One of the most common oncological diseases with a high degree of lethality is gastric cancer.
Malignant degeneration first covers the mucous layer of the organ walls, then goes deeper. Metastasis in cancerous lesions of the stomach occurs in more than 80% of patients, in this regard, the pathology differs quite a serious course.
Concept and statistics
Cancerous gastric damage in most people affected by this disease begins from glandular cells of the epithelial layer. Gradually, the neoplasm spreads deeper and along the walls of the organ.
Malignant form of the stomach has several forms, most often in patients with adenocarcinoma.
Survey of patients with stomach cancer allowed to establish that:
- This disease is more typical of men.
- The average age of the sick people is 65 years. The risk of developing neoplasm increases after reaching 40 years of age and decreases after 70 years.
- More patients are identified in Asian countries. This is due to some features of life and diet, as well as the fact that with a low level of social culture and income, people are less likely to undergo preventive examinations.
- Cancer, covering the walls of the stomach, quickly metastasizes. Through the walls of the organ, the tumor can germinate into the intestine and pancreatic tissue, with the blood flow cancer cells enter the lung tissue and liver. On lymphatic vessels, cells with an atypical structure pass into the lymph nodes.
- Gastric cancer is on the second place in mortality, the first place is malignant lung damage.
According to statistical data, 19 people with malignant gastric lesions per 100,000 population are identified in Russia, but according to some sources, this figure now reaches 30 people.
The image depicts the intestinal bacterium Helicobacter pylori, which can lead to gastric cancer
Before the appearance of the first signs indicating a pathology can pass from 11 months and sometimes up to 6 years.
Causes of
The science of gastroenterology deals with a detailed study of cancerous stomach tumors. This department of medicine studies the causes and mechanisms of the onset of the disease, its symptoms and flow characteristics.
Long-term studies still do not allow us to single out one main cause, which affects the degeneration of stomach cells into cancer cells. Many factors can contribute to atypical changes, and the most important ones are:
- Negative effects of chemical and toxic substances. Carcinogenic components can be contained in plant foods grown with the use of nitrates. Dangerous to humans, various dyes, solvents, gasoline, these drugs can get into the stomach by careless handling. Carcinogens accumulate in marinated and smoked dishes, too fatty food.
- Influence of radiation. Irradiation in a large dose leads to a disruption in the structure of cells, which provokes tumor growth.
- Helicobacter pylori. This bacterium has a protective membrane, so it can stay in the stomach for a long time. But the most dangerous thing is that Helicobacter pylori first changes the structure of the mucous membrane, and then violates its basic function. Thus, conditions are created for malignant degeneration.
- The effects of certain drug groups. The probability of a malignant tumor is increased in people taking rheumatic drugs and a number of other medications with a long course of use. Tobacco smoking and alcohol abuse. Tobacco, as well as ethyl alcohol, contains a large number of carcinogens and toxic ingredients, which negatively affect the state of the whole organism.
- Features of power supply. Rebirth of the mucous layer is facilitated by constant overeating, the use of spicy, smoked, fatty foods.
Gastric cancer also has an inherited predisposition. If close blood relatives were treated for this disease, it always makes sense to undergo a periodic examination with a gastroenterologist.
Risk factors include surgery on the organ, and a number of precancerous diseases. It is an atrophic gastritis with a chronic course, an adenoma of the stomach, malignant anemia, Menetria's disease, a chronic ulcerative lesion of the walls of the organ.
Classification of
In oncology, it is customary to use several classifications of gastric cancer, this is necessary to select the most effective course of therapy.
Features of the macroscopic form of growth of cancerous formation in the stomach are reflected in the Bormann classification. According to this division, this education is divided into four types:
- Polypovaja ( another name - mushroom-shaped) tumor. This neoplasm from the mucous layer grows into the cavity of the organ, the boundaries of the tumor are clear, the base broad or in the form of a thin stem. Mushroom type of cancer is prone to slow growth, metastases with this form of disease occur late. Polypic cancer is mainly found in the antral part.
- Obstructed tumor. This new formation resembles a saucer in its shape, has raised outer edges and a deepened core. The growth of the tumor is exophytic, metastases also appear late. Cancer expression in most patients is formed in the large curvature of the organ.
- Ulcerative infiltrative cancer of the stomach. This formation has no clear outlines, tumor growth is infiltrative.
- Diffuse-infiltrative carcinoma. This type of tumor has a mixed structure, formed in the mucous and submucosal layers. On examination, small ulceration can be detected, at later stages of this form of cancer a thickening of the walls is formed.
According to the histological type, the cancer in the stomach is divided into the following types:
- Adenocarcinoma. It is detected in almost 95% of cases. The tumor receives its development from the secretory cells of the mucous layer.
- Squamous cell. A tumor of this type is the result of cancerous degeneration of epithelial cells.
- Ring-celled cell. The tumor begins to form from goblet cells responsible for the production of mucus.
- Carcinoma of the glands. The reason for the formation of this type of cancer is an atypical transformation of ordinary glandular cells.
The photo shows what the stomach looks like in patients with cancer of the adenocarcinoma. Stage 4
The classification of the cell structure allows one to assess the aggressiveness of the growth of the cancers, distinguish:
- The highly differentiated cancer cells have little differences in their structure compared to normal cells. This form has the slowest rate of growth and slope to the appearance of metastases only at the last stage.
- Moderately differentiated cancer has an average degree of difference from normal stomach cells.
- A low-grade form of cancer is exhibited when atypical cells are almost completely different in structure from normal cells.
- Undifferentiated. Tumor grows from immature cells of the mucous wall. It is characterized by accelerated growth, the most malignant course and the rapid appearance of distant metastases.
By the type of its growth, stomach cancer is divided into:
- Diffuse. Cells of a growing tumor with each other have no connection. The tumor covers the entire thickness of the walls of the organ, but does not protrude into the cavity. Diffuse type of education is more often detected with undifferentiated cancer.
- Intestinal type. In this type of pathology, the altered cells have a connection with each other, the neoplasm protrudes into the cavity of the organ. Intestinal cancer is characterized by slow growth and is characterized by the least aggression.
One of the most important classifications of cancer of the stomach is the TNM division. This classification is used all over the world, it helps to determine the prevalence of cancer and establishes an anticipated prognosis of treatment.
The abbreviation stands for:
- T - tumor. The figure next to this letter indicates the degree of cancer growth.
- N - node, that is, the penetration of cancer into the lymphatic vessels.
- M - presence of metastases.
Prevalence and size of a tumor in the stomach:
- T1 - malignant formation sprouts the wall of the organ. This stage is divided into two. Stage T1a is confined to a connective tissue that is below the submucosa. T1b - the tumor does not extend beyond the submucosa.
- T2 - the neoplasm begins to penetrate into the muscle layer.
- T3 - the tumor began to come out in the surface shell.
- T4 - the tumor has sprouted through all layers of the wall of the stomach. T4a - the tumor has left the stomach wall. T4b - the tumor has begun its passage into the esophagus, liver or abdominal wall.
Lymph node involvement:
- N0 - no lymph nodes in cancer cells.
- N1 - Cancer cells are detected in one or two lymph nodes located near the stomach.
- N2 - defeat of 3-6 lymph nodes.
- N3a - lesion from 7 and up to 15 closely located with the stomach lymph nodes.
- N3b - lesion of more than 15 lymph nodes.
The spread of cancer from the stomach to other organs is divided into:
- M0 - there is no malignant lesion of other organs.
- M1 - metastases are diagnosed in distant internal organs.
Low-differentiated
Low-grade gastric cancer has certain characteristics of atypically altered cells.
With this type of tumor, cancer cells have an increased ability to grow severalfold. Cellular elements thus become similar to stem cells.
This determines that they can perform only two functions - to receive nutrients and constantly share. This change is responsible for the high aggressiveness of low-grade cancer.
The prognosis of recovery of patients with low-grade forms of cancer depends on the stage of the process. If the disease is detected in the first stage, then a comprehensive treatment can completely cure 90 percent of the people out of a hundred.
In the second stage, the survival rate reaches 50%.At the last stages the forecast is not so consoling. Because of the presence of metastases and the large extent of cancerous growth of the organ wall, the patient is offered only maintenance therapy.
Since low-grade gastric cancer is prone to aggressive flow and a rapid change in stages, it is rarely detected at the initial stages of development.
This affects the fact that the lethality with this type of disease is quite high. Five years after the diagnosis is established, no more than 30 percent of patients survive.
Undifferentiated
Histological examination of cells with undifferentiated stomach cancer reveals a wide variety of them, ranging from lymphocyte-like to giant multi-nuclear. Atypical cells almost completely lose their identity with those from which they originated.
The characteristics of a low-grade cancer include the almost complete absence of a supporting structure - stroma and early appearance of ulceration.
Undifferentiated cancer is characterized by the rapid development of all stages, the early appearance of clinical signs and metastases. In this type of malignant neoplasm, one of the worst survival predictions.
In almost 75% of cases, the identification of undifferentiated cancer is combined with the detection of secondary foci in distant organs. For this type of tumor characterized by frequent relapses.
Infiltrative
The infiltrative form of a cancerous stomach tumor usually covers the lower region of the organ.
A similar type of cancer visually similar to an in-depth ulcer, the bottom of which is tuberous, and the edges are bluish-gray. Symptoms similar to peptic ulcer.
The boundaries of the infiltrative-ulcerous tumor are indistinct, the cancer cells can be scattered across all layers of the stomach, which leads to a complete cancerous lesion of the entire organ.
The proliferation of abnormal cells through the submucosal layer with the accumulation of lymphatic vessels gives an impetus to the early appearance of metastases.
As the malignant process worsens, the affected wall thickens, the folds of the inner mucous wall are smoothed, the stomach loses the elasticity necessary for it.
In infiltrative cancer, the tumor is widely spread and devoid of its bounding boundaries. In the study, individual cancer inclusions are found more than five centimeters from the expected boundaries of malignant formation. Due to this, this form of neoplasm is one of the most malignant.
Saucer-like
Saucer-like form of cancer of the stomach is a deep ulcer, surrounded by a border in the form of a roller.
This roller has a hilly surface and an uneven height. The bottom of such an ulcer can be metastases, passing to neighboring organs. In the middle of the bottom there is a gray or brown coating. The size of the tumor varies from two to 10 cm.
The location of saucer-like cancer is the anterior wall of the antral part of the stomach, less often the greater curvature and the posterior wall of the organ.
The prognosis of survival of patients with saucer-shaped cancer depends on the size of this tumor, its prevalence to neighboring organs. At the first stages it is possible to suspend the process of ulceration with modern methods of treatment, but relapses quite often occur.
Cardioesophageal
Cardioesophageal cancer is a malignant tumor that affects the lower part of the esophagus and that part of the stomach that connects to the esophagus. This arrangement of cancer presents certain difficulties in the diagnosis of the disease, and this form of cancer is rarely detected in the first stage.
Combined cancer of the two digestive organs is less treatable, a favorable outcome of the disease is observed only in the first stages of the disease. At the last stage, the operation is practically not performed, and therefore patients are offered supportive treatment courses.
Squamous
A squamous cell tumor is formed from the epithelium, more precisely, of its flat cells. These cells along with glandular participate in the formation of the mucous layer of the stomach.
It is possible to suggest the development of this form of cancer by the appearance of sites of dysplasia - the centers of proliferation of atypical epithelium.
At the first stage of the disease it can be almost completely cured. But the difficulty lies in the diagnosis, so patients with the first stage of squamous cell carcinoma of the stomach on the account is not enough.
At the last stage of this type of malignant neoplasms, the survival rate for five years reaches only 7%.
Exophytic
Exophytic cancer is characterized by the defeat of only one specific area of the stomach. Cancer of this type grows in the form of a polyp, knot, plaque, saucer.
Growth of education occurs in the lumen of the stomach, its cells are tightly connected, this leads to a slow growth of the tumor, Exophytic cancer causes the appearance of metastasis only at the final stages.
Treatment involves surgical removal of neoplasm, chemotherapy and radiation therapy. With timely intervention, the prognosis for the patient is favorable.
Diffuse
Diffuse cancer is one of the aggressive forms of a stomach tumor. The tumor with this form of growth grows inside the organ, while it affects all its layers - mucous, submucosal, muscular.
Cancer cells in a diffuse tumor are not connected to each other and therefore can be located throughout the body thickness, this does not allow to clearly define the boundaries of cancer.
Tumor germination through connective tissue layers leads to thickening of the body walls, which affects the loss of elasticity and makes the stomach immobilized. Gradually, the lumen of the organ decreases significantly.
The diffuse tumor grows slowly, due to this the expressed symptoms of the disease appear in the last stages. This determines the adverse outcome of treatment and high mortality.
Adenogenic
Adenogenic cancer belongs to the group of undifferentiated tumors. Similar tumors are formed from the epithelial cells of the mucous layer, which, as a result of malignant degeneration, lose their ability to function normally.
Adenogenic formation looks like strands, they go deep into the stomach and form loose areas of altered tissues.
Adenogenic form of stomach cancer is endowed with increased ability to early metastasis, this determines its high malignancy. Treatment of such a malignant neoplasm is always complex, the prognosis is usually not very favorable.
Antrum oncology
The antral part of the stomach is the lower parts of the organ.
According to statistical data it is in this place that most of all malignant processes are detected - 70% of all stomach tumors.
In the antral region, the most common findings are:
- Adenocarcinoma.
- Solid cancer with a non-iron structure.
- Skirr is a cancer that forms from connective tissues.
The tumors located in the antrum are mostly characterized by infiltrative( exophytic) growth. Education is devoid of clear outlines, is prone to the rapid appearance of metastases. Relapse of disease with antral forms of cancer occurs more often.
Cardiac Oncology
In the cardiac department of the stomach, cancer is detected in 15% of patients. With this form of cancer, the painless course of the disease is often detected.
Characteristic and latent course of cancer, in which the tumor is detected already at an impressive size. From the cardiac part of the stomach, the cancerous tumor often passes to the esophagus and then the symptomatology of this pathology also appears.
First signs of stomach cancer
At an early stage of development, stomach cancer does not give a clear clinical picture. But still, with a careful attitude to your health, you can notice several recurring manifestations of the disease.
Similar manifestations of gastric cancer are referred to as "small diagnostic symptoms", these are:
- Disorder of the usual , manifested by weakness, increased fatigue.
- Decreased appetite.
- Discomfort in the stomach. Some people are concerned about the feeling of heaviness, others feel a marked overflow of the stomach, reaching the appearance of soreness.
- Weight reduction.
- Mental changes. They are expressed in the appearance of apathy, depressive state.
Quite often, initially, some patients with gastric cancer worry about dyspepsia.
They appear:
- Decreased or no appetite.
- Appearance of aversion to previously loved types of food. Especially often people feel reluctant to eat protein foods - dishes from fish, meat.
- The lack of physical satisfaction from eating.
- Nausea, periodic vomiting.
- Rapid overfilling of the stomach.
Usually one of the above symptoms may be due to inaccuracies in the diet. But if there are several of them at once, then it is necessary to exclude malignant neoplasm.
General symptoms of the disease in women and men
The general symptoms and signs indicating the development of stomach cancer in men and women are:
- Pain and a feeling of heaviness in the chest area. Similar symptoms can pass to the area of the back and shoulder blades.
- Disturbances in the work of the digestive system. An eructation, heartburn, severe swelling in many patients appear before the pain sign of cancer.
- Dysphagia, that is, a violation of swallowing. This change most often indicates a malignant tumor in the upper part of the stomach. Initially, the difficulty is caused by the ingestion of a solid food lump, then the soft and semi-liquid food normally stops passing.
- Nausea is associated with the fact that the lumen of the stomach decreases, and there is no proper digestion of food. Relief often appears after vomiting.
- Vomiting with an admixture of blood indicates a common cancer process or tumor disintegration. Blood can be scarlet or in the form of separate inclusions. Frequent bleeding causes anemia.
- The appearance of blood in the stool. To determine the selection of blood can be on a black chair.
As the malignant growth grows, the symptoms of intoxication - weakness, lethargy, irritability, anemia, may be fever. When cancer cells enter other organs, their functioning is disrupted, and consequently new symptoms of the disease appear.
Symptoms in children
Stomach cancer is also found in children. Signs of the disease are increasing gradually and their initial stages are often confused with manifestations of enterocolitis, gastritis, dyskinesia of bile ducts.
Often a routine treatment is prescribed, which somewhat smoothes the symptoms of the disease.
Symptoms that indicate gastric cancer in a child are divided into three groups:
- Early signs - deterioration of health, poor appetite, weakness.
- Typical symptoms, they grow gradually. This is pain, discomfort in the stomach, the child makes complaints of eructations, bloating, colic. Sometimes there is a loose stool with an admixture of blood.
- The unfolded picture of a cancerous tumor appears at the last stage. The child has almost constant pain in the abdomen, almost no appetite, there may be a prolonged constipation. Often there is a clinic of an acute abdomen, with which the child enters the hospital. In children, a large tumor can be probed through the abdominal wall.
Degrees and stages of
Five successively different stages of stomach cancer are distinguished:
- Zero stage. The growing tumor has microscopic dimensions, is on the surface of the mucous membrane, there is no damage to other organs and lymph nodes.
- The first stage is divided into two. Stage 1a - neoplasm does not extend beyond the walls of the organ, there are no cancer cells in the lymph nodes.1b, the tumor also does not extend beyond the walls, but there are already cancerous inclusions in the lymph nodes.
- The second stage also has two variants of flow.2a tumor - a tumor in the walls, cancer cells are detected in three to six lymph nodes;the cancer grasps the muscle layer, there is a lesion of one or two near the lymph nodes that are with the organ;lymph nodes are not affected, but the cancer has enveloped the entire thickness of the muscle layer.2b - tumor within the wall, cancer inclusions in seven and more lymph nodes;a tumor in the muscle layer, atypical cells from three to six lymph nodes.
- On the of the third stage, the tumor sprouts through the wall of the stomach, afflicting nearby organs and several groups of lymph nodes.
- The fourth stage is exhibited when there are metastases in distant systems and lymph nodes.
How quickly the tumor develops and the way of metastasis
The cancer of the stomach in most people develops slowly. Precancerous pathologies can sometimes be present in humans for more than 10 years.
In later stages, there are metastases that spread in three ways:
- Implantation by , or in other words, contact. Metastases are formed by germination of the tumor into neighboring organs - esophagus, spleen, gall bladder, liver, intestine.
- Lymphogenous pathway. In the walls of the body there are lymphatic vessels, into which cancer cells penetrate and then they enter the lymph nodes together with the current of lymph.
- The hematogenous pathway is the promotion of cancer cells along with blood. Usually metastases appear in the liver due to the portal vein. The hematogenous pathway promotes the appearance of malignant tumors in the kidneys, lungs, adrenals.
Can an ulcer go to cancer?
Stomach ulcer can give a push to the cancer process.
Malignancy is observed in 3-15 percent of people with ulcers of the walls of the stomach.
The reason for the transition of the ulcer into cancer is a permanent damaging effect on the cells of the organ.
Cells with a broken structure gradually lose their ability to substitute for typical, new cells, in their place begin to form atypical.
There are a number of factors that contribute to the malignancy of the ulcer. This is the consumption of a large number of spicy and smoked food, a preference for using hot dishes, a small amount of plant food.
The risk of developing cancer increases with frequent relapses of the disease, in old age and with a genetic predisposition to cancer.
Complications of
With the development of a cancerous tumor in the stomach, serious complications may develop, including:
- Bleeding. Stenosis of the stomach.
- Perforation of the walls of the organ.
- Ascites.
- Cachexia.
- Anemia.
Diagnosis
If there is a suspicion of cancer in the stomach, as well as an early gastric cancer, fibrogastroscopy, radiography, ultrasound, CT is prescribed. A biopsy is mandatory, blood is examined for cancer markers, a biochemical test is performed.
How to treat a stomach tumor?
When a cancer is detected, a surgical operation is prescribed. During its carrying out, some part of the stomach, as well as the entire organ, can be removed entirely with the seizure of neighboring structures.
Radiation therapy and chemotherapy are prescribed by courses before and after surgery. At the last stage only irradiation or chemotherapy is applied, which allows to prolong the patient's life.
How many patients live and the survival prognosis
The outcome of the treatment of an identified cancerous lesion in the stomach depends on its stage, the prevalence of the pathology, the age of the patient, the presence of metastases.
The first stage of
In detecting stomach cancer in the first stage and after successful treatment, 80 people out of a hundred survive for the next five years.
The second
The five-year survival rate is estimated at 56%.
Third
In the third stage, stomach cancer is most often detected. At this stage, the five-year survival rate is just over 35%.
Last
Overall prognosis of five-year survival rate of 5%.The prognosis for patients with stage 4 gastric cancer with metastases in the liver is extremely unfavorable, even worse, if there are several foci of secondary cancer in the liver. Treatment can prolong life only for a maximum of several months.
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