Gastric adenocarcinoma is one of the most common forms of malignancy of this organ.
At the first stages the formation of a cancerous tumor of this species proceeds practically without characteristic changes in the state of health, therefore adenocarcinoma is rarely detected in the first stage.
A characteristic difference between adenocarcinoma and early appearance of secondary foci of malignant process, that is, metastasis. This further aggravates the course of the disease.
Concept and statistics of the disease
Adenocarcinoma develops from epithelial glandular cells that have undergone a number of provoking factors atypical changes.
It is this type of cancer in the stomach that develops in most patients, according to adenocarcinoma statistics it is almost 95% of all malignant neoplasms.
Due to the high incidence of this disease in the medical literature, it is referred to as stomach cancer.
The formation of adenocarcinoma can take several years, sometimes this period reaches 15-20 years.
Clinically, gastric cancer in most of the examined patients begins after about 45 years.
Gastric adenocarcinoma leads to the development of metastases in more than 82%.Disease is more susceptible to men. In advanced cases, surgical intervention is impossible, since the malignant process seizes organs, lymph nodes and tissues located next to the stomach.
Causes of development of
The main cause of adenocarcinoma in the stomach is a marked violation of blood supply and wall nutrition and suppression of secretion in the body. Such pathological changes are most often caused by the carcinogenic effects of certain substances.
Among the main causes of stomach cancer are:
- Exposure to tobacco tar and ethyl alcohol. Adenocarcinoma is detected in most cases in patients who have a long history of smoking and alcohol-abusing containing drinks.
- Irrational nutrition. The risk of developing gastric cancer is increased in people who prefer to eat fatty, smoked and salt-rich foods. In such dishes there are many special substances - nitrites. When they get into the stomach, hydrochloric acid acts on them, and complexes are formed that damage the mucous layer and thus provoke the transformation of normal glandular cells into atypical ones.
- Prolonged following the diet of with minimal consumption of dietary fiber, lack of vitamins and trace elements.
- Bacterium Helicobacter pylori. This microorganism causes an infiltrative gastritis, which proceeds with atrophic changes in the mucous layer. With age, with long-term infection with Helicobacter pylori, the likelihood of cancer development increases.
A definite value in the formation of gastric adenocarcinoma is attributed to genetic predisposition. The carried out researches have allowed to establish, that the cancer cells in a stomach practically never develop, if there are no background diseases.
The probability of adenocarcinoma formation increases if a person has a history of:
- Chronic atrophic or hyperplastic gastritis.
- Peptic ulcer.
- Polyps in the stomach.
- Operations on the organ.
Most patients with adenocarcinomas in the stomach live in ecologically disadvantaged areas, work in hazardous industries and their age is more than 50 years.
Classification of
Gastric adenocarcinoma has several classifications. According to the Bormann classification, gastric cancer is divided into five species and four subspecies.
Five main types:
- Polyposis or restricted type of tumor.
- Ulcerous, characterized by enlarged external borders.
- Pseudo-ulcerative. By its changes is similar to a stomach ulcer.
- Diffuse form of adenocarcinoma.
- Non-secret type of stomach cancer.
Photo of polypous adenocarcinoma of the stomach
Four subspecies:
- Papillary adenocarcinoma. It is formed from the papillary structures of the epithelium, grows into the cavity of the organ, the form of formation is digitiform.
- The tubular gastric adenocarcinoma consists of branched or cystic-dilated structures.
- Mucous is a subtype of cancers. In the malignant process, mucus is constantly produced, it is noticeable during gastroscopy.
- Ring-like cell carcinoma. Isolated cancer cells affect the walls of the trunk.
According to the type of structure, the adenocarcinoma of the stomach is divided into:
- Low-differentiated. The structure of this tumor does not depend on the type of organ tissues, the probability of early development of metastases is increased. Has one of the highest degrees of malignancy.
- A highly differentiated tumor is an entity whose cells are little distinguishable from healthy ones. The outcome of the disease can be considered favorable.
- The mildly differentiated cancerous tumor is characterized by the large appearance of atypical cells compared to the highly differentiated form.
- Malodifferentsirovannaya adenocarcinoma is a tumor in which ferruginous complexes are practically absent.
- The undifferentiated form of adenocarcinoma of the stomach is characterized by pronounced malignancy of atypical cells. The outlook is unfavorable.
Low-grade adenocarcinoma of the stomach
A low-grade form of adenocarcinoma is exposed when the lowest degree of cell differentiation is established. That is, they lose their specialized structure and do not fulfill the necessary function.
The video shows a low-grade gastric cancer detected by a gastroscopy:
This form of cancer has an aggressive course, the malignant formation is formed quickly enough and the formation of secondary cancer can occur quickly. The tumor spreads in the thickness of the walls. The prognosis for poorly differentiated forms of cancer for patients is unfavorable.
Highly differentiated
The peculiarity of highly differentiated gastric adenocarcinoma can be attributed to a slight tendency of the cells to polymorphism. That is, atypical cells have a similar structure to the common glandular cells of the epithelium and continue to perform part of their functions.
Pathological changes are detected only in the nucleus of cells, it becomes elongated. A highly differentiated cancer grows slowly, sometimes several years pass before the appearance of the first clinical signs of the disease.
This form of adenocarcinoma is quite successfully treated, but the chance of no relapse is higher in patients with the first stages of cancer.
Moderately differentiated
Moderately differentiated gastric adenocarcinoma is an intermediate tumor. By its course is closer to highly differentiated tumors, but cells with a changed structure are detected much more often.
Since there are no characteristic manifestations of this form of malignant process, it is rarely possible to detect the tumor in time. This creates difficulties in the treatment, but if it is done in a timely manner, then the prognosis for the patient is positive.
Symptoms of
Gastric adenocarcinoma develops almost always quite slowly. At first, malignant process does not lead to the appearance of specific signs and therefore early detection of glandular cancer is most often possible with preventive examinations or when examining for other diseases.
The patient most often appears intolerant to protein foods, this refers to meat and fish dishes.
The following symptomatology is associated with adenocarcinoma of the stomach:
- Pain in the stomach. The intensity of pain is not associated with eating, as for example, with peptic ulcer. That is, pain can appear before eating, after it, or bother the person constantly. Painful sensations are often given in the back, scapula, sternum.
- Disturbance of bowel movement. A tumor in the stomach causes a lack of proper digestion of food, which in turn leads to diarrhea or prolonged constipation.
- Complete absence of appetite occurs in the last stages.
- Weight reduction.
- Fast fatigue , lethargy, loss of habitual ability to work.
- Stuffed stool. The appearance of black feces is a sign of bleeding from the stomach, which can indicate the disintegration of the tumor with the involvement of the stomach walls and a number of located organs in the pathological process.
- Vomiting with food or blood.
Malnutrition and recurring bleeding lead to the development of anemia, due to this the skin of a person becomes pale, yellowish. The lack of hemoglobin negatively affects the condition of the hair and nails.
On adenocarcinoma of the stomach may indicate periodic increased salivation, raising body temperature to 37.5 or more degrees. The nervous system suffers. Irritability, apathy, depressive conditions often accompany the formation of a malignant tumor in the stomach.
It should be borne in mind that the glandular cancer of the stomach often occurs without pain and other symptoms indicating a disorder in the gastrointestinal system. It is these tumors that are most dangerous, since they are detected in the last stages, in which the operation is not effective.
Stages of
Adenocarcinoma of the stomach passes through several successive stages of development.
- The early stage of is when the malignant neoplasm does not extend beyond the mucous membrane. The tumor is small in size, there is no penetration into the adjacent organs. At this stage, toxins are released slightly, so the symptoms of intoxication are practically absent, and there are no specific manifestations of the disease. Sometimes you can pay attention to a slight deterioration in appetite.
- The second stage is set when the neoplasm begins to occupy the muscle layer. Cancer cells enter the lymphatic system, so the nearest lymph nodes can grow in size. Symptoms are mild, the main manifestations are disturbances in digestion, minor pain, poor appetite, the first signs of intoxication appear.
- At the third stage, the tumor captures all layers of the stomach and begins to penetrate the peritoneum, liver, pancreas, esophagus. Secondary foci of cancer cells are found not only in the nearest lymph nodes, but also in distant ones.
- The fourth stage is characterized by the appearance of numerous metastases.
Diagnosis
If a patient identifies symptoms similar to the symptoms of adenocarcinoma in a patient, he assigns to him a series of examinations. Most often for the diagnosis of malignant formation in the stomach is prescribed:
- Esophagogastroduodenoscopy. This method is one of the most informative, it allows you to determine not only all the changes in the stomach cavity, but it is also necessary to take the material for the histological analysis.
- Radiography of the stomach with contrast material determines the location of the formation, reveals abnormalities in the peristalsis of the organ.
- The ultrasound scan is assigned to detect cancerous processes in other organs and the lymph system.
- Computed tomography scans the entire body layer by layer. This modern diagnostic method allows you to establish a primary focus and identify secondary changes.
- Blood test is assigned to detect inflammation, signs of anemia. In the blood, cancer markers are also identified, indicating a high probability of a malignant process in the body.
Treatment of
Treatment for a patient with gastric adenocarcinoma is selected only after a complete examination. If the cancer is in the first stages, then an operation is mandatory, during which the tumor itself is removed with the tissues that have been altered nearby.
It is possible to remove most of the stomach or complete resection. Obligatory lymph nodes are also cut off, because through them cancer cells can penetrate into distant organs.
In the final stages, surgical intervention is inadvisable, since it is impossible for a person to deprive not only one stomach, but also all cancer-affected vital organs.
In such a course of the disease, the patient is assigned maintenance therapy, consisting of radiation exposure, chemotherapy sessions, pain medication, and drugs aimed at improving the function of the stomach.
If a growing tumor makes it difficult to move food through the esophagus, an operation can be performed that will remove obstruction.
Chemotherapy and radiotherapy sessions are prescribed before and after surgery. Their use will allow the destruction of some cancer cells, which reduces the risk of a re-malignant process.
How effective is chemotherapy for gastric adenocarcinoma
Chemotherapy for gastric adenocarcinoma is prescribed in several cases:
- To alleviate a patient's condition in advanced stages of cancer.
- To slow the growth of the tumor and to prevent the appearance of secondary foci.
- After the operation to destroy the remaining cancer cells.
The type of chemotherapy for each patient is selected individually. There are effective treatment regimens, where two or more chemotherapeutic agents are used at once.
Such treatment is carried by most people quite hard, worried about severe nausea, weakness, there is leukopenia with the corresponding manifestations, hair falls out.
Chemotherapy reduces the likelihood of recurrence of the disease and significantly increases the chances of a sick person for a longer life expectancy. The effectiveness of this method of treatment of cancerous tumors will increase with the simultaneous appointment of radiation therapy and with the possibility of surgical intervention.
Metastasis
The formation of metastases with adenocarcinoma significantly worsens the course of the disease. In this type of cancer, secondary foci are initially formed in the organs of the abdominal cavity, such as the liver, pancreas, and spleen.
Probably penetration of atypical cells into tissues around the navel and lungs. The defeat of lung tissue causes the development of a painful cough, the attack of which can be accompanied by the release of mucus streaked with blood.
Complications of
The main complications of adenocarcinoma include:
- Perforation of the organ. A tumor that occupies all the walls of the stomach, during its melting, can cause perforation with the release of stomach contents into the abdominal cavity. This leads to the development of peritonitis.
- Bleeding. Penetration of the tumor into the blood vessels causes their damage, which is manifested by periodic bleeding.
- Stenosis of the gatekeeper.
- Ascites. The accumulation of fluid in the abdominal cavity is provoked by compression of the developing tumor of venous vessels.
- Anemia. Reduction of hemoglobin occurs as a result of malnutrition and frequent bleeding.
Forecast
How long will a person with an identified adenocarcinoma of the stomach, depends on the stage of the malignant process of the body's response to a prescribed course of therapy.
The most unfavorable outcome is always observed in the fourth stage - in five years only two percent of people avoid the lethal outcome of the .
Prevention
The likelihood of developing gastric adenocarcinoma is much lower in those people who always adhere to the principles of healthy and rational nutrition. The lack of influence of tobacco carcinogens and alcohol also reduces the risk of changes in the walls of the stomach.
It should also always be remembered that non-treated diseases of the stomach can give impetus to the formation of atypical cells. Therefore, it is always necessary to treat chronic diseases and consult a doctor when there are even minor changes in the digestive organs.
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