Treatment of stomach cancer

Surgical treatment of stomach cancer and currently remains the only one of any effective remedy. This is due to low sensitivity of stomach cancer radiation therapy, and insufficient effectiveness of modern chemotherapy drugs. The task of all doctors is reduced to the early detection of gastric cancer, the surgeon to remove part of the stomach or even all of it together with the main collectors lymphatic basin, which has defined clear metastases or which may exist is not yet visible, but can be microscopically proven elements of the cancer.
The main medical-surgical method is resection of the stomach in healthy tissues. She has a number of significant, binding, features: the removal of all large and small Salnikov, holding resection, some distance from the visible edge of the tumor in cranial direction not less than 6-7 cm below the pyloric ring not less than 2-3 cm (individualization in relation to the structure and type of tumor growth).
In the localization of cancer in the area of small curvature and pyloric need radical removal of regional nodes of the first collector. They are located in a small gland.
To ensure proper radicalism operations should remove part of the stomach together with a considerable part of the lesser omentum and gastro-pancreatic conjunction with her lymph nodes, and all the great seal with the gastrocolic ligament, without damaging vessels mesocolon. All these formations that may potentially contain metastases should dissect a single block with all carry out part of the stomach resection or with the whole stomach when gastrectomy.
Immediate results of operations of stomach cancer in the last 20 years has dramatically improved. Direct smertelnoj declined from 29 percent to 4.3 percent. Operiruet gastric cancer patients remained nearly the same (60%), the number of the operated, so to speak radically increased from 45%to 55%. The resectability increased by: (a) expansion of indications to remove his cancerous Department stomach even if it germination in neighboring organs; b) the extension of the resection; C) wider operating patients with so-called pre-cancerous conditions (polyposis stomach ulcers small curvature and the body of the stomach and subcardial ulcers, anatsidnyh, rigid and pseudotumorous gastritis).
The success of treatment of patients with gastric cancer, largely depends on rational preoperative preparation and proper postoperative management, and it should be remembered that these patients greatly disturbed metabolism, they are dehydrated, are in a state of cancerous intoxication, and sometimes depletion anemia. We should not forget about the age of a large group of patients who have expressed a General phenomenon of atherosclerosis, and sclerosis of coronary and cerebral vessels, there myocardiodystrophy, angina, there are decompensation of blood circulation, respiratory failure or the consequences of earlier myocardial infarction. Quite often observed and pancreatic insufficiency, not speaking about diabetes and gipofizarnah and General hormonal deficiency. However, the impossibility of long-term postponement of the preparation, which is conditioned by the essence of cancer, have sometimes led to preparations for the operation in a short period of time.
Care for patients after surgery for cancer of the stomach should consist of the observance of General activities (oral hygiene, frequent flushing, frequent rubbing of the skin, ventilation, respiratory gymnastics and etc.) and special procedures aimed at draining the lungs and bronchi by reasonable movements in bed, giving the patient the provisions of Fowler, often early getting up from the bed, appointment procedures for elimination of pulmonary hypostasis and face means.
To resolve gipoproteinemii and carbohydrate metabolism (in patients with a tendency to hypoglycemia) should, in addition to parenteral nutrition, enter in the composition of food is easily digestible proteins (eggs, cheese, etc.,) and a sufficient amount of carbohydrates. You need injecting drugs sodium, calcium and potassium for the normalization of electrolyte balance of the organism, and if the patient is not enough drinking (vomiting), then enter parenteral slowly not less than 2,5-3 liters saline solution with glucose.
The choice of the nature of the operation in stomach cancer depends on many factors: the location of the tumor, its type and growth, distribution or germination in neighboring organs, etc., and, of course, from the General condition of the patient. Roughly thematisiert, should be distinguished: a) Subtotal resection of the stomach with the line of crossing above the left gastric artery (cancer of the output section of the stomach); b) total resection, or rather a gastrectomy (cancer of the body of the code or the upper section of the small curvature); C) resection of the cardia (cancer of the cardia, rolling on the esophagus). The last operation can be performed as abdominal (Karelian Isthmus boots, A. G. Savin), or transpleural way.
Data B.p. Napalkova (1958), based on the experience of observations over 3000 patients with gastric cancer and produced 1500 its resection with account of the true long-term results (5-7 years), cause with great care to use the term "radical surgery". The apparent "radical" is usually based on the fact that morphologically, outwardly as if unable to excise large portion of the stomach with his ligamentous apparatus and seals or make a gastrectomy when really it is never obvious no metastases or these metastases are of a purely local character, beyond the boundaries of the I-II collector lymph nodes pool stomach. Because when operation microscopic metastasis cannot be detected, make good use instead of the term "radical" following "oncologichesky" characteristics produced by gastric cancer operations: "take away" operations and diagnostic operations.
To "take away" transactions include: a) supposedly radical, extremely wide resection of the stomach or gastrectomy, as she even within ligament-packing machine and in the I - II reservoirs of the lymphatic system remains were discovered metastases; b) conditionally (doubtful) radical when metastases already in these reservoirs were, but as a single unit carried out; C) deliberately non-radical (palliative)when metastases were in the III-IV collectors and their managed to carry out or when there was a single node in the liver (next door), or was localized germination stomach cancer in one or more adjacent organs (liver, pancreas, mesocolon, colon, the leg of the spleen, the edge of the diaphragm).
To "diagnostic" operations should include laparotomy, in which it is shown that because of the presence of disseminated metastases or carcinomatosis to do resection pointless.
In addition to the "oncologichesky" characteristics, one should also consider the technical side of things and on this basis to distinguish among "taking away" operations: 1) limited resection aboral Department of the stomach; 2) limited resection of the oral Department or cordectomy; 3) extended resection of the stomach, mandatory feature of which is the ligation of the left gastric and short splenic artery; and 4) the gastrectomy.

In a long-term observation is that among patients who underwent combined resection, more than 5 years is home to around 20%, while this type of resection are as if to a known non-radical operations. Already it is quite justifies the rationality of the combined resection of stomach cancer in General, when a strict accounting of contraindications. These data are close to the above mentioned figures.
However, the mapping of remote results in relation to the nature resection combinations shows that to extend indications for combined resections most efficiently when it is necessary to do in the direction transverse colon, then in the direction of mesocolon or piece of peritoneum, covering the pancreas and even rarer in the direction of the left lobe of the liver (here is remote survival rate is very low). Quite different is obtained after resection, combined with resection of the pancreas, especially her head. Here are the available remote monitoring only a few patients. In addition to the General high direct mortality combined resections, even among the survivors it was especially significant loss of between 1 and 2 years after surgery.
The analysis of remote results of histological structure and type of tumor growth showed that in patients, who lived after the surgery 5 years or more, was glandular cancer with exophytic growth. All patients with endophytic type growth of cancer cells died in the 1st year after surgery. Thus, you should take particular care to treat the combination gastrectomy with removing the affected tissue of the pancreas. Equally important is to refrain from combined resections and endophytic the growth of cancer of the stomach and negalesite its structure.
The immediate causes of deaths after surgery for gastric cancer diverse. In the first place remains peritonitis arising from the insolvency of seams anastomosis, from pancreatic necrosis and melting, insolvency seams stump duodenum or anastomosis, lymphogenous generalization of infection from cancer focus on the peritoneum. The second place is occupied cardiopulmonary complications, especially in patients of advanced age, already previously had aggravating their cardio-pulmonary disease. In 1% of cases the cause of death is postoperative bleeding into the lumen of the gastrointestinal tract. Often we lose patients from insurmountable atony of the gastric stump or paresis guts. Some patients die from neprijatnostej the gemokoagulyatsii and pulmonary embolism.
To define, whether there was a lymph node metastasis not yet offered any reliable means. It was recommended to enter into the stomach, for example, methylene blue, or injecting it (or radioisotope products) during operation in the lymphatic system of the stomach wall and watch and not be detected if so sites that bad perceiving blue (or counter) because of the infestation of their metastases. These proposals were not convincing and achieved recognition. Therefore, the surgeon during the operation is feeling lymph nodes in areas already mentioned collectors lymphatic basin stomach and decides on the presence or absence of metastases. In some cases, you can resort to urgent biopsy of the lymph node, but a negative response it is not reliable. Thus, the outlined objective still remains allowed only very tentatively. It makes you to treat all resections for cancer of the stomach, declared "radical", just as it supposedly radical.
Radiation treatment of patients with gastric cancer, is not effective. About 10% of all malignant tumors of the stomach after irradiation for some time decrease. Noted that the most sensitive are tumors of the dome and of the gastric cardia. Small cell lung cancer that originates from the epithelium of the Foundation of the glands, also belongs to the group of more radiosensitive tumors. Colloidal cancer is much more resistant. Diffuse cancer fibrous type absolutely not sensitive. On the contrary, lymphosarcoma and reticulocytosis be very sensitive and would disappear after radiotherapy for a long time. Most cancers of the stomach, even succumbing to the original exposure, then, however, show an even greater vigor than before irradiation.
Chemotherapy in the hospital of stomach cancer has not found wide application because of their low efficiency.