Stomach cancer

"Stomach cancer does not have a specific symptomatology and, in many cases, when the tumor produces clinical manifestations it is already very advanced".

DR. JORGE BAIXAULI
SPECIALIST. DIGESTIVE TRACT TUMOURS AREA

Stomach cancer is caused by the uncontrolled growth of one of its inner layer cells, progressively forming a mass or ulceration. When a gastric ulcer is detected, biopsies must be performed to determine whether it has malignant transformation or not.

Stomach cancer is a high mortality neoplasm. Survival at 5 years is 20-30%. It continues to have a high recurrence rate after surgery in the form of local relapse or occult micrometastatic disease.

Stomach cancer is twice as frequent in men as in women and has a certain hereditary component that allows preventive measures to be taken.

The Clínica Universidad de Navarra has a highly qualified medical-surgical team for the treatment of patients with stomach cancer. In addition, we perform a follow-up by the nursing service that helps to improve symptomatic control and promote the rapid recovery of our patients.

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What are the symptoms of stomach cancer?

Many of the symptoms developed by patients with gastric cancer often overlap with other causes of benign etiology.

Unfortunately, it is more common to develop symptoms in more advanced stages in relation to tumor growth or symptoms derived from metastatic lesions.

The most common symptoms are:

  • Unexplained weight loss
  • Abdominal pain
  • Nausea or vomiting
  • Early feeling of fullness
  • Tiredness
  • Blood loss (appearance of melena or hematemesis)

Do you have any of these symptoms?

You may have stomach cancer

What are the causes?

The causes can be multiple, being many factors that have an influential role in its development.

  • Age and sex: males over 60 years old.
  • Higher incidence in certain geographical areas.
  • Patients with a family history have a 2 to 10 times higher risk of developing a stomach tumor. Some hereditary alterations such as diffuse gastric cancer, Lynch Syndrome, Familial Polyposis, Li Fraumeni Syndrome, Peutz-Jeghers Syndrome or BRCA1 and 2 mutation may increase the risk of developing gastric cancer.
  • Infections: H.pylori may be responsible for peptic ulcers with risk of transformation into a tumor ulcer. Epsten Barr Virus infection.
  • Dietary habits: Diets rich in salt, low in fruits and vegetables or high consumption of alcohol and tobacco are related to a higher incidence.
  • Premalignant lesions (atrophic gastritis or intestinal metaplasia) and previous surgeries can favor the appearance of gastric cancer.
  • Having received ionizing treatment is another probable risk factor and may be the cause in approximately 1% of the diagnosed cases.

What is the prognosis of stomach cancer?

The prognosis of gastric carcinoma depends on multiple factors, including patient characteristics (age, sex, immunologic, nutritional and general status, and associated diseases) and tumor characteristics (location, size, macroscopic and microscopic aspects, histologic type and grade, TNM staging, peritoneal cytology and biological characteristics).

Treatment-dependent prognostic factors for gastric cancer are classified according to resectability and type of resection, type of lymphadenectomy, postoperative morbidity and mortality, preoperative transfusion, radiotherapy, chemotherapy and immunotherapy. However, in spite of the fact that all the factors previously mentioned must be taken into account, it must be considered that it has a five-year survival rate in localized tumors of 68%.

How is stomach cancer diagnosed?

For the diagnosis of stomach cancer, the physician will take a medical history and perform a physical examination to guide him/her on the patient's habits and/or the existence of symptoms and signs that may lead to the suspicion of stomach cancer.

For diagnosis, the best means is gastroscopy. This exploration, in addition, allows obtaining samples.

Echoendoscopy better detects the degree of local infiltration and the presence of locoregional adenopathy. In addition, the study must be completed with a CT scan, and a staging PET scan or diagnostic laparoscopy may even be necessary.

How is stomach cancer treated?

Taking into account the initial stage, molecular characteristics and clinical situation of the patient, an individualized therapeutic plan is developed.

In gastric surgery, the diseased area of the stomach is removed. Depending on the location of the tumor within the stomach, it will be indicated to remove the entire stomach or only part of it. Sometimes it is also necessary to remove neighboring organs to achieve a complete resection.

The types of surgery are: subtotal (partial)/total gastrectomy. In the surgical procedure, a regular lymphadenectomy is performed (currently D2 lymphadenectomy is indicated).

Currently, the minimally invasive laparoscopic approach is used in an attempt to improve the patient's recovery after surgery and to restore daily life sooner.

Possible post-surgical complications may include rupture of the spleen, biliary and/or pancreatic duct injuries, esophageal perforations, dehiscence/fistulas, bleeding, post-operative acute pancreatitis, dysphagia. In addition, the patient may develop early dumping syndrome or late dumping.

Weight loss and nutritional deficit is a common consequence in these patients. An assessment by the Endocrinology and Nutrition service is recommended from the time of diagnosis for further support and follow-up. 

Due to the surgical complexity of this pathology, it is essential to go to specialized centers. The Clínica Universidad de Navarra has a highly qualified medical-surgical team to perform this procedure. In addition, we perform a follow-up by the nursing service that helps to better symptomatic control and promote the rapid recovery of our patients.

Sometimes, even when the tumor is in very advanced stages, palliative surgery is performed. The purpose of this surgery is to alleviate or prevent symptoms related to the tumor.

The different therapeutic possibilities can be:

  • Subtotal gastrectomy: consists of the removal of part of the stomach containing the tumor to treat problems derived from the tumor, such as tumor bleeding, obstruction or even pain not controlled with medication.
  • Gastric bypass (gastrojejunostomy): this surgery is performed in those tumors that block the passage of food thus preventing the possibility of oral feeding of the patient. In this surgery the tumor lesion is not removed but a bypass is made from the upper part of the stomach to a new connection in the small intestine so that food can pass through this route.

If the patient is not suitable for surgery or the symptomatology is not so severe, other less aggressive techniques are used to achieve adequate symptomatic control.

Chemotherapy is the medical treatment that consists of the application of chemical substances to the organism. Chemotherapy can mainly be administered intravenously or orally, although there are other forms of administration.

Depending on the time of administration of the treatment it is called:

  • Neoadjuvant treatment: this is the administration of chemotherapy prior to possible surgery. The aim is to reduce tumor size and thus facilitate surgery.
  • Adjuvant treatment: is the administration of chemotherapy after surgical resection. The aim is to eliminate possible microscopic disease and prevent recurrence of the disease.
  • Palliative treatment: is the administration of treatment in a palliative manner. The intention is to reduce the burden of the disease and thereby derive clinical benefit.

The Department of Medical Oncology of the Clínica Universidad de Navarra has a specialized Area Nurse who is in permanent contact with the patients to minimize the side effects derived from the medication.  In addition, a telephone follow-up is carried out during treatment to detect possible toxicities and alleviate them in an early and effective manner.

Monoclonal antibodies are drugs directed against specific proteins that act on specific receptors.

Receptors are small molecules or molecular complexes located on the cell surface. Upon activation, a cascade of events occurs, creating a response to the activation.

Monoclonal antibodies act by inhibiting the activation of these receptors, thereby preventing the proliferation or growth of tumor cells.

Gastric or gastric bed irradiation together with chemotherapy is a fundamental strategy for the cure of selected patients with gastric cancer. Precise irradiation techniques are essential to reduce adverse effects on abdominal organs.

In situations of abdominal or retroperitoneal relapse after a first surgery and radiotherapy, proton therapy or intraoperative radiation therapy can achieve greater local control of the disease in these patients.

There are several types of radiotherapy:

  • External: employs beams of ionizing radiation (electromagnetic waves) generated by radiation equipment remote and external to the patient (linear accelerators).
  • Internal (brachytherapy): this is a special radiation technique based on the introduction of a radioactive source (radioisotope) into the tumor or into the tumor bed itself (healthy tissue close to the tumor that remains after its removal and which has a high risk of containing residual microscopic disease).

The Clínica Universidad de Navarra has a Proton Therapy Unit. This therapy, due to its lower toxicity, is especially indicated for the treatment of tumors that are difficult to access or close to organs at risk.

In patients with advanced disease it can be an effective therapy to alleviate pain (analgesic radiotherapy), bleeding (hemostasis radiotherapy) or local control. 

In addition to all of the above, we must not forget the emotional aspect of cancer patients.

At the Clínica Universidad de Navarra we have the possibility of carrying out a joint evaluation with the Palliative Medicine Service in order to achieve an adequate symptomatic management as well as the possibility of expressing and orienting the possible emotional effects that this disease causes in the patient and his family.

The combination of an adequate symptomatic and emotional control has shown a better tolerance to medication and a better coping with the adverse events that occur during the evolution of this process.

Proton therapy against cancer

Proton therapy is the most precise external radiotherapy modality, providing better distribution of radiation dose and therefore less irradiation of healthy tissues.

The Proton Therapy Unit of the Clínica Universidad de Navarra in its Madrid headquarters is the most advanced in Europe and the first in a Cancer Center, with all its healthcare, academic and research support.

Where do we treat it?

IN NAVARRE AND MADRID

The Digestive Tract Tumors Department
of the Clínica Universidad de Navarra

The Digestive Tube Tumors Area is composed of a multidisciplinary team of experts in the diagnosis and treatment of diseases of the digestive tract.

It includes specialists in the digestive system, radiology, pathological anatomy, surgery and medical and radiotherapeutic oncology and nursing support.

What diseases do we treat?

Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Integral evaluation of the patient.
  • Cutting edge technology.
  • Expert professionals who are a national reference.

Our team of professionals

Clinical Trials

At the Clínica Universidad de Navarra we have a large number of clinical trials aimed at different oncological pathologies. We have several clinical trials in different stages of stomach cancer that allow us to recruit a high number of patients in each clinical situation.

In addition, the Clinic has a Central Trials Unit (UCEC), which facilitates and guarantees patient safety and the most rigorous scientific and ethical control of first level clinical trials, shortening to the maximum the administrative deadlines for their implementation.

Safer than ever to continue taking care of you

We update safety protocols weekly with the latest scientific evidence and the knowledge of the best international centers with which we collaborate.