Gastric or stomach cancer is a cancer that forms in tissues lining the stomach. In India there were 57,394 new cases diagnosed in 2018 alone.
TYPES OF GASTRIC CANCER
Based on types of cells in the tumour
- Adenocarcinoma: Tumour that originates from cells in the lining of the gut that secretes mucus and other fluids.
- Gastrointestinal Stromal Tumours (GIST): These are tumours that start in the muscle tissue of the digestive tract.
- Lymphoma: These tumours start in the lymph nodes which are part of the body’s immune system.
- Carcinoids: These are tumours that start in special hormone-producing cells in the intestine.
Based on how the disease has advanced cancer
- Very Early Cancer: The tumour has not spread beyond the first layer of the stomach and has not spread to the lymph nodes
- Locoregional cancer: The cancer has grown beyond the first layer of the stomach and may have grown to surrounding lymph nodes.
- Metastatic cancer: The cancer has spread to distant sites and organs in the body.
STAGING OF GASTRIC CANCER
If you are diagnosed with gastric cancer, your doctor will run more tests to determine the extent (stage) of your cancer. The stage of your stomach cancer is based on the size and spread of the tumour and helps the clinical team decide which treatments are optimum:
- Stage I: The tumour is limited to the top layer of tissue that lines the inside of the esophagus or stomach. Cancer cells also may have spread to a limited number of nearby lymph nodes.
- Stage II. The cancer has spread deeper into a deeper muscle layer of the esophagus or stomach wall. Cancer may also have spread to more of the lymph nodes.
- Stage III. The cancer may have grown through all the layers of the esophagus or stomach and spread to nearby structures. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.
- Stage IV. This stage indicates that the cancer has spread to distant areas of the body.
Sources:European Society of Medical Oncology (ESMO); Cancer India; American Cancer Society; National Comprehensive Cancer Network (NCCN); Mayo Clinic; Cancer.Net;
DIAGNOSTIC TESTS FOR GASTRIC CANCER
- Clinical history and examination: The doctor will ask for symptoms such as abdominal pain, heartburn, acidity, burping, nausea, vomiting, blood in vomit, swelling in the abdomen, poor appetite and unexplained weight loss. The abdomen will also be examined for swelling and pain.
- Endoscopic examination: The doctor uses a thin, flexible, light-emitting tube called an endoscope to examine the esophagus (food pipe) and stomach by passing it down the patient’s throat. If any abnormality is seen a sample of the tissue is taken using tools attached to the endoscope and are sent to the lab.
- Radiological examination: CT-scan is useful to stage the cancer and detect spread of the cancer to other parts of the body. It may also be used to guide the doctor while collecting a biopsy sample. In some cases, contrast may be injected in to the vein to improve the visualisation of the tumour on CT. Chest X- and a PET scan are used to detect the spread of cancer (also called metastasis). A special X-ray called a barium meal can allow radiologists to gather more details on the tumour wherein the patient swallows a liquid containing barium, which acts as a contrast agent. An endoscopic ultrasound uses an ultrasound probe introduced down the throat and into the stomach to provides images of the layers of the stomach wall and nearby lymph nodes. It is useful to determine how far the cancer has spread in the stomach wall and in the nearby tissue.
- Histopathological examination / Biopsy: A sample collected by endoscopy or surgical removal is examined by the pathologist under the microscope. The pathologist will confirm the diagnosis of cancer and provide information about the characteristics of the tumour cells that can help in deciding the best route of treatment.
- The doctor may also conduct other tests such as genetic tests and immunohistochemistry. These tests may include HER-2 (a growth promoting protein in tumour cells that can be specifically targeted), PDL-1 (an immune checkpoint protein that can be targeted by immunotherapy).
TREATMENT OF GALLBLADDER CANCER
The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.
- Endoscopic Mucosal Resection (EMR): EMR can be done for those patients in whom the cancer does not extend beyond the inner layer of the stomach (also known as mucosa). A small tube is passed down the throat and into the stomach and the tumour is removed.
- Surgery: The surgeon aims to remove all cancerous tissue from the body and may remove a part of the stomach, or the entire stomach. There are various types of :
- Distal subtotal gastrectomy: It is used for tumours that are found in the lower distal part of the stomach. The lower part of the stomach, first part of the small intestine and the lymph nodes are removed. Reconstruction is done by connecting a part of the small intestine to the remaining upper part of the stomach.
- Proximal gastrectomy: It is used for tumours in the upper part of the stomach. This surgery removes the upper part of the stomach, some part of the esophagus and lymph nodes in the area. Reconstruction is done by pulling the remaining part of the stomach up to the remaining upper part of the esophagus.
- Total gastrectomy: If the tumour has spread throughout the stomach, and the complete removal of the stomach is performed. The oesophagus is attached to the small intestine). If the lymph nodes or organs around the stomach are affected, those will be removed as well along with the tumour. In some cases an adjuvant therapy is a therapy given in addition to surgery. This may be chemotherapy either alone or combined with radiotherapy.
- Side effects: Bleeding, blood clots, injury, to nearby organs, heartburn, abdominal pain vitamin deficiencies, leakage of abdominal contents, diarrhoea.
- Chemotherapy: Chemotherapy uses chemical agents to destroy cancer cells. A chemotherapy regimen consists of a number of cycles given over a period of time and may include a single drug or a combination of drugs. It maybe sometimes be combined with radiotherapy. Side effects: Side effects depend on the agent used, but common side effects include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhoea.
- Radiation therapy: This form of therapy uses high-energy particles to destroy cancer cells. Patients may receive radiation from an external machine (external-beam radiation therapy). It is sometimes used before surgery to shrink the size of the tumor or after surgery to destroy any cancer cells that were left behind. Side effects: fatigue, mild skin reactions, upset stomach, and loose bowel movements.
- Targeted therapy: Some cancers have specific genes or proteins that can be targeted to block the growth and spread of the cancer cells and prevent damage to healthy cells. Targeted therapies can include HER2-targeted therapy and Anti-angiogenesis therapy among others. Side effects depend on the agent used.
- Immunotherapy (biologic therapy): This form of therapy boosts the body’s immune system to fight cancer cells. There are a number of different agents that can be used. Side effects: Different side effects are caused by different agents but common side effects include skin reactions, allergies, flu-like symptoms, diarrhoea, and weight loss.
- Palliative Care: Palliative care deals with the physical symptoms and side effects of cancer and related therapies. It focuses on improving the quality of life of the patient.
Sources: American Cancer Society; European Society for Medical Oncology (ESMO); eMedicine; Mayo Clinic; Cancer.Net
MULTI-DISCIPLINARY TEAM (MDT): Unlike most other diseases, cancer treatment requires an integrated approach from several specialists, each with their own expertise. This team of specialists who would work together on your cancer, is referred to as the Multi-Disciplinary Team (MDT). Many global organisations have recognized the importance of a MDT for cancer treatment, as it improves coordinated care to you, as a patient. Your MDT would include specialists from the following:
- Gastroenterologist: Specialist dealing with diseases of the gastrointestinal tract. Performs the endoscopic procedures.
- Surgeon or surgical oncologist: Specialist in operating on various types of cancer
- Medical oncologist: Specialist who decides the optimum schedule and agent for chemotherapy
- Radiation oncologist: Specialist in administering radiation therapy to treat cancer
- Pathologist: Examines biopsies and other samples under the microscope
- Radiologist: Specializes in using imaging tests to diagnose diseases such as gastric cancer
- Genetic Specialist: A clinician/scientist who determines the genetic make-up of a tumour.
- Physiotherapist: Physical therapists provide support for patients, especially to alleviate the effects of some of the treatments for cancer.
- Counsellor: Psychologist by training that offers counselling to patients
- Dietitian: Offers personalized support to cancer patients
- Palliative care specialists: These professionals help patients and families deal with the emotions that come with a cancer diagnosis and cancer treatment such as anxiety and depression as well as keep the patient comfortable especially in incurable cases.
Some hospitals that take an organ-based approach to cancer, have a separate department for Gastrointestinal Cancers. These teams comprise of specialists who have dedicated training in cancers of the digestive system.
TUMOR BOARD: A tumor board is a meeting where a Multi-Disciplinary Team discusses cancer cases and share knowledge. The board’s goal is to determine the best possible cancer treatment and care plan for an individual patient. Having fresh perspectives from other doctors makes it much easier to come up with that plan.
In some hospitals, all cancer cases are discussed at the Tumor Board, while in other hospitals the Tumor Board focuses on cases where a doctor seeks inputs from other specialists on the patient's case. It’s OK to ask your doctor if or why your case was discussed at a tumor board. Or if it wasn’t, why not? In some cases, a patient’s treatment plan is very straightforward using standard treatment guidelines, and the doctor may feel a tumor board review isn’t needed. However, you can request that one be done.
SUPPORT GROUPS: These are offline or online groups that connect patients suffering from cancer. Do find out about a support group around you. The hospital where you are being treated may have a support group that you could join.
Sources: Mayo Clinic; Cancer.Net
Choosing your oncologist and hospital is a very important decision, we recommend you make the time to research your options. We profile doctors and hospitals based on their range of services to treat gastric (stomach) cancer. Use our search tools to find a suitable medical provider. You may call us for assistance to find a medical provider or make a booking.
If you’ve been diagnosed with cancer, you need to find an oncologist to begin your treatment. An oncologist is a doctor who specializes in treating cancer. For gastric cancer, you can start by visiting a surgical oncologist or a gastrointestinal surgical oncologist. Choose someone you are not only confident about but also comfortable with.
TIPS TO FIND AN ONCOLOGIST
- Look for Specialists: Look for doctors who treat your specific type of cancer - gastric cancer or digestive tract cancers. You may need to work with more than one type of oncologists – surgical, medical or radiation oncologists.
- Gather Feedback: Discuss with friends and family, especially those who’ve taken similar treatment before. Online communities are a quick way to get feedback from others who’ve experienced your type of cancer before.
- Check the doctor’s credentials: Find out if the doctor has received any advanced training. There may be super-specialists available for gastrointestinal cancers, who have received dedicated training on treating gastric If doctor’s credentials are not available easily, you have the right to ask for it from the doctor directly.
- Review doctor’s experience: Check how long the doctor has been practicing after completion of formal oncology education. How many patients with your type of cancer – gastric cancer – does the doctor see every year? In case of surgeons, studies have proven that higher volumes of surgeries lead to better outcomes. Organ-specific surgeons are also available in some hospitals, they have advance training and experience in operating cancers in specific organs.
- Find out hospital affiliations: Which hospitals does the doctor practice in? The availability of a multiple types of doctors at the hospital where you get treated is important. Find out what support staff is available at the hospital e.g. dietitian, counselor, home healthcare facilities etc.
TIPS TO FIND A HOSPITAL
- Lookout for hospitals with lot of experts: Look for hospitals that offer a multi-disciplinary approach to gastrointestinal cancer treatment. This means each you receive inputs from many cancer experts. You will be helped by specialists including surgeons, medical oncologists, radiation oncologists, oncology nurses and other supporting staff. Find out if the hospital has surgeons with dedicated training for gastrointestinal cancers? Does the hospital have Tumor Board reviews – how often are they conducted and will your case be discussed there if you wish?
- Work with a major cancer hospital, even if it is far: Most experts in high-volume centers are willing to work with your local doctors. Usually, part of the treatment (for example, surgery) can be executed in the major center and the post-surgery treatment is executed locally.
- Research hospital’s Gastrointestinal Cancer volumes: How many cases of gastrointestinal cancer are treated in the hospital every year? High volume centers with multiple specialists available for gastrointestinal cancers may have better expertise and specialized medical infrastructure required.
- Consider Clinical Trials Availability: Ask whether the doctor or hospital has access to clinical trials and if you are eligible for any. Clinical trials are research studies that test new ways to treat cancer that you can be involved with. By being involved, you can help improve treatments and outcomes for future patients.
- Insurance Acceptance: Check if the hospital accepts your insurance. Check if the hospital has a desk that can assist you with claims.
Sources: Rogel Cancer Center; Cancer.Net