The gastric cancer is a malignant neoplasm, which develops from the mucosal layer of the stomach.
The gastric cancer is a very common disease, it is still the fifth most common cancer and the third most common cause of cancer death in the world.
In Georgia, the gastric cancer is the fourth most common neoplastic malignancy.
The chemotherapist of the National Center of Surgery, Nata Murusidze, talks about gastric cancer.
- Dr. Nata, what is the cause of gastric cancer?
- The exact cause of the gastric cancer is unknown, but I can list some factors, that can predispose a person to the development of this disease:
- Gender. Males are affected more than females (especially in the age group 50-70 years)
- The presence of Helicobacter, which causes gastritis. A gastric ulcer can cause the atrophy and dysplasia, which is the precancerous state.
- Atrophic gastritis, Menetrier’s disease, partial gastrectomy.
- Alimentary factors: salty, smoked, canned or sour products, consuming a large amount of meat can increase a chance of developing gastric cancer.
- Alcohol and smoking.
- Gastric cancer and genetics. Does a genetic factor play a role in the development of this disease?
- Yes, a genetic factor should always be considered. 10% of cases are familial, 1-3% is associated with the hereditary factors. The hereditary syndromes associated with the cancer are hereditary diffuse gastric cancer (HDGC), Lynch syndrome, familial adenomatous polyposis. In this case, we have a mutation of the p53, STK1, APC, CDH1 genes.
- What are the symptoms of gastric cancer?
- Unfortunately, it is very hard to diagnose the disease at an early stage, because the symptoms are nonspecific at the beginning of the disease. These symptoms develop at the later stage: loss of appetite, food aversion, nausea, vomiting, belching, anemia, unexplained progressive weight loss, loss of interest in life, people and work, apathy.
- How is the disease diagnosed, and what are the modern methods used at the National Center of Surgery?
- Despite the availability of modern devices, an indispensable method for diagnosing the gastric cancer is gastroscopy. At this time, the endoscopist assesses the general condition of the mucosa, conducts a biopsy of the suspicious areas. Histomorphological examination of the obtained specimen allows us to determine the nature of the neoplasm. The classification is carried out according to the criteria of the World Health Organization and the Lauren classification. According to Lauren's classification, diffuse and intestinal types are distinguished, and according to the World Health Organization, the most common form is adenocarcinoma, which is papillary, tubular, and mucinous. There are also other rare forms, such as the gastrointestinal stromal tumor (GIST), lymphoma, neuroendocrine tumors.
The next step after the diagnosis is to determine the stage and spread of the process, which is critical for determining the correct treatment regimen. Clinical staging has become much easier with the increase in the modern research machines.
The National Center of Surgery is equipped with all the latest technologies that are used and implemented in the world - computed tomography (CT), magnetic resonance imaging (MRI). Very soon, positron emission tomography (PET) will start functioning.
- What are the types of treatment methods of gastric cancer used in the National Center of Surgery?
-A treatment of the gastric cancer is based on the modern guidelines. Each case is discussed with the members of a multidisciplinary team, which includes a clinical oncologist, radiologist, surgeon and other specialists. We think about every detail, in the end, we sum up wha t regimens and stages of treatment should be offered to the patient to obtain the maximum effect.
The treatment of stomach cancer is complex and involves several methods.
Surgical treatment:
This is a radical method of the treatment and used only for the localized gastric cancers.
The volume of the surgery depends on the location and size of the tumor. It is possible to perform the full or partial gastrectomy with D2 lymph dissection, which is the standard for surgical treatment of gastric cancer.
Medicamentous treatment (chemotherapy)
By the modern standards, the medication therapy plays an important role in the treatment of cancer.
According to the international guidelines, the treatment of gastric cancer in IB-III stage begins with neoadjuvant or preoperative chemotherapy. At this time, the goal of drug treatment is to Downstage (lower the stage), ie if there are metastatic lesions (cN +) before the beginning of chemotherapy in the lymph nodes, then after the treatment this picture can change and the pathological processes occurring in the lymph node may regress. As a result, after further investigation of the lymph node, metastatic lesions are not detected (ypN0) and this condition certainly has the best prognosis. At this time, overall survival and disease-free survival rate increase significantly.
Adjuvant or postoperative chemotherapy is prescribed when the patient has not received neoadjuvant chemotherapy. The goal of adjuvant chemotherapy is to increase overall survival and disease-free survival rate.
With the stage IV gastric cancer, palliative chemotherapy is prescribed to reduce the symptoms caused by the tumor, improve the survival rate and the patient's quality of life.
Targeted therapy is used in combination with chemotherapy to treat the common forms of gastric cancer, where FISH (fluorescent in situ hybridization – which marks the chromosomes with the fluorescent dye to identify the fragment of the DNA) or immunohistochemical method reveals hypersecretion of the HER2 gene.
- Can the gastric cancer be prevented and what can you advise to our readers?
– For the purpose of prevention, it is important to have a healthy lifestyle, avoid alcohol and smoking, change the diet, primary prevention, regular examination of people with the family history of cancer. It is possible to prevent the development of cancer or to detect it earlier by the early diagnosis of the precancerous state, treatment, periodic monitoring.
National Center of Surgery address – Tbilisi, Digomi Chachava street N5.
You can contact the Call-center of the National Center of Surgery at 577 11 91 19 or 2 02 25 25;
If you have some questions, you can contact the chemotherapist of the National Center of Surgery Nata Murusidze at 599 29 42 00;
Wish you health!
