Overview of Stomach Cancers
Stomach Cancer Surgery | The stomach and duodenum are two of the important parts of the digestive system. The stomach sends small pieces of food to the duodenum after feeding, and thanks to the hormones secreted in the duodenum, both bile and pancreatic secretions are activated, making a great contribution to digestion. These two organs play a critical role in the proper functioning of the digestive system. Stomach and duodenum diseases have a wide range. Common ones include benign diseases such as stomach ulcers, gastritis, stomach bleeding, gastroesophageal reflux disease (GERD), as well as serious cancers such as stomach cancer and duodenal cancer.
The Functions and Importance of the Stomach
The stomach is an important organ of our digestive system and undertakes vital tasks for our body. It takes the first steps in digesting food and absorbing nutrients.
The Basic Functions of the Stomach:
*Storing Food: The food we eat is temporarily stored in the stomach. In this way, the digestive system works more regularly and the body absorbs nutrients slowly.
*Breakdown of Food: The stomach breaks down food mechanically and chemically thanks to its strong muscles and the acid it secretes. In this way, food is broken down into smaller pieces and the effect of digestive enzymes becomes more effective.
*Production of Digestive Enzymes: The stomach produces digestive enzymes such as pepsin. These enzymes play an important role in the breakdown of proteins.
*Preservation of Food: Stomach acid protects the body from infections by killing harmful bacteria.
*Transition of Food to the Small Intestine: The stomach slowly passes the digested food to the duodenum.
Stomach Cancer, Causes and Risk Factors
More than 90% of stomach tumors are malignant. 95% of primary malignant tumors are Adenocarcinoma, or stomach cancer, 4% lymphoma, and 1% GIST. Rare tumors are carcinoid, angiosarcoma, carcinosarcoma, and YEHCa. The tumor can remain in the stomach. It can also spread to other organs such as the liver, lungs, or the lining of the abdominal wall. Tumors such as melanoma or breast cancer can invade the stomach through blood (hematogenous), and colon and pancreatic cancers can invade the stomach due to proximity, and these are called metastatic stomach tumors.
Stomach cancer is a tumor that develops as a result of abnormal and uncontrolled growth and proliferation of the mucosal cells lining the stomach. Early-stage stomach cancer usually does not show symptoms. Sometimes, people experience nausea and general stomach discomfort. However, these symptoms are also common symptoms of conditions such as indigestion or gastritis. Therefore, it is difficult to diagnose stomach cancer in its very early stages. Stomach cancer is an aggressive tumor and usually causes symptoms in advanced stages. Worldwide, stomach cancer is the fifth most common cancer and the second leading cause of cancer-related deaths. More than half of new cases occur in developing countries. It is particularly common in East Asia, Eastern Europe, and Central and South America. Higher latitudes are associated with a higher risk of stomach cancer. Among developed countries, Japan and Korea have the highest rates of disease. Stomach cancer is the most common cancer in Japan. In the United States, stomach cancer is 15th, which is considerably less common than in Eastern societies. It is more common in men and occurs most often in people in their 70s. It has a higher mortality rate in African Americans, Asian Americans, and Hispanics than in whites.
Helicobacter Pylori Infection
Helicobacter pylori (H. pylori) bacteria are the most important risk factor for gastric adenocarcinoma. In 1994, the International Agency for Research on Cancer (IARC) labeled H. pylori a definite carcinogen; it is the most common cause of infection-related cancers. Numerous scientific studies have shown its association with the development of gastric cancer. H pylori increases the risk of developing gastric cancer by approximately sixfold. The primary mechanism is thought to be the presence of chronic inflammation. Long-term infection with the bacteria can lead to atrophic gastritis or chronic active gastritis. In some patients, gastritis progresses to intestinal metaplasia, dysplasia, and eventually gastric cancer.
Diet and Nutritional Habits
The risk of stomach cancer is directly affected by the type of foods we eat and how they are prepared. In particular, the consumption of excessively salty and processed foods can increase the risk of stomach cancer. Other important dietary features:
Highly salty and processed foods: Pickles and overly salty foods, canned and smoked meats, and high dietary intake of nitrates can increase the risk of stomach cancer. High (but not low or modest) alcohol levels increase the risk.
Low fruit and vegetable intake: Inadequate fruit and vegetable intake can increase the risk of stomach cancer. These foods are full of antioxidants and vitamins, which can help prevent cancer cells.
Alcohol consumption: If you drink more than three alcoholic drinks a day, your risk of stomach cancer increases. Alcohol consumption, especially when combined with smoking, is a major risk factor for stomach cancer.
Smoking and Tobacco Use
Smoking is one of the major factors that increases the risk of stomach cancer and many other cancers. Harmful chemicals in cigarette smoke directly affect the stomach and pave the way for cancer development. Secondhand smoke is also a factor that increases the risk of stomach cancer.
Genetic Factors and Family History
If a close blood relative has stomach cancer, you may be at higher risk. Blood relatives are parents, siblings, and close relatives related to you by blood. They are not related by marriage or adoption. A first-degree blood relative is a parent, sibling, or child. The risk of developing stomach cancer is higher in those with a family history of stomach cancer. 5-10% of stomach cancers are familial, with a 2-3 times higher risk in a first-degree relative.
For reasons not yet fully understood, the risk is higher in people with blood type A.
3-5% of stomach cancers are associated with genetic cancer predisposition syndromes, including:
-Hereditary diffuse gastric cancer (40% associated with CDH1 variants)
-Gastric adenocarcinoma and gastric proximal polyposis
-Familial intestinal gastric cancer
-Hereditary nonpolyposis colorectal cancer syndrome (HNPCRC; Lynch syndrome): This genetic disease can increase the risk of developing many cancers, including stomach cancer. 10% of those with HNPCRC develop stomach cancer (mostly intestinal).
– Familial adenomatous polyposis
– Peutz-Jeghers syndrome
– Juvenile polyposis syndrome
– Li-Fraumeni syndrome
– Ataxia-telangiectasia syndrome
– Bloom syndrome
– Hereditary breast and ovarian cancer syndrome (associated with BRCA1 and BRCA2)
– Xeroderma pigmentosum
– Cowden syndrome
Conditions that lower the acid level in your stomach: Certain conditions cause stomach acid levels to be low, which can increase your risk of stomach cancer:
*Autoimmune gastritis, an autoimmune disease that also causes pernicious anemia.
* Menetrier disease, a rare disease that causes large folds to form in the stomach.
Age and Gender
Stomach cancer is generally more common in older individuals. Individuals aged 50-70 may be more prone to stomach cancer. It is rare under the age of 40. Men are also at higher risk of stomach cancer than women. This difference is due to hormones, genetics and lifestyle factors.
Chronic Stomach Diseases
Chronic inflammation in the stomach can lead to changes in your cells, including inflammation from Helicobacter pylori infection. These changes increase your risk of stomach cancer.
How does stomach cancer develop in cell changes?
Gastritis, or inflammation, can cause cells in the stomach lining to change into different types of cells. Normal cells in the stomach can turn into atrophic gastritis. This can turn into intestinal metaplasia, then dysplasia. Finally, the cells can turn into stomach cancer.
Atrophic gastritis: Chronic inflammation in the stomach is called gastritis. When there is inflammation in the stomach for a long time, this can cause the normal lining of the stomach to thin. This is called atrophy, also known as atrophic gastritis.
Sometimes, this change can be reversed if we treat the cause of the inflammation. If the inflammation continues, it can lead to gastric intestinal metaplasia.
Gastric intestinal metaplasia: If the inflammation continues for a long time, the atrophied cells can change again. They start to look more like the cells that should line the intestines, not the stomach. This is called gastric intestinal metaplasia. Gastric intestinal metaplasia is not cancer, but it is a condition that can turn into cancer.
Dysplasia: Cells that have changed into intestinal metaplasia are more likely to change again. If they do, it is called dysplasia. These are abnormal, precancerous cells that can change into cancer cells. These lesions must be treated or closely monitored to prevent them from becoming cancerous.
Low-grade dysplasia means that only a few changes have occurred in the cells.
High-grade dysplasia means that many cells have changed. There are no signs of cancer, but high-grade dysplasia is more likely to become cancerous.
Stomach ulcers: Stomach ulcers are also called peptic ulcers or gastric ulcers. Stomach ulcers are open sores in the lining of the stomach. Ulcers and chronic (long-term) inflammation can turn the cells into cancer. Chronic inflammation can also lead to gastric lymphoma in some cases. A symptom of a stomach ulcer is a burning sensation in the stomach. Some stomach ulcers do not hurt until they bleed.
Gastric polyps: Stomach polyps, especially adenoma polyps, carry a risk of stomach cancer.
Physical Activity and Obesity
Low physical activity levels and obesity are other important factors that can increase the risk of stomach cancer. Obesity can promote a spectrum of cancer that leads to the functioning of certain hormones. In addition, loss of physical activity can prevent the digestive system from functioning properly.
Environmental Factors
You can increase your risk of stomach cancer due to certain factors. Especially exposure to carcinogenic substances such as radon, air pollution and long-term exposure to certain chemicals can increase the risk of stomach cancer.
Can Stomach Cancer Be Prevented?
Stomach cancer develops as a result of a series of genetic, growth and lifestyle factors. Stomach cancer is a partially preventable disease. In addition to unchangeable factors such as genetic predisposition, changeable factors such as lifestyle and eating habits play an important role in the development of stomach cancer.
Some important steps that can help prevent stomach cancer:
*Healthy Diet: Consuming plenty of fruits and vegetables, choosing fibrous foods, avoiding salty and processed foods, and limiting processed red meat consumption can reduce the risk of stomach cancer.
*Protection from Helicobacter pylori Infection: This bacteria is an important risk factor for stomach cancer. Regular dental and oral care and attention to hygiene can reduce the risk of this infection.
*Avoiding Smoking and Alcohol: Smoking and alcohol are factors that significantly increase the risk of stomach cancer. It is very important to give up these habits.
*Fighting with Obesity: Obesity increases the risk of stomach cancer, as do many types of cancer. Regular exercise and a balanced diet are important for maintaining a healthy weight.
*Avoid Foods Prepared with Salt Drying Methods: These types of foods can increase the risk of stomach cancer due to their nitrate and nitrite content.
*Regular Check-ups, Controls: Even if you do not have symptoms, it is important to go to the doctor regularly and have necessary tests such as Gastroscopy for early diagnosis.
What are the symptoms of stomach cancer?
Gastric cancer is usually an insidious disease, it gives late symptoms. A vague feeling of discomfort in the epigastric region is the most common initial symptom. The most common symptoms in advanced stages are weight loss, loss of appetite and early satiety. Weakness, dysphagia, nausea, vomiting, bloating and abdominal pain are other symptoms. Occult bleeding is common, Fe deficiency anemia and +FOBT test are present. Acute GI bleeding occurs in 5% of patients. In cancers that affect the stomach-esophagus junction, namely the cardia, there is dysphagia with difficulty swallowing. Some patients present with metastasis findings such as liver enlargement (hepatomegaly), ascites or jaundice. In 50% of patients, there is a palpable abdominal mass during examination. We may also rarely encounter Trousseau syndrome (Thrombophlebitis) Paraneoplastic syndromes, Acanthosis nigricans (black spots in the axilla and groin) or peripheral neuropathies.
Common symptoms of early-stage gastric cancer are as follows:
- Persistent stomach pain, indigestion or discomfort
- Painful burning sensation in the chest
- Bloating, usually after eating
- Nausea (feeling like vomiting)
- Loss of appetite (not wanting to eat)
- Fatigue (feeling very tired) even after resting
- Trouble eating or swallowing
- Feeling full after eating only a small amount of food
- Burps
- Weight loss
- Black stools (poop) or blood in stool
If you experience any of these symptoms, you should definitely see a doctor.
Remember, stomach cancer that is diagnosed early can be treated more successfully.
Stage 4 stomach cancer is advanced or late-stage cancer, also called metastatic stomach cancer. It has spread to other parts of the body and causes symptoms. The symptoms caused by stage 4 stomach cancer may be the same as the symptoms of localized (early-stage) stomach cancer. This is because the symptoms are usually caused by a tumor in the stomach.
Weight loss, fatigue, and weakness are more common in stage 4 stomach cancer. They will worsen as the cancer cells spread throughout the body.
Common symptoms of stage 4 stomach cancer include:
- Unexplained weight loss
- Vomiting after meals
- Stomach pain, usually after meals
- Difficulty swallowing
- Belching
- Jaundice (yellow tint to the skin or whites of the eyes)
- Anemia (low blood count)
- Persistent stomach ulcers
- Ascites (fluid buildup around the stomach)
- Weakness
Are the symptoms of stomach cancer different in men and women?
The symptoms of stomach cancer are the same for men and women. Men are more likely to develop stomach cancer than women. However, recent research studies suggest that stomach cancer is also increasing in women.
Do stomach ulcers and cancer show the same symptoms?
The symptoms of both stomach ulcers and stomach cancer can be similar. In both cases, you may feel:
- You are full and don’t want to eat
- Bloating
- Heartburn (pain that extends from your belly to your chest)
- Mild nausea (feeling like you’re going to throw up)
A common symptom of stomach cancer is constant stomach pain. The most common symptom of stomach ulcers is a burning pain in the stomach that can come and go. The pain depends on when and what you eat.
How is Stomach Cancer Diagnosed?
Endoscopy: Endoscopy should be performed on all patients over the age of 45 with newly developed dysphagia or dyspepsia + alarm symptoms (KK, RK, D, Bleeding and anemia) or dyspepsia + family history. Upper GIS Endoscopy, namely Gastroscopy, examines the esophagus, stomach and duodenum, and if necessary, 98% of stomach cancers can be identified with biopsy or cytology. Endoscopic biopsy provides definitive diagnosis, provided that it is taken from the area where malignant changes are present.
Barium X-ray: It is quite difficult to distinguish cancer from benign ulcers radiologically with an X-ray taken by oral dye: Benign ulcer craters project outward from the lumen, while malignant ulcer craters project into the lumen. In addition, in benign ulcers, gastric folds radiate from the ulcer crater. Today, we almost never use barium X-rays for diagnosis.
Computerized Tomography (CT): 3D images of your stomach are created with CT. The images show bones, organs, muscles, tumors and other soft tissues, and can also show the location and size of a tumor.
During a CT scan, a machine uses radiation to take detailed pictures of your stomach. It takes a series of pictures from different angles. A computer connected to the machine combines the images to create a 3-D image.
Some CT scans use a special substance called contrast dye. The contrast dye makes it easier to see differences inside your body.
CT is the best preoperative staging tool before surgery, rather than a diagnostic tool. An MRI is often not necessary after a good abdominal-pelvic CT scan.
How Does Endoscopic Ultrasound, EUS, Detect Stomach Cancer?
EUS is a procedure that uses sound waves to show images of your stomach. It tells us about:
- How deep the tumor has grown into the tissue.
- If your lymph nodes are enlarged.
- If there is a tumor in nearby tissues.
- How a tumor is responding to cancer treatment.
This procedure uses a flexible tube called an endoscope to see the inside of your stomach on a video screen while you are under anesthesia. The thin, lighted tube is advanced through your mouth and into your stomach.
An ultrasound probe on the end of the endoscope uses high-frequency sound waves to create still or moving pictures. The probe emits sound waves that bounce off tissues or organs and create echo patterns.
These patterns are shown on the ultrasound machine’s screen as images called sonograms. The sound waves bounce off the walls of your stomach. They create pictures of your abdominal (stomach) area, including nearby lymph nodes and organs.
EUS gives full information about the tumor’s penetration into the stomach wall. It frequently shows >5mm Perigastric and Celiac LNs. It cannot see <5mm LNs. The most important aspect is that it distinguishes between early T1 stage tumors and advanced gastric cancer.
Is PET-CT required for every stomach cancer?
PET-CT: Cancer cells accumulate the positron emission of 18F Fluorodeoxyglucose. It is very useful in revealing distant metastasis. It should be used before major surgery, especially in tumors with a high risk of spreading to other organs or in patients with high comorbidities, i.e. those who cannot tolerate major surgery.
Staging Laparoscopy and Peritoneal Cytology: Diagnostic laparoscopy is a minimally invasive procedure that allows the stomach and intra-abdominal organs to be seen. Minimally invasive means that the procedure is performed with 2 or 3 small incisions (cuts) that cause less damage to your body. A laparoscope is a long, thin surgical instrument with a video camera on its end. During laparoscopy, your surgeon inserts the laparoscope into your abdomen (belly) through a small incision made in your skin. This instrument allows the inside of your abdomen to be seen. The outer wall of the stomach, lymph nodes and nearby organs can be examined. It can check if the cancer has spread to these areas. Laparoscopy is a good and fast method in terms of showing Liver and Peritoneal metastases (23-37%) that are not detected by preoperative X-ray
Peritoenal lavage cytology is 40%+ and most of these patients develop peritoneal metastases. Local (intraoperative hyperthermic chemotherapy, KT) treatment protocols are tried for these patients, but their benefits are controversial.
Which Department Should You Go To For Stomach Cancer?
Stomach cancer is usually among the digestive system cancers and can be difficult to detect in the early stages. A person with suspected stomach cancer should be referred to a series of treatment specialists for the correct diagnosis and treatment process. The areas that will change place in the stomach treatment process and these intervals are detailed in detail. A person with stomach complaints can apply to internal medicine, general surgery, gastroenterology. What should be done directly, especially if there are risk factors for stomach cancer.
1-Endoscopy, Gastroscopy: Directly seeing the stomach is the most important procedure in terms of detecting cancer. GIS Endoscopists can observe cancerous tissues or lesions by looking inside the stomach.
2-Biopsy: During the endoscopic examination, biopsies should be taken from each suspicious lesion for pathological examination. Biopsy is necessary to definitively determine the presence of cancer.
If the diagnosis of stomach cancer is confirmed, the clinician may refer the patient to an Oncological Surgeon for further evaluation and surgery. After the oncological surgeon completes the staging of stomach cancer with examinations such as CT and EUS, he/she evaluates it in a multidisciplinary manner in the oncology council and plans the surgical treatment.
What are the Stages of Stomach Cancer (Stage 0, 1, 2, 3, 4)?
Staging is a part of the diagnostic process. It tells how far the cancer has advanced. It describes the size, location and spread of the tumor. Staging helps to choose the best treatment and follow-up plan for stomach cancer.
The stage of stomach cancer is decided by examining the physical examination and the diagnostic and imaging tests (CT, EUS, sometimes PET-CT).
There are 5 stages of stomach cancer from 0 to 4. The lower the number, the less the cancer has spread and the easier it is to treat. Stomach cancer stages are also defined as 0, I, II, III, IV and V.
They use the TNM system to describe the stage of stomach cancer:
*T describes the main tumor. It tells how deep the tumor is in the layers of the stomach wall.
*N describes whether the tumor has spread to nearby lymph nodes.
*M describes whether the cancer has metastasized (spread) to other parts of the body.
What is Stage 0 Stomach Cancer?
There are some cancer cells limited to the stomach mucosa, that is, only the inner lining of the stomach. This stage is also called carcinoma in situ.
What is Stage 1 Stomach Cancer?
In this early stage of stomach cancer, the tumor has spread from the mucosal cell layer to the next layers. It most likely has not spread to nearby lymph nodes. However, it is possible that it has spread to only 1 or 2 nearby nodes. It is not in other parts of the body.
What is Stage 2 Stomach Cancer?
Stage 2 cancer has spread to other layers. It may have spread to nearby lymph nodes. It has not spread to other organs or distant lymph nodes.
What is Stage 3 Stomach Cancer?
Stage 2 stomach cancer has spread to other layers and nearby lymph nodes. It has not spread to other organs or distant lymph nodes.
What is Stage 4 Stomach Cancer?
Stage 2 stomach cancer is advanced cancer. It has spread to other organs or distant lymph nodes. Stage 4 is also called metastatic stomach cancer. It begins when cancer cells travel through the body through the lymph or blood systems. Stomach cancer cell tumors form in other parts of the body.
The 5-year relative survival rate for people with metastatic (advanced) stomach cancer is low, at only 7%. This means that only 7 out of every 100 people diagnosed with this type of advanced stomach cancer will still be alive after 5 years.
Treatment for Stomach Cancer
In Japan, where stomach cancer is very common, strict screening endoscopies are used to find and treat stomach cancers at a very early stage. This means that more people do not die from stomach cancer.
Can Stomach Cancer Be Treated Endoscopically Without Surgery?
Endoscopic Submucosal Dissection (ESD): When stomach cancer is caught early, it can be removed without surgery using an endoscopic procedure called ESD, providing a complete cure for these patients.
Surgical Treatment of Stomach Cancer
The most common treatment method for Stage I-III Stomach Cancers is still surgery. Gastrectomy is a surgery performed to remove part or all of the stomach. Especially the Japanese prefer Radical Gastrectomy, that is, a surgery in which a large part or all of the cancerous stomach is removed together with the nearby and regional lymph nodes. The contributions of this radical oncological surgery: 1-It contributes to survival, 2-It allows for accurate staging, 3-It eliminates the need for RT, or radiation therapy, especially in D2 and above lymphadenectomy. However, in order not to increase the complications in radical surgeries, an experienced oncological surgeon should be on this subject.
Types of gastric cancer gastrectomy
- Partial gastrectomy
- Distal subtotal gastrectomy
- Total gastrectomy
- Laparoscopic, Robotic gastrectomy
- Proximal gastrectomy
The most frequently performed surgeries are Distal subtotal gastrectomy and Total gastrectomy. These surgeries can be performed with open surgery or minimally invasive surgery. Minimally invasive methods such as laparoscopy or robotic gastrectomy offer advantages over open surgery. Minimally invasive methods cause less damage to the body. They cause less pain.
The benefits of minimally invasive cancer surgery (laparoscopic or robotic) include:
- Less blood loss.
- Shorter hospital stay.
- Faster recovery.
- Less scarring.
- Less risk of infection.
- Fewer complications (problems) during and after surgery.
Surgical Oncology Department
Surgery plays an important role in the treatment of stomach cancer. Surgical oncologists are specialized general surgeons who provide surgery in accordance with oncological principles in the surgical treatment of cancer. Gastric surgery surgeries usually vary according to the stage of the cancer, the location of the tumor and its appearance, and the general health changes.
Post-operative Recovery
The recovery process of the surgery may vary depending on the growth stage, the deterioration of general health and the scope of the surgery. In general, the recovery process progresses as follows:
First Days: The patient usually stays in the hospital for 4-6 days after the surgery. During this period, pain management, fluid and nutritional therapy, antibiotic prophylaxis and other supportive treatments are performed.
Early Mobilization: Patients are encouraged to mobilize early after the surgery. This can accelerate the recovery process and includes supplements.
Diet: In stomach cancer surgery, patients usually start eating liquid food the next morning. In patients who are compliant, soft foods are switched to on the second day.
Discharge: When the patient’s post-operative eating, drinking, urination and defecation are at a sufficient level, they are discharged after coming for a check-up with recommendations.
Follow-up Process: Patients should be followed up regularly during and after the recovery process. It is also necessary to check that the cancer has not returned after the end of oncological medical treatment, i.e. chemotherapy.
Post-Operative Complications
Some complications may occur after stomach surgery. These include:
Infections: Can be seen in the surgical area, especially after open surgery.
Digestive Problems: Since a part of the stomach is removed, digestive problems (discomfort after heavy meals, bloating) may be experienced.
Nutritional Deficiencies (Nutritional Deficiencies): A part of the stomach is removed, which may lead to vitamin and mineral deficiencies. This situation lists deficiencies such as vitamins B12 and iron.
Healing of wounds: The wound healing process after surgery may vary depending on the recovery period and general health performance.
Stomach cancer surgery is a very important step in cancer treatment. In surgery, the removal of cancerous tissue, the removal of lymph nodes and the expansion of the spread of cancer have a large tissue. The recovery process after surgery should usually be carefully monitored and taken into account. Stomach cancer surgery is a multidisciplinary permanent treatment process and needs to be planned specifically.
Palliative Care Department
If stomach cancer is in the advanced or terminal stage, palliative care can be applied to increase the quality of life. Palliative care includes treatment methods aimed at alleviating cancer-related complaints and provides psychological, physical and emotional support for the person.
Palliative care is used with the following circulars:
- Pain management,
- Alleviation of digestive problems,
- Control of values such as loss of appetite and fatigue.
- Palliative care offers a general care, comforting process.
Life After Gastrectomy
After gastrectomy, patients may encounter some changes, especially in eating. The components necessary for the reorganization of the digestive system should be fed with smaller meals. In addition, some nutritional deficiencies (such as vitamin B12, iron) may be seen and additional treatment may be applied in this case.
Removal of Lymph Nodes
Stomach cancer can usually spread to the lymph nodes. During surgical intervention, lymph nodes in the cancerous area are also formed. This procedure is performed to determine the expansion of the cancer and to see its sphericity more clearly.
Lymph node removal is important to see if the cancer has spread to other organs. If there is treatment in the cancerous lymph nodes, the process may change and additional treatment methods (chemotherapy, radiotherapy) may be applied.
Palliative Surgery or Endoscopic Intervention
Gastric cancer may not usually be detected before it reaches advanced stages and radical surgery cannot be performed. Major problems such as inability to swallow due to cancer or vomiting due to stomach obstruction after eating may occur. In this case, palliative interventions should be considered to relieve the patient from distress. Some examples of palliative surgery may be:
In tumors that hold the stomach outlet, a new path is created between the upper stomach and the small intestine, creating an opportunity for food to pass from the stomach to the intestines. Gastric bypass: This procedure is performed surgically. However, today, thanks to experienced endoscopists, this problem can be solved without surgery with Endoscopic Metal Stents.
Preoperative Preparation
Before surgery, patients and their tests are subjected to a comprehensive evaluation. This evaluation is an important step for the successful completion of the process and usually includes the following steps:
Physical Examination: The patient’s general health status and the extent of the cancer are reviewed.
Blood Tests: Blood tests are performed to evaluate the stage of the cancer and organ functions.
Imaging Tests: CT, EUS, and if necessary, MRI and PET-CT are also used.
Anesthesia Evaluation: The anesthesiologist evaluates whether the patient is suitable for anesthesia and determines the anesthesia to be used during the procedure. If deemed necessary, cardiology and Echo tests are requested.
Patients are generally advised to change their diet before surgery.
Choosing the Surgery Method
The type of surgery varies depending on the stage and location of the cancer.
The Role of Prof. Dr. Kemal DOLAY in the Treatment of Stomach Cancer
He meticulously applies the radical surgical techniques preferred by Japanese surgeons in stomach cancer. He surgically removes the cancerous part of the stomach without leaving a tumor inside and the surrounding nearby lymph nodes and regional lymph nodes with D2+, i.e. extended lymphadenectomy. He believes that this surgical method, although difficult, will provide the best contribution to the patient’s life. In all these surgical decisions, he informs the patient and decides on the most suitable surgery transparently and with the patient’s approval. With his experience in a bloodless and fine dissection surgery, patients do not need blood supplements at the time of surgery. He applies close follow-up, early mobilization, and early nutrition protocols after surgery.
Adjuvant Treatment and Multidisciplinary Approach
Surgical intervention in stomach cancer treatment is usually the first and biggest step of cancer treatment. However, Adjuvant KT (treatment applied after surgery) also plays an important role. Prof. Dr. Kemal DOLAY determines the person’s treatment plan specifically for the person and this plan is shaped with a multidisciplinary approach. In some patients, Neoadjuvant KT can be planned before surgery.
Targeted Therapy and Immunotherapy: Targeted therapy and immunotherapy are new treatment methods that target the cancer and protect healthy tissues.
Prof. Dr. Kemal DOLAY is an expert with extensive experience in stomach cancer surgery. From early diagnosis to surgical intervention, from adjuvant treatments to postoperative care, patients are offered good treatment methods at many stages. In addition, the treatment process is managed with a multidisciplinary approach, and all possibilities are mobilized to extend the life limits of patients.
