Abdominal cancer (gastric adenocarcinoma): causes, symptoms, diagnosis and treatmentNovember 5, 2017
- Causes of abdominal cancer
- Classification of abdominal cancer
- Symptoms of adenocarcinoma of the stomach
- Diagnosis of gastric adenocarcinoma
- Abdominal cancer: treatment of a gastric adenocarcinoma
- Prognosis and prevention of gastric adenocarcinoma
Adenocarcinoma of the stomach is a malignant tumor that originates from the glandular cells of the epithelium of the stomach wall. This disease constitutes the overwhelming majority of cases of stomach cancer and ranks first among oncology in many countries, including USA, Australia, Japan and South America.
Often this pathology is meant by the term “stomach cancer”. The difficulty lies in the fact that there are no symptoms in the early stages, therefore early diagnosis is difficult. About 40% of patients turn to the gastroenterologist already with the advanced stage, and in some cases, due to the concomitant pathology, surgical removal of the tumor is impossible. At the same time, the lethality with radical treatment is about 12%.
Causes of abdominal cancer
The exact etiology of the adenocarcinoma of the stomach is unknown. The reason for the development of this pathology is the long-term effect of carcinogenic agents against the background of oppression of secretion and circulatory disorders. To the development of gastric cancer predisposes a number of factors.
The processes of malignancy have a genetic predisposition, depend on the characteristics of nutrition, a number of household factors.
The relationship between the incidence of the disease and the infection of Helicobacter pylori, a bacterium that causes gastritis and peptic ulcer, is proved (in patients with this microorganism, the incidence of gastric cancer is twice as high).
The incidence is age specific: adenocarcinoma of the stomach is more common after 55 years.
Men suffer from this disease three times more often than women. An important role in the development of the cancer process is played by smoking and alcohol. The use of strong alcoholic beverages leads to the development of focal proliferative processes in the gastric mucosa, and eventually – cancer.
Also, in the development of adenocarcinoma of the stomach, factors such as a diet with a low content of dietary fiber, vitamins, antioxidants, pernicious anemia, chronic atrophic gastritis, adenomatous polyp of the stomach, hyperplastic gastritis matter. Among the endogenous causes do not exclude the role of N-nitroso compounds, synthesized in the stomach at various pathological conditions. A massive synthesis of them occurs in diseases with an anacidic condition.
Adenocarcinoma almost never occurs in a healthy stomach. Gastroenterology distinguishes precancerous (background) diseases and changes in the gastric mucosa.
Pre-cancerous diseases include conditions that can potentially lead to the development of cancer: chronic gastritis, polyps, chronic ulcers, residual part of the stomach after resection, and others. To the precancerous changes in the gastric mucosa are morphologically proven changes that indicate the development of the process towards malignancy (malignancy). These changes are combined by the term “dysplasia”.
Classification of abdominal cancer
There are following types of adenocarcinoma of the stomach:
- ulcer-cancer – the tumor has the form of a saucer with ulceration in the central zone;
- skirr – the pathological process extends to the greater part of the organ and penetrates deep into the gastric wall;
- polypoid cancer – a tumor with clear boundaries, visually resembling a polyp;
- pseudo-ulcer cancer – this form for a long time resembles the manifestation of a stomach ulcer;
- tubular adenocarcinoma – a tumor from cells of a cubic, cylindrical epithelium;
- mucocutaneous adenocarcinoma is a tumor from the mucinous (slime-producing) cells.
According to the TNM classification, which takes into account the degree of organ infiltration, regional lymph node involvement and the presence of metastasis in remote areas, four stages of the disease are identified. There is also a histopathological classification based on the degree of differentiation of cancer cells (high, medium, low grade, undifferentiated adenocarcinoma).
Symptoms of adenocarcinoma of the stomach
The most frequent symptoms of abdominal cancer are:
- pain localized in the epigastric region,
- the intensity of which is usually not related to eating,
- and lack of appetite.
Often develop disorders of the stool – constipation, diarrhea. Typical weight loss, weakness, apathy. Of great importance is the identification of “small” signs (a feeling of discomfort in the epigastrium, a loss of satisfaction from food, an unpleasant aftertaste, fatigue, a decrease in ability to work, anemia).
Symptoms of the disease depend on the location of the tumor, the nature of its growth, histological characteristics, changes in other organs. Usually, local symptoms appear when the size of the formation interferes with the normal functioning of the stomach. If there is a tumor in the antral (outlet) section of the stomach, a clinic of pyloric stenosis develops (narrowing the pyloric lumen).
Tumor, localized in the body of the stomach, for a long time does not appear, because the stomach volume is large enough.
This form is usually found when the tumor reaches a significant size and the first signs may already be symptoms of general intoxication.
When the cardiac part of the stomach (its upper part) is damaged, there are growing signs of dysphagia – it is difficult for a patient to swallow, it is necessary to thoroughly chew food and drink heavily. With a significant tumor size, it is difficult to pass liquid food.
With the germination of the stomach tumor into neighboring organs, the development of distant metastases, the clinic can be diverse and depends on the localization of the lesion.
Diagnosis of gastric adenocarcinoma
In the diagnosis, an important role is given to the survey. The detailed identification of specific symptoms, as well as “small” criteria, suggests a malignant lesion. Anamnesis of this disease is usually short, characterized by a rapid progression of symptoms. Gastroenterologist with objective research carefully examines the areas of the most frequent metastasis of stomach cancer: the neck, liver, lungs, navel, ovaries.
To clarify the diagnosis, conducting differential diagnosis, laboratory and instrumental methods of investigation are used. A general blood test can detect anemia. A blood test for oncomarkers is conducted: CEA (cancer embryonic antigen), CA (cancer antigen).
Gastroscopy for abdominal cancer diagnosis
Gastroscopy and EGDS with biopsy allows to visualize a pathological focus, to take tissue samples from suspicious areas for histological and cytological examination. The detection of cancer cells in the biopsy is a reliable diagnostic feature. Determination of the type of cells, the degree of differentiation allows to determine the form of the disease, to predict the course and to formulate an optimal treatment regimen.
Radiography of the stomach with contrasting makes it possible to assess violations of the anatomy of the inner wall of the stomach. Characteristic signs of cancer are defined: defect filling, changing contours. To determine the degree of penetration of cancer into the wall of the stomach, nearby organs, lymph nodes, endoscopic ultrasound is performed. In the course of this test, it is possible to perform fine needle biopsy of a suspicious area (biopsy with ultrasound guidance).
Computed tomography (CT), magnetic resonance imaging (MRI) for stomach cancer can detect a tumor, but the main purpose of these methods is to determine the damage to nearby organs, the presence of metastases in regional, distant groups of lymph nodes, liver, lungs and other organs. Tomography makes it possible to determine which method of treatment in this case will be most effective. Differential diagnosis of adenocarcinoma of the stomach is carried out with gastritis, ulcer, as well as stomach polyps.
Abdominal cancer: treatment of a gastric adenocarcinoma
The main and only radical method of treatment is operational. Radiation and chemotherapy for this pathology as independent techniques are used exclusively in cases of contraindications to surgical intervention, as well as in the fourth stage.
The operation can be performed in two versions: gastrectomy (the entire stomach is removed with regional lymph nodes, part of the esophagus, small intestine, other nearby tissues) or subtotal resection (the organ part is removed from the tumor and a small area of surrounding tissues).
The choice of tactics is determined by the size, localization of the tumor, its histological characteristics.
If in the course of a standard operation the formation can not be completely removed but covers the stomach, causing significant digestive disturbances, the following techniques can be applied:
- endoluminal stenting – the introduction of a stent (tube) into the stomach, which allows preserving the lumen of the organ. It is carried out with the aim of enabling the patient to eat independently.
- endoluminal laser therapy is a method of endoscopic laser treatment in which cancer cells are removed by a laser beam as a knife.
Chemotherapy for gastric adenocarcinoma is not a highly effective method. It is used before surgical treatment in order to reduce the size of the formation and improve the result of treatment, either in the case of contraindications or inexpediency of the operation to improve the patient’s condition.
As adjuvant treatment, it is prescribed in combination with radiation therapy after resection in order to destroy the remaining tumor cells.
Radiation therapy is also not used as an independent method. Used in combination with surgical treatment, with contraindications to it – with chemotherapy. It is used to reduce the symptomatology (pain syndrome) as a palliative method.
Prognosis and prevention of gastric adenocarcinoma
The prognosis for adenocarcinoma of the stomach is determined by the stage of the disease, the localization of the tumor.
Adenocarcinomas of the lower part of the stomach, the cardiac section usually have a better prognosis, because in view of the location, the symptoms appear earlier, at earlier stages, when radical treatment is possible. Also the prognosis depends on the histological characteristics of the cancer: the higher the degree of differentiation of the cells, the better the result of treatment can be achieved.
In most cases, adenocarcinoma of the stomach is diagnosed at later stages, in early cases only up to 20% of cases are diagnosed. Later diagnosis significantly worsens the prognosis of the disease. Therefore, every patient who is on treatment in the department of gastroenterology, if there are potentially dangerous symptoms, must undergo the necessary examination to exclude cancer.
Prevention of gastric cancer is the rational nutrition, smoking cessation, the use of strong spirits, the restriction of products containing preservatives, dyes.