Medical: gastric carcinoma
Gastric tumor, gastric ca, gastric adenocarcinoma, cardiac tumor
Gastric cancer (gastric carcinoma) is the fifth most common in women and the fourth most common in men. Gastric carcinoma is a malignantly degenerated, uncontrollably growing tumor derived from the cells of the gastric mucosa. The causes of gastric cancer include food-borne nitrosamines, nicotine and Helicobacter pylori. In most cases, the tumor causes late symptoms when it is already well advanced. Due to the late diagnosis, the cancer of the stomach is often treated too late, so that this cancer has a rather unfavorable prognosis for the patients.
The tumor stage on the above-mentioned page for diagnosing gastric cancer determines the tumor stage.
The tumor stage is crucial for further treatment planning. However, an exact assessment of the tumor stage often succeeds only after the operation, if the tumor has been surgically removed (resected) and examined histologically as well as the lymph nodes. There are various divisions for the stomach tumors, for example, the appearance of the tumor cells, the type of growth or the location in the stomach.
The TNM classification is the generally accepted classification system for tumors of various types.
T stands for tumor size and its extent in the wall layers of the organ
N stands for the number of affected lymph nodes
M for Tumorabsiedelungen (metastases) in distant organs.
T: primary tumor
T X : primary tumor can not be assessed
T 0 : no evidence of primary tumor
Tis: Carcinoma in situ, Tumor cell detection without ingrowth (invasion) into the lamina propria mucosae
T 1 : Tumor grows into the lamina propria mucosae and / or submucosa
T2: Tumor grows into the muscularis propria or subserosa
T 3 : Tumor grows into the serosa, neighboring organs are tumor-free
T 4 : ingrowth into the neighboring organs (colon transversum), liver (hepar), pancreas (pancreas), diaphragm (diaphragm), spleen (splen), abdominal wall.
(The wall layers of the stomach are explained on the Anatomy stomach page.)
N: lymph node involvement
N X : regional lymph nodes can not be assessed
N 0 : no regional lymph node metastases present
N 1 : Metastases present in 1-6 regional lymph nodes
N 2 : Metastases present in 7-15 regional lymph nodes
N 3 : Metastases present in more than 15 regional lymph nodes
M: distant metastases
M X : distant metastases not assessable
M 0 : no distant metastases present
M 1 : distant metastases present
R - Additional classification
R: After surgery (resection)
R 0 : Complete tumor removed
R 1 : remained only microscopically visible residual tumor.
R 2 : visible (macroscopic) residual tumor visible to the naked eye
The treatment of patients requires intensive cooperation between the specialist in surgery, internal medicine, radiotherapists and pain therapists.
In therapy, the TNM classification is used as a key decision-making aid. There are appropriate treatment guidelines for each tumor stage. So you can describe three treatment goals, which are considered depending on the stage.
The only chance of recovery for the patient is to radically remove the tumor (R 0 resection), which is only possible in about 30% of the patients. As gastric cancer is usually recognized late and treated with it, it is often necessary to perform a total gastric removal (gastrectomy), which is always accompanied by a generous lymph node removal.
Often you also remove (resect) the large (omentum majus) and the small network (omentum minus) and the spleen (splen). Depending on the location of the tumor, a distinction is made between different surgical techniques.
Here are the surgeons various options available to restore the continuity of the gastrointestinal tract and to reconstruct a connection between the rest of the stomach and the subsequent intestine (anostomosis).
In some patients, the tumor process is very advanced, so that no more healing (curative) surgery can be performed. However, many different surgeries are available that can alleviate the symptoms (palliative therapy). The focus is on surgical techniques that ensure food passage.
The distant gastric tumor is assessed microscopically (histologically) after removal histologically. For this purpose, the tumor specimen is cut at certain locations and at the edges of the resection. From these samples wafer-thin sections are produced, stained and evaluated under the microscope. Here, the tumor type is determined, its spread in the stomach wall is assessed and those with distant lymph nodes are examined for tumor invasion. To completely exclude lymph node involvement, the pathologist must examine at least 6 lymph nodes. Only after the tissue findings, the tumor can be clearly described according to the TNM classification.
Radiation therapy is used in this type of tumor when the tumor is not operable and does not respond to chemotherapy.
You can not cure stomach cancer by radiotherapy.
As gastric cancer is usually adenocarcinoma (see above), it usually does not respond well to chemotherapy. As with radiotherapy, chemotherapy is therefore used as a palliative therapy when there is no possibility for surgery. Sometimes chemotherapy is also used to shrink the tumor and make it operable (neoadjuvant therapy).
If the food pathways are severely restricted by the tumor, the patient's nutrition must be ensured by auxiliaries. For example, a plastic tube (tube) or a tubular wire frame (stent) must occasionally be implanted to keep the food passage open. These surgical procedures can usually be performed minimally invasively during gastroscopy.
Laser therapy may be used as an alternative to a tube or stent. In doing so, the parts of the tumor obstructing the food passage are evaporated by the laser, thereby reducing the extent of the esophagus or stomach. Unfortunately, the tumor often grows from the underlying layers, so that the treatment must be repeated after 7-14 days.
If other therapy options for keeping the food passage open fail, a tube, a feeding tube (PEG), can be placed directly through the skin into the stomach. This treatment is a small surgical procedure. Under endoscopic control, a hollow needle (cannula) is first advanced through the skin to the stomach in order to place a plastic tube over it as a permanent connection to the stomach. The PEG, unlike a nasogastric tube, offers many benefits to the patient:
The patient can self-feed through this tube of food ("astronaut diet"). The probe is less clogged compared to the nasogastric tube and you can deliver more food at once. Another important point for the patient, however, is the aesthetics, as the tube disappears invisibly under the clothing for others.