Clinical course and complications of gastric cancer

The clinical course of stomach cancer is highly diverse and has many features. In the course of stomach cancer is influenced first of all 3 factors: 1) the nature of the growth and spread of the tumor; 2) the extent caused by a tumor of functional disorders and 3) related complications.
Rapid growth are characterized by endofitno-ulcer forms. Endophytic, polypoid forms of cancer develops slowly and flow over a long time. Relatively slow and seemingly favorable (in the sense of externally noticeable violations) over different serosnye form, although sometimes they actually affect the whole stomach. Postoperative prognosis with them very unfavourable; rapidly developing metastatic generalization of the process as a result of active infiltrating the growth of cancer elements of the tumor.
Expressed eating disorders cause cancers, located at the entrance to the stomach and out of it, but do they differ slow current.
In younger patients, rapid for stomach cancer and metastasis they are more frequent than in older patients.
In our country it is accepted to distinguish stage 4 clinical course of gastric cancer. Characteristic to this:
I stage. It is characterized by the following signs: swelling in diameter no more than 2 cm, germinating it only mucous membrane of the stomach and the lack of visible metastases.
II stage. Tumor sizes in diameter are 4-5 cm; the tumor grows submucosa even the muscles of the stomach; there are metastases in the next regional nodes, and there began spreading of tumor in the coming bodies that promotes fusion of the stomach with them. Complications of tumor is in this stage that occur infrequently.
III stage. The tumor grows podberezny layer or serosa stomach, neighboring organs and tissues, low-moving. This reveals a tendency to the development of a conglomerate of organs and tissues. Tumor sizes increase, there is a tendency to collapse. Metastases capture nodes III and IV of the lymphatic collectors of the basin of the stomach. At this stage there are numerous complications.
IV stage is final. There are extensive or total loss of the stomach moving on to neighboring organs, distant metastases in lymph nodes (neck), in the bones, lungs. Due to germination of metastases develop cancer infiltrate and there is complete immobility of cancer of the body
The final determination of the stage of the disease often becomes possible after a detailed study of the remote preparation of the stomach and histological studies of its walls and removed with him lymph nodes.
For stomach cancer often varies with metastatic disease, bleeding, anemia, perforation, of the cancer spreading to adjacent organs and the emergence of co-infectious processes.
Metastases of stomach cancer are characterized by the multiplicity and diversity of their sizes. Metastasis is most often spread through the lymphatic system, less the blood vessels; metastases occur by implantation of stray cancer cells.
Bleeding in stomach cancer can be rich if the tumor is localized to a small curvature near major vascular branches, or during germination of its authorities, rich in blood vessels. In cancer of the stomach is often abundant bloody vomiting. At surface collapse of cancer is often hidden bleeding, defined by the reaction of yens Gregersen collection. Often there is bleeding in the stomach opening, but in the presence of metastases or perforation of the tumor, it can occur in the free abdominal cavity. Due to blood loss, nutritional disorders and metabolic disorders of stomach cancer develops progressive character of iron deficiency, anemia.
If the perforation of the cancer of the stomach in free abdominal cavity occurs pattern of acute abdomen, such as when ruptured stomach ulcer, but recognized harder. Perforation of gastric cancer in the colon with the occurrence of gastrointestinal fistula first described Haller (1751). Described cases of perforation of gastric cancer in the gallbladder, the vertical part of the duodenum, in the pleural cavity, etc.
Perforation of gastric cancer is associated primarily with the development of tumor necrosis, inflammation, acute thrombosis of vessels in tumors and inflammatory limfangoita.
The germination of gastric cancer in related bodies sometimes leads to the formation of cancer conglomerate, which includes several bodies. In the clinical course of the disease is manifested by a sharp pain in the back during germination in the pancreas or in the root of the mesentery. The germination of gastric cancer in the mesentery of the transversal colon is manifested progressive swelling, limitation of smaduamei tumor, increased pain on palpation, temperature reaction of the organism. The germination of gastric cancer in the abdominal wall can simulate infiltrate or cellulitis in it. Often the cancer metastasis is located in lig. tores hepatis, and it captures the skin and the navel.
There are three types of germination of stomach cancer:
a) filamentous or filmy peritoneal adhesions or flat seam, which contains cancer cells;
b) spreading of cancer with the development of inflammatory infiltrate, creating the impression that the tumour has already spread into adjacent body;
in true germination cancer, often in tubular or parenchymatous organs, when there is infiltration of the surrounding tissues, which significantly changes the growth and for cancer.
In the decay of a cancer of a stomach ulcer occurs as a complication of inflammatory infiltration of the walls of the body, often causing hidden, causing short-term, difficult to explain the rise in temperature, with the shift of leukocyte formula acceleration ROHE, the advent of unexplainable at first glance, tromboflebitov limbs, lung under the guise of pneumonia. Due to poor nutrition the cancer suppurative processes in it in the form limfangoita, phlegmon, thrombophlebitis in the tumor tissue and in the tissues and organs surrounding it, are frequent.
Disintegrating ulcer cancer of the stomach flows often with a heavy General phenomena and intoxication. This is based on the influence of the rotten microbial flora. Thrombosis or squeeze main artery can cause necrosis of the wall of the stomach that may be superficial, deep, sekvestriruyut (with the defeat of the main vessel) and abstemious when purulent putrid hearth occurs in the tumor itself. All this leads to the development of a long fever, and sometimes septic conditions and purulent metastases in lungs, kidneys and other organs.
Often in stomach cancer can form an abscess wall with acute or, on the contrary, very slow current. In the future may develop suddenly perforation and acute peritonitis, less frequently, bleeding, or the formation of ulcers with very different localization.