric cancer are higher aggressiveness, a tendency to infiltrative growth and invasion of nearby organs. The diagnosis is made on the basis of anamnesis, complaints, results of gastroscopy with biopsy, ultrasound and CT scan of the abdominal organs. Treatment is surgical, drug or radiation.
General information
Causes of recurrent stomach cancer
In clinical practice, oncologists usually use the M.D. classification. Laptin, according to which there are three groups of recurrent gastric cancer:
- Left (residual) cancer or early relapse. Occurs up to 3 years after removal of the primary cancer. Accounts for 63% of the total number of relapses.
- Repeated cancer or late relapse. Develops 3 years after removal of the primary malignant tumor. Accounts for 23% of the total number of relapses.
- Primary (initial) cancer. Occurs 3 or more years after removal of a benign stomach tumor. Accounts for 15% of the total number of relapses.
The reason for the development of relapse of stomach cancer is the resumption of the tumor process, not removed malignant cells in the remaining part of the organ or regional lymph nodes. The likelihood of relapse depends on the stage and degree of differentiation of the tumor. Stage I-II cancer recurs in 19%; with stage III primary neoplasms, the risk of developing gastric cancer recurrence increases to 45%. The largest number of recurrent tumors are detected in poorly differentiated forms of primary cancer.
Symptoms of recurrent stomach cancer
Relapse of stomach cancer develops against the background of existing post-resection disorders, so the initial stages of the disease may go unnoticed by the patient. A characteristic sign indicating the occurrence of a recurrent oncological process is the worsening of symptoms after a clear interval, the duration of which can range from several months to several decades.
The clinical picture resembles the symptoms of primary gastric cancer. Patients complain of weakness, unreasonable fatigue, apathy, loss of interest in activities that previously brought joy and satisfaction, as well as decreased ability to work for several weeks or months. Patients with recurrent gastric cancer experience a persistent deterioration in appetite, weight loss, “stomach discomfort” (lack of satisfaction after eating, a feeling of a full stomach when eating a small amount of food, pain, a feeling of fullness or heaviness in the epigastric area), nausea, vomiting and pallor skin.
With early relapses of gastric cancer, mainly localized in the anastomotic area, frequent vomiting, dehydration and severe exhaustion due to stenosis of the gastrointestinal anastomosis may be detected. With late relapses of gastric cancer, often located in the cardiac region, the leading symptom usually becomes dysphagia. Often the oncological process spreads to the entire remaining part of the stomach, which entails rapid progression of symptoms.
Diagnosis of recurrent stomach cancer
The diagnosis is made taking into account the medical history, complaints, objective examination data, results of instrumental and laboratory tests. During the survey, attention is paid to the progression of post-resection complaints over time, lack of appetite, weight loss and the appearance of “stomach discomfort”. The most informative research method that allows reliably diagnosing recurrent gastric cancer is gastroscopy with endoscopic biopsy. To identify ascitic fluid and liver metastases, ultrasound of the abdominal organs is prescribed. In some cases, using this technique it is also possible to detect enlarged retroperitoneal lymph nodes.
More detailed information about the condition of nearby organs and lymph nodes in case of relapse of stomach cancer is obtained using CT scan of the abdominal cavity. Sometimes, for the same purpose, laparoscopy is performed, which allows one to assess the condition of the anterior surface of the stomach, the lower and anterosuperior surface of the liver, ovaries and spleen, and detect ascites and peritoneal carcinomatosis. To determine the level of anemia, patients with recurrent gastric cancer are prescribed a general blood test, and a biochemical blood test is performed to assess liver and kidney functions. The final diagnosis is made after a morphological examination of the material taken during gastroscopy.
Treatment of recurrent stomach cancer
Treatment is predominantly surgical. In most cases, the most promising surgical option is gastric stump extirpation. In case of a large gastric stump and a small tumor located in the anastomosis area, gastric resection is sometimes performed. The possibility of reoperation depends not only on the size, location and extent of recurrent gastric cancer, but also on the type of primary surgery. After gastric reconstruction according to Billroth-II, repeated operations can be performed more often than after surgery according to Billroth-I.
Due to previous lymph node dissection, lymphatic metastasis in recurrent gastric cancer differs from that in the primary tumor. Lymphogenic metastases can be found in the area of the hilum of the spleen, left paracardial lymph nodes, lymph nodes along the inferior phrenic artery and lymph nodes in the mesentery of the small intestine. Features of the lymphogenous spread of cancer cells necessitate extended lymph node dissection, removal of the spleen and resection of the mesentery.
In case of widespread relapse of gastric cancer, complicated by severe strictures, palliative operations are performed. Chemotherapy provides temporary tumor regression in some patients, but does not affect average life expectancy. This treatment method can be used if radical removal of the tumor is impossible. In some cases, it allows you to delay palliative surgery or do without such intervention. Radiation therapy for recurrent tumors is rarely used due to problems with effective irradiation of deep-lying organs and the high resistance of gastric cancer to radiotherapy.
Prognosis for recurrence of stomach cancer
The prognosis for recurrent stomach cancer is in most cases unfavorable. The average five-year survival rate is 26%. With early relapses, 23% of patients survive up to 5 years from the moment of surgery, with late relapses – 27% of patients. The average life expectancy for a relapse of signet ring cell carcinoma is 18 months, for a relapse of a poorly differentiated tumor - 25 months, for a relapse of gastric adenocarcinoma - 33 months. In the presence of lymphogenous metastases, the life expectancy of patients with recurrent gastric cancer is reduced to 17 months. With germination of the liver, colon and pancreas, 23.8% of patients manage to cross the three-year mark; 19% of patients survive up to 5 years from the moment of reoperation. The most unfavorable location for recurrent gastric cancer is the anastomotic area; only 13% of patients survive 5 years after surgery.