Stomach Cancer

Stomach cancer is a malignant disease that usually affects the gastric juice-producing glandular cells of the mucous membrane (adenocarcinoma). More rarely, lymphatic (MALT lymphoma) or muscle or connective tissue cells (sarcoma) degenerate.

It is still a fairly common cancer, even though the trend in Germany and Europe is downward. Men are affected slightly more often than women. The risk of developing stomach cancer increases with age. Cases of stomach cancer are rather rare under the age of 50.

Causes and risk factors

The exact causes for the development of stomach cancer are not known. However, various risk factors come into question:

Poor eating habits: frequent consumption of highly salty, smoked, cured or grilled food (formation of nitrosamines and other carcinogens), low consumption of fruit, vegetables and fibre, intake of mould toxins through mouldy food
Smoking and frequent alcohol consumption
Infections with the bacterium Helicobacter pylori and resulting inflammation of the gastric mucosa (gastritis)
Presence of other diseases: Chronic atrophic gastritis (type A), gastric ulcers that do not heal, gastric polyps, chronic heartburn (reflux), operations on the stomach, Ménétrier's disease (proliferating gastric mucosa)
Genetic predisposition

Symptoms

Gastric carcinomas do not cause any specific symptoms at the beginning and are therefore usually discovered very late. Moreover, symptoms that do occur are rather non-specific at first and can also indicate other diseases of the stomach. If gastrointestinal complaints persist for longer than 6 weeks despite therapy, you should consult your family doctor or a gastroenterologist for more detailed investigation.

The following symptoms can be an indication of stomach cancer:

Persistent upper abdominal discomfort, such as a feeling of pressure, fullness, heartburn, belching, nausea, loss of appetite, flatulence
Sudden intolerances or aversions to certain foods, often meat
In later stages: Vomiting blood and blood in the stool (tarry stools) - these indicate bleeding in the stomach
Anaemia with conspicuous pallor, fatigue and loss of performance (chronic blood loss due to stomach bleeding)
Fever, night sweats, weight loss
In the advanced, metastatic stage: fluid on the abdomen (ascites), jaundice, lower abdominal discomfort in women

Diagnosis

If symptoms persist for a long time and stomach cancer is suspected, a gastroscopy should be performed. To do this, the doctor inserts a flexible tube (endoscope) through the patient's mouth and oesophagus into the stomach up to the duodenum. The inside of the stomach is visible on a monitor via a camera. In addition, tissue samples can be taken from conspicuous areas using small forceps inserted through the endoscope. These are then examined histologically and provide information as to whether it is a tumour.

Once the diagnosis of stomach cancer is confirmed, the tumour is classified more precisely on the basis of the tissue characteristics. Endoscopic ultrasound (endosonography) can be used to show how deeply the tumour has penetrated the stomach wall and whether neighbouring lymph nodes are enlarged or affected.

In addition, ultrasound examinations (sonography) of the abdominal cavity and computer tomography (CT) of the chest and abdominal cavity are performed to detect or exclude possible metastasis. In some cases, we also perform a laparoscopy, an examination of the abdomen from the inside.

On this basis, we can determine the spread of the tumour, assign the disease to a specific stage and derive therapy options. These are discussed in the multi-disciplinary tumour meeting, in which gastroenterologists, surgeons, radiologists, oncologists and, if necessary, other specialists take part. The end result is an individually tailored therapy concept that promises the best possible prospects of success.

Treatment

Surgical therapy

The aim of surgical therapy is to completely remove the tumour tissue and thus cure the gastric carcinoma. In the early stages, when the tumour is still limited to the top layer of the mucosa, it can be removed during a gastroscopy (endoscopic resection). For this purpose, only the tumour tissue and neighbouring tissue are cut out. If the tumour has already spread further, the stomach is partially or completely removed (gastrectomy). As a rule, the associated lymphatic drainage area is also removed. The rest of the stomach or the end of the oesophagus is connected to the small intestine to allow the passage of food again. In advanced stomach cancer, the growing tumour often obstructs the passage of food. In these cases, the narrowing can be bridged by a stent or a feeding fistula can be created for artificial nutrition if necessary (endoscopic gastrostomy).

In gastric surgery, too, minimally invasive surgery is used if possible, especially for small tumours. In minimally invasive surgery, also called the 'keyhole technique', various surgical instruments are inserted into the abdominal cavity through small incisions in the abdominal wall. The doctor can watch the operation on a monitor via a camera. With the help of this technique, it is possible to remove the affected tumour tissue just as successfully as with a large abdominal incision.

Drug therapies

In some cases, chemotherapy is given before surgery to shrink the tumour and increase the chances of success of the surgery (neoadjuvant chemotherapy).

If complete removal of the tumour by surgery is not possible or if metastasis has already occurred, palliative chemotherapy is considered as a therapy option. This is intended to reduce the size or slow down the growth of the tumour and its metastases. The patient's chance of survival can thus be increased and their quality of life improved.

In advanced, metastatic stomach cancer, antibody-based targeted therapies can be used to complement chemotherapy in some patients. These have a direct effect on the metabolic processes of the cancer cells. The drugs are based on different mechanisms of action, which are designed to prevent the progression of the disease in different ways. So far, two drugs have been approved for the treatment of stomach cancer, which inhibit either the blood supply or the cell growth of the tumour. Which drug holds more promise can only be clarified individually, based on the histological characteristics of the tumour and other factors. In addition, there is the consideration of possible side effects that can also occur with these groups of medicines. In the multi-disciplinary tumour meeting, the specialists involved discuss the best possible approach in detail.

Unfortunately, a complete cure in advanced stages is not possible at present, even with this still quite new therapeutic approach. However, in many cases, the drugs lead to a longer-term containment of the disease and thus to a sustainable improvement in the quality of life.

Integrative therapies

During your inpatient stay at Havelhöhe, we combine conventional medical therapies with integrative treatments that help you to strengthen your self-healing powers, activate the immune system and mobilise your strengths. Mistletoe is also available as an accompanying naturopathic medicine that strengthens the immune system and can also reduce the side effects of cancer therapy, e.g. symptoms of exhaustion or fatigue syndrome that may occur. Hyperthermia also helps to activate the immune system through a specifically induced fever reaction.

Further integrative therapies can additionally significantly reduce the side effects of cancer therapy. These include movement and body therapies, e.g. eurythmy therapy and rhythmical massage therapy, as well as painting and music therapy. Additional support is provided by our anthroposophic care therapies, which promote regeneration.

You also have the option of taking advantage of psycho-oncological counselling. You can discuss possible fears there as well as the effects of the disease on your family situation or prospects for the time after treatment.

Perspectives

The earlier a stomach carcinoma is detected, the better the chances of a complete cure. In the more advanced stages, the chances of recovery are lower. However, even with more advanced disease, there are now treatment options that can prolong life expectancy and improve the patient's quality of life. At the Havelhöhe Oncology Centre, we work closely with our Supportive Cancer and Palliative Care Unit in these cases and offer PIPAC (pressurised intraperitoneal aerosol chemotherapy) and HIPEC (hyperthermic intraperitoneal chemotherapy).

Aftercare

Regular follow-up is important in order to be able to respond to changes at an early stage and to treat any secondary symptoms that may occur in a targeted manner.

The frequency of follow-up examinations for stomach cancer depends on the diagnosed stage, the fine tissue characteristics of the cancer cells and the type of surgery. Your attending physician at the Havelhöhe Community Hospital will discuss your individual aftercare plan with you and give you a copy of the agreed schedule. As a rule, the examinations take place more frequently at the beginning and later only once a year.

An important issue for stomach cancer patients is monitoring their nutritional situation to avoid weight loss or deficiencies. All patients undergoing gastrointestinal surgery at the Havelhöhe Community Hospital receive nutritional counselling. After major gastric resections or in the case of complete gastric removal, vitamin B12 (1000 micrograms) must be administered as an injection every 2-3 months, as the absorption of vitamin B12 is no longer possible via the gastrointestinal tract. Vitamin B12 is an important vitamin for blood formation and nerve metabolism.

In addition to physical, laboratory and instrumental examinations, the attending physicians strive, if necessary, to further improve the patients' quality of life by arranging psychological or complementary medical services. (http://www.krebsinformationsdienst.de/wegweiser/adressen/psychoonkologen.php)

Before discharge from the Havelhöhe Community Hospital, you will receive an aftercare passport from our Aftercare Documentation and Study Outpatient Department, in which all therapies and check-ups can be clearly noted. Medical aftercare is provided on an outpatient basis by your attending general practitioner or consultant, with whom we work closely.

We also ask you to report to our aftercare outpatient clinic at regular intervals so that we can document the progress of your treatment.