Diagnosis and treatment of gastric cancer
In the previous issue we learned that gastric cancer is the fifth most common cancer and one of the most deadly cancers in the world. It was also stated that quitting smoking and alcohol, following a diet high in fiber, fresh fruits and vegetables, avoiding over processed foods or containing high levels of nitrite and nitrate, and treatment for infection with Helicobacter pylori, then we can reduce the risk of gastric cancer. In this issue we will talk about the screening, diagnosis and treatment of gastric cancer.
The goal of screening is to identify early cancers (before the disease progresses) of a country’s health care systems to take remedies and reduce the incidence of morbidity and mortality. For gastric cancer, screening is done in three ways: Pepsinogen testing in the blood, gastric x-ray scan as well as gastric endoscopy with the help of Barium-meal Gastric Photofluorography.
It should be noted that all of these approaches have been successful in countries such as Japan where gastric cancer is high and their effectiveness in the United States has not been proven. In other words, the application of these methods on a large scale in the United States has not reduced the incidence of mortality from gastric cancer.
Gastric cancer is diagnosed by taking a patient’s history and careful examination. The patient usually has symptoms such as indigestion, heartburn, nausea, flatulence, and abdominal pain, diarrhea or constipation with severe weight loss, bloody vomiting, or black stool (Melena).
Next, most doctors perform an upper gastrointestinal endoscopy. In this way, the doctor can see the esophagus and stomach as well as the small intestine, and if there is a lesion or inflammation, the doctor can do biopsy on the lesion and send it to the pathological laboratory for diagnosis.
Another method is endoscopic ultrasound, which allows the physician to ultrasound the gastric mucosa and muscle tissue in addition to seeing the inside of the stomach with the camera. Different imaging modalities such as Barium-Gastric Photofluorography, CT-scan and MRI can also be used to diagnose the disease if needed.
The decision to treat the disease is made on the basis of the progression of the disease or its so-called “staging”. If gastric cancer is diagnosed in its very early stages, Stage 0 (where the lesions are confined to the inner lining of the stomach and have not yet spread to the lower layers), only surgery is required. Depending on the extent of the lesions, surgery may be performed by endoscopy, laparoscopic or open surgery, and part of the stomach or all of it may be removed.
Lymph nodes are usually removed around and near cancerous lesions. If the cancer spreads to the lower layers of the gastric mucosa or its muscles and the disease enters Stage I or higher stages, surgery alone is usually insufficient and should be followed by complementary treatments such as chemotherapy as well as Radiation Therapy.
Chemotherapy and strengthening the immune system
Some patients require chemotherapy or radiation therapy before surgery, and these may continue after surgery. The success of treatment in these stages depends on the patient’s age, physical strength, and psychological state in addition to appropriate treatment. Other treatments include strengthening the immune system to fight cancer, known as Immunotherapy.
Gastric cancer is one of those cancers that has a tendency to relapse that is treated similarly to chemotherapy and radiation. Unfortunately, despite all the remedies as mentioned in the previous article, gastric cancer is one of the most deadliest cancers because the average lifespan of those diagnosed is only 24 months and the chance of the patient surviving for five years after diagnosis and treatment is only about 10%.
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