Stomach cancer

Treatment of stomach cancer in Russia

Stomach cancer still remains a serious oncological problem that requires the use of effective treatment strategies. In Russia, diagnostic and therapeutic methods aimed at increasing the effectiveness of the fight against this disease are being actively improved. Russian medical centers have advanced equipment and qualified specialists, which allows them to use the latest approaches, including surgical operations, chemotherapy, radiation and targeted therapy. The main goal is to achieve remission, alleviate the condition of patients and increase life expectancy.

Causes of occurrence

• The development of the disease is associated with a combination of genetic, external and biological factors. Although the exact mechanisms of malignant cell degeneration are not fully understood, there are several main reasons that contribute to the development of pathology.
• Helicobacter pylori infection. The bacterium causes chronic gastritis and ulcers, which can lead to precancerous changes in the gastric mucosa.
• Improper nutrition. Eating salty, smoked foods and foods with nitrates damages the mucosa and increases the risk of cancer.
• Smoking and alcohol. Toxic substances damage the mucosa and contribute to the formation of cancer cells, especially in chronic inflammation.
• Genetic predisposition. People with a family history of stomach cancer have a higher risk, and hereditary syndromes can increase the likelihood of the disease.
• Chronic stomach diseases. Atrophic gastritis, intestinal metaplasia, polyps and adenomas increase the risk of cancer.
• Exposure to carcinogens. Work with toxic substances, radiation and poor ecology contribute to oncology.
• Surgical interventions. Stomach operations can change acidity and motility, creating conditions for cell degeneration.

Symptoms of stomach cancer

In the initial stages, stomach cancer may proceed without obvious symptoms or be accompanied by minor discomfort, which often goes unnoticed. As the disease progresses, clinical manifestations intensify.

Early symptoms

In the early stages, it manifests itself with non-specific signs that are often disguised as gastritis or peptic ulcer disease:

• Stomach discomfort - a feeling of heaviness, fullness after eating, even with a small amount of food;
• Change in appetite - decreased interest in food, especially meat products;
• Aversion to food - often accompanied by a loss of taste preferences;
• Slight weight loss - associated with decreased appetite and indigestion;
• Heartburn and belching - a burning sensation in the upper abdomen, belching with an unpleasant taste;
• Mild nausea - occurring periodically, especially after eating.

Advanced stages

As the tumor grows, the symptoms become more pronounced:

• Pain in the epigastric region - constant or periodic, aching, dull, not associated with food intake;
• Nausea and vomiting - vomiting with blood is possible;
• Severe weight loss - sudden weight loss without obvious reasons;
• Anemia - pale skin, weakness, dizziness due to chronic blood loss;
• Dysphagia - difficulty swallowing if the tumor is localized in the cardiac region of the stomach;
• Change in stool - black tarry stool (melena) due to gastric bleeding.

Symptoms of metastases

When the tumor spreads to other organs, the following are possible:

• Enlargement of the liver – with metastases to the liver (hepatomegaly, jaundice);
• Ascites – accumulation of fluid in the abdominal cavity;
• A lump above the collarbone (Virchow's node) is one of the signs of metastasis to the lymph nodes;
• Bone pain – with damage to bone tissue.

Classification and Staging of Stomach Cancer

Stomach cancer is classified according to several parameters, including the histologic type of tumor, the extent of spread (stage), and the degree of cell differentiation.

Classification by histologic type

The most common type of stomach cancer is adenocarcinoma, accounting for about 90% of all cases. Other, less common types include:

Mucose (colloid) – a tumor with a high content of mucus. Usually soft in consistency and slowly progressing, but can metastasize.

Solid – a tumor consisting of a dense mass of cells without significant mucus content. Most often occurs as well-defined nodules.

Fibrous – a tumor with pronounced fibrous tissue, which gives it a dense structure. Often penetrates into adjacent tissues and can cause thickening of the stomach walls.

Small cell – an aggressive form of cancer consisting of small, rapidly dividing cells. This form usually has a poor prognosis and is characterized by the rapid spread of metastases.

Squamous cell – a rare form originating from the flat epithelial cells of the mucous membrane. Often observed in chronic inflammations and gastric ulcers.

There is also a classification by the type of tumor growth: polypoid, ulcerative, infiltrative and mixed types.

Stomach cancer stages

Stomach cancer staging is based on the TNM (Tumor, Nodes, Metastasis) system, which evaluates:

• T (Tumor) – characteristics of the primary tumor: its size and extent of spread into the stomach wall and adjacent tissues;
• N (Nodes) – extent of lymph node involvement in the tumor process;
• M (Metastasis) – presence of metastases to distant organs.

Based on these criteria, the following stages of stomach cancer are distinguished:

• Stage 0 (carcinoma in situ) – the pathological process is limited to the gastric mucosa, without extending beyond it.
• Stage IA – the tumor penetrates the mucosa or submucosa, but without lymph node involvement and distant metastases.
• Stage IB – spread to the mucosa or submucosa with damage to 1-2 lymph nodes or to the muscular membrane without lymph node involvement and metastases.
• Stage IIA – invasion of the muscularis propria with involvement of 1-2 lymph nodes or penetration of the subserosa without involvement of lymph nodes and metastases.
• Stage IIB – spread to the subserosa with involvement of 1-2 lymph nodes or to the serous membrane, without involvement of lymph nodes and metastases.
• Stage IIIA – invasion of the serous membrane with involvement of 1-2 lymph nodes, or invasion of adjacent organs without involvement of lymph nodes and metastases.
• Stage IIIB – involvement of adjacent organs with involvement of 1-2 lymph nodes, or penetration of the serous membrane with involvement of 3-6 lymph nodes, or penetration of adjacent organs without involvement of lymph nodes and metastases.
• Stage IIIC – penetration of adjacent organs with involvement of 3-6 lymph nodes or penetration of the serous membrane with involvement of more than 7 lymph nodes. Stage IV – the presence of distant metastases to other organs, regardless of the size of the primary tumor and the involvement of lymph nodes.

Diagnostics

Diagnostics of pathology includes a comprehensive medical examination to identify the tumor, determine its location, size, extent of spread and type, as well as assess the general condition of the patient. The main diagnostic methods:

• Anamnesis and physical examination - the doctor collects information about complaints, medical history, risk factors and heredity. Palpation of the abdomen helps to identify painful areas and formations.
• Gastroscopy is the main diagnostic method that allows you to visually examine the gastric mucosa, identify suspicious changes and, if necessary, perform a biopsy for histological analysis.
• Histological examination - a biopsy obtained during gastroscopy is sent to the laboratory for examination for the presence of cancer cells and their characteristics.
• X-ray with contrast - allows you to evaluate the contours of the stomach using a contrast agent (barium), although it is currently used less often.
• Computed tomography (CT) - is used to assess the spread of the tumor, the condition of the lymph nodes and identify metastases to distant organs (liver, lungs).
• Magnetic resonance imaging (MRI) – can be used for a detailed assessment of the tumor, especially in the liver and lymph nodes.
• Ultrasound (US) – helps in assessing the condition of the liver, lymph nodes and metastases, and EUS provides a detailed image of the stomach wall and surrounding tissues.
• Positron emission tomography (PET-CT) – is used to assess the spread of the tumor and identify metastases, especially in complex cases.
• Laboratory tests – blood tests (general, biochemical, for tumor markers, such as CEA, CA 19-9) help assess the patient's condition and detect possible signs of cancer.

The combination of these methods helps to accurately diagnose the disease, determine its stage and create an individual treatment plan. The MARUS platform helps organize examination and treatment of stomach cancer in Russia, providing patients with access to qualified specialists and modern medical technologies.

Treatment methods

Therapy for gastric cancer is determined by its stage, tumor localization, patient's health, and a number of other individual characteristics. Medical practice uses surgical treatment, chemotherapy, targeted and immunotherapy, radiation, as well as symptomatic therapy aimed at alleviating the patient's condition and improving his quality of life in the late stages of the disease.

Surgical treatment

Surgery is the main method of treating the pathology at the initial and some advanced stages. The main goal of surgical treatment is the complete removal of the tumor and areas of the stomach infected with cancer cells.

Types of operations:

Gastrectomy - partial removal of the stomach if the tumor is localized in a certain part of it;
Gastrectomy - complete removal of the stomach if the tumor covers most of it or if other methods are ineffective;
Lymphadenectomy - removal of affected lymph nodes to prevent metastasis;
Minimally invasive surgeries (laparoscopy) can be performed for patients with limited lesions of the stomach, which shortens the recovery period;
Reconstructive surgeries - in case of removal of part or all of the stomach, the digestive tract is restored for normal functioning of the digestive system (for example, anastomoses).

Chemotherapy

Chemotherapy is used in the late stages of stomach cancer, as well as after surgery to prevent relapses. Its action is based on the use of drugs that destroy cancer cells or inhibit their growth and division. Depending on the time of administration, chemotherapy can be:
Neoadjuvant - used before surgery to reduce the size of the tumor;
Adjuvant - performed after the intervention to destroy the remaining cancer cells, usually using platinum drugs and topoisomerases.

Targeted therapy

Targeted therapy is based on the use of drugs aimed at specific molecules that are involved in the development and progression of the tumor. These agents act exclusively on cancer cells without damaging healthy tissue. In the later stages, targeted therapy can be used as an independent method or in combination with chemotherapeutic drugs. The effectiveness of the method largely depends on the molecular characteristics of the tumor.

Immunotherapy

Immunotherapy is aimed at activating the patient's immune system to fight pathological cells. Drugs are used that enhance the immune system's ability to recognize and destroy mutated cells. Blockers of PD-1/PD-L1 and CTLA-4 molecules are considered particularly effective, as they help increase the activity of immune cells against the disease. This method is often used in the later stages, when other therapeutic measures have failed.

Radiation therapy

Radiation therapy is used to shrink a tumor, especially when surgery is not possible, and as an additional treatment after surgery to kill any remaining cancer cells. One type of radiation therapy is stereotactic radiotherapy, which allows high doses of radiation to be precisely directed at the tumor while minimizing damage to healthy tissue.

Palliative care

Palliative care aims to improve the quality of life of a patient with advanced stages of the disease. It includes pain relief (use of analgesic drugs), symptom relief (nausea, vomiting, loss of appetite and indigestion), psychological support and assistance in organizing care. Palliative care is important to improve patient comfort in the late stages of the disease, when other treatments are no longer effective.

Complications

Even with early diagnosis and effective treatment, there is a risk of complications, especially if the disease is detected at a later stage. The most common and serious problems associated with stomach cancer:

Pyloric stenosis is a narrowing of the exit from the stomach, which makes it difficult for food to evacuate into the duodenum. Requires urgent surgical intervention, otherwise it can cause dehydration and electrolyte disturbances.
Gastrointestinal bleeding is a dangerous complication caused by damage to blood vessels by a tumor. It can lead to massive bleeding and chronic anemia.
Perforation of the stomach is an ulcer that destroys the walls of the organ, which can cause peritonitis. Sometimes it occurs without obvious symptoms, hiding the problem.
Ascites is an accumulation of fluid in the abdominal cavity with metastases in the peritoneum, which causes bloating and difficulty breathing.
Metastasis is the spread of cancer to the lymph nodes and distant organs (liver, lungs, bones, ovaries), which complicates treatment and worsens the prognosis.

Prognosis and survival in stomach cancer

The main indicator of the prognosis for oncological diseases is the five-year survival rate, which reflects the percentage of patients who have survived five years after diagnosis and the start of treatment for the malignant process. Early diagnosis significantly increases the chances of successful treatment. At the first and second stages of stomach cancer, the probability of survival is 40-60%.
Late stages of the disease (III and IV) have a less favorable prognosis, since metastases can spread throughout the body. However, depending on the therapy (chemotherapy, targeted therapy, immunotherapy), it is possible to increase life expectancy and improve the quality of life.

Prevention

Preventive measures are aimed at preventing the development of cancer by eliminating risk factors and maintaining the health of the digestive system:
Rational nutrition with sufficient amounts of vegetables, fruits and fiber while limiting salted, smoked and canned foods;
Quitting smoking and excessive alcohol consumption, which damage the gastric mucosa;
Early detection and treatment of Helicobacter pylori infection to prevent chronic inflammation and precancerous changes;
Control of chronic stomach diseases (gastritis and peptic ulcer) under the supervision of a doctor;
Regular medical examinations, especially in the presence of a genetic predisposition or other risk factors.

Rehabilitation after treatment

During the recovery period after surgery, chemotherapy or other treatments, patients often need specialist help to adapt the body to new conditions. Rehabilitation includes dietary support, as patients may have difficulty digesting food and maintaining normal nutrition. Psychological support is also important, as the disease and treatment experienced can leave a mark on a person’s emotional state. Physical activity aimed at restoring strength and improving overall endurance is an essential part of rehabilitation. It is important to follow regular check-ups and medical examinations to detect possible relapses in a timely manner.