As compared to other cancers, stomach cancer is less common in USA, but it is more prevalent in other parts of world. Adenocarcinoma is the most common type of stomach cancer. It is the cancer of inner lining of stomach wall. Though the exact cause of stomach cancer is not known certain contributory factors are eating too much of spicy and salty food. Low fiber diet, family history of gastric cancer, gastric ulcer caused due to H. Pylori bacteria, gastritis of long duration, excessive smoking and stomach polyps.
Weight loss, loss of appetite, nausea and vomiting, vomiting of blood, pain in upper part of abdomen is characteristic of stomach cancer.
Treatment Options For Stomach Cancer
When the diagnosis of gastric carcinoma has been made, laparotomy should always be carried out. Advance in anesthesia, efficient pre and post-operative management have definitely increased the scope of surgery in gastric carcinoma. More patients who were previously unfit for operation are now becoming operable.
The disease spreads so fast that only 50% of the cases will be qualified for exploration. Of these, 50% will not be suitable for radical operation and only palliative measure should be adopted. Only 5% of cases who will be suitable for radical operation will survive for more than 5 years.
Whenever possible, an abdominal approach is always preferred to an abdomino-thoracic one, as the latter carries a greater risk. Only in cases of involvement of the upper 1/3rd of the stomach, an abdomino-thoracic approach can be considered.
A definite plan is made out on the extent of the growth. After this one should look out for the signs which will disqualify radical surgery.
Contra-Indications For Radical Surgery
- Fixation of the growth to the pancreas or posterior abdominal wall.
- Fixity of the involved lymph nodes.
- Presence of secondary lymph node all over the peritoneal cavity.
- Presence of multiple secondary in the liver.
Radical Surgery For Gastric Cancer
Radical operations means resection of the growth with at least 1 inch of the surrounding healthy wall of the stomach (1inch outside the palpable margin of the tumor), together with all the lymph nodes draining the stomach.
Position of the growth radical gastrectomy may either be:
- Total radical gastrectomy.
- Upper radical partial gastrectomy.
- Lower radical partial gastrectomy.
Total Radical Gastrectomy
This operation is indicated for growths involving the middle of the stomach or the whole of the stomach. By this procedure regurgitation of bile and pancreatic juice into the esophagus is prevented. It must be remembered that mortality of total gastrectomy even in expert hand is as high as 30% in comparison to that of the partial gastrectomy which is only 5%.
So the tendency should go for partial gastrectomy more and to perform total gastrectomy only in those cases where the surgeon is very much sure that the local spread of the tumor has definitely gone beyond the domain of partial gastrectomy.
Upper Radical Partial Gastrectomy
It is indicated for growth involving the cardia and upper third of the stomach. The pyloric end of the stomach is preserved and is anastomosed to the esophagus. A pyloroplasty is usually performed to prevent post-vagotomy retention.
Lower Radical Partial Gastrectomy
- This operation is indicated for carcinoma of the lower 1/3rd of the stomach. The operation is ultimately completed with gastro-duodenal anastomosis (Billroth I) or if first part of the duodenum has been resected, gastro-jejunal anastomosis (Billroth II) is performed.
- Palliative operation for gastric carcinoma: It has already been discussed that in quite a good number of patients after exploration; the growth comes out to be not suitable for radical operations. In these cases some sort of palliative operation should be performed.
Palliative Surgery For Gastric Cancer
- Palliative resection of the growth- whenever possible, if the malignant mass in the stomach can be resected together with the healthy margin of gastric wall, this should be undertaken.
- Antral exclusion operation- for fixed adherent irremovable growth involving the distal, antral or pyloric portion of the stomach, which defies resection, antral exclusion combined with ante-colic gastro-jejumostomy is indicated.
- Gastro-jejunostomy- for irremovable malignant lesions of the antrum and pylorus associated with obstructive symptoms, anterior or ante-colic jejunostomy or a gastrostomy is indicated.