Diagnosis
Stomach cancer can be diagnosed on endoscopy. Endoscopy aids sampling the abnormal area (biopsy) which can confirm the presence of cancer.
Further, ultrasound and CT scans can help assess the local, regional and distant spread of cancer. PET CT can be useful in picking up cancer at distant sites which may not be obvious with other imaging modalities.
Genetic and molecular testing can be performed in presence of high-risk factors and when the disease has spread, to aid planning targeted therapy.
Before proceeding with surgical removal, laparoscopic assessment (keyhole surgery to view inside the abdominal cavity) helps identify any small areas where cancer may have spread to and not picked up on the conventional scans.
Treatment
Surgery remains the cornerstone for curative treatment with multimodality therapy including prior chemotherapy and chemotherapy after surgery helping improve the outcomes largely.
Surgery (Radical gastrectomy) consists of removal of a part (subtotal) or entire (total) stomach along with the removal of lymph nodes referred to as D2 lymphadenectomy. In a selected subgroup of patients, this can be done by minimally invasive surgery.
When cancer is advanced and causes an inability to eat orally, endoscopic procedures like stenting to tackle the cancer-induced block in the food passage can be useful. Rarely, surgical bypass and/ or feeding procedure may be performed for alleviating the inability to eat and improve the condition to consider starting other modalities of treatment like chemotherapy and targeted therapy.
Gastric Cancers - After surgery, radiation therapy is used in some cases to reduce the chances of tumour recurring. In this situation, proton therapy can help to reduce the immediate side effects that patient experiences due to radiation. Radiation therapy is also used with palliative intent to relieve local pain.
What does one need to do after surgery?
Depending upon whether part or the entire part of your stomach is removed, you may need to take certain nutritional supplements to restore your levels of hemoglobin, vitamins and minerals like calcium. Initially, the food portion size will be less and as the body adapts it will increase. It is important to be in touch with the nutritionist who will monitor and guide your progress.
Further, you may be advised to proceed with chemotherapy and/ or radiotherapy after recovery from surgery.
After completing multimodality therapy, you will be kept on regular follow-up. At follow-up, blood tests, scans, endoscopy will be performed at varying intervals to help pick up any recurrence, which can then be dealt with promptly.
Our involvement in treating the bile duct will need removal and reconstruction. Sometimes part of adjacent intestine may have to removed followed by reconstruction, if involved by tumour.
Minimally invasive surgery has been used in gall bladder cancer suspected to be in early stages especially when there is a gall bladder polyp and caution needs to be exercised.
Other Gastrointestinal Cancers
Copyright © 2023 Apollo Proton Cancer Centre. All Rights Reserved