Stomach cancer is difficult to cure

Diagnosis cancer

Stomach cancer

Degeneration in the stomach area can have a benign (benign tumor) or malignant (carcinoma) character. Benign tumors make up about 20% of all new tissue formations in the stomach. They mainly show up in the form of polyps (swelling) or glandular cysts. These can usually be removed endoscopically (with a sling) or minimally invasive.

The risk factors

One factor is the colonization of the stomach with the bacterium Helicobacter pylori. However, this thesis is also controversial, since only a few patients with Helicobacter also develop stomach cancer.
Other causes are:

  • Malnutrition (rich in nitrosamines = salty, smoked, cured with a simultaneous reduction in vitamins)
  • Increased consumption of alcohol
  • nicotine
  • Family predisposition (ten percent of all gastric cancers)

Polyps that are not removed can show malignant cell changes over time.

The frequency

In terms of frequency, gastric cancer ranks fifth among men and sixth among women. In other countries, however, this is partly very different. In Japan, for example, significantly more people develop stomach cancer than in Germany or the USA. Why this is so is not known for sure. It is believed that frequent consumption of salted and salty products may play a role in East Asia. However, the exact reasons for the development of the carcinoma have not been established in Germany, Asia or the USA.

The species

In up to 70% of cases, the tumor is located in the lower part of the stomach, just before the exit. Ten to 20% arise in the upper corner of the stomach, directly after the entrance and in the body. Stomach cancer has different stages and forms. There are superficial, protruding and deepened tissue growths that differ according to the TNM classification (tumor lymph node metastases). Early-stage tumors are limited to the mucous membrane and the area just below the mucous membrane.

The symptoms

The development of a carcinoma often goes undetected for a long time - the first signs are usually unspecific: abdominal pain, nausea and poor appetite. In the course of the disease, there is weight loss in over 80 percent of cases. Those affected often complain of pain in the upper abdomen. In addition, there are nausea, vomiting, loss of appetite and physical weakness. A badly damaged stomach wall tends to bleed, which can be shown in the vomit (hematemesis). Delayed gastric emptying or difficulty swallowing and heartburn occur depending on the location. Particularly large carcinomas can even be felt in particularly thin people. Lymph node involvement is a sign of spread. The Virchow's lymph node, located directly in the left collarbone fossa, may be enlarged and palpable in this case. Metastases in the liver often present the symptoms typical of a liver disorder with jaundice (yellowing of the skin and sclera) and ascites (accumulation of fluid in the free abdominal cavity).

The diagnosis

In terms of differential diagnosis, diseases that cause symptoms similar to those of stomach cancer must first be ruled out. These include gastric ulcer, gastritis, irritable stomach syndrome, diseases of the bile or liver disease, reflux and heartburn. The complaints can be narrowed down further by asking specific questions (anamnesis). Looking at and feeling the abdomen helps the doctor make a more precise diagnosis. Unfortunately, blood tests are not very helpful. Often there is anemia. In the case of bleeding carcinomas, blood can be found in the stool, usually in the form of melena (tarry stool). There are also tumor markers for gastric cancer. These have a diagnostic value when they are increased. If they are normal, it does not mean that there is no cancer. A gastroscopy with tissue removal (biopsy) is the first choice. The further examinations serve to assess the operability and to detect metastases (X-ray contrast media, sonography, computed tomography, etc.)

The treatment

The therapy is chosen depending on the stage. The ablation line should run 5 to 7 cm from the tumor. That means a stomach resection (75% of the stomach is removed), or a total removal of the stomach. Local erosion currently plays a subordinate role. The connection in the digestive tract is restored by a suture between the upper stomach and the first loop of the small intestine or, if the entire stomach is missing, a suture between the esophagus and the first loop of the small intestine.

Life expectancy and the chances of recovery

An early diagnosis increases the chances of survival enormously. Overall, the survival rate of isolated carcinomas after five years is around 50%, with metastases it drops to around 15%. If an operation can be performed at an early stage, when the stomach cancer is still limited to the innermost layer of the stomach, the life expectancy after 5 years is over 90%. The surgical removal of the metastases (at the same time or in a second moment) depends on many factors and is not always possible. Further progress can be expected from chemotherapy in the near future, both after and before the operation. An interdisciplinary treatment of gastric cancer is becoming more and more popular.

The follow up

In terms of quality of life, patients who have only part of their stomach removed are better off than those who no longer have a stomach. Regular oncological follow-up is still recommended. If there is a relapse (recurrence of the carcinoma), the treatment options are limited.