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All you need to know about
Gastric cancer

1. What is Gastric Cancer?

Gastric Cancer is a cancer that involves the stomach which is the part of the digestive system between the food pipe and the intestine.

2. What are the symptoms in a person with Gastric Cancer?

Gastric Cancers usually present with nonspecific symptoms such as indigestion, or upper abdominal burning or pain, which are often confused with ulcer disease, delaying diagnosis, and treatment. Unexplained anemia [low hemoglobin] or unexplained weight loss which is significant [more than 10% of body weight] is one of the presenting features and should be investigated with a colonoscopy to rule out colon cancer and an upper GI endoscopy if colonoscopy is normal.

3. What causes Gastric Cancer?

Dietary plays a major role. Consumption of pickled food, spicy food, excess chilli consumption, consumption of high-temperature foods [barbecued meats], smoked dried salted meat, use of soda in cooking, and consumption of dried salted fish have emerged as significant dietary risk factors in various parts of India. pickled and smoked and barbequed food, and a high salt diet predispose to Gastric cancer.

Tobacco consumption in any form- smoked or chewed, and alcohol consumption are also risk factors. Helicobacter pylori is a bacterium that grows in the stomach. It causes changes in the stomach lining, which can lead to gastric cancer. Around 10% of persons develop this cancer due to a change in the genes [called a mutation], some of these mutations may be inherited from the parents. Read More...
Gastric Cancer Treatment
4. Can Gastric cancer be prevented?

Dietary modifications of non-starchy vegetables including specific allium (particularly garlic and onion) vegetables, green, and yellow vegetables as well as fruits (rich sources of antioxidants) probably protect against stomach cancer.

The only intervention, which can prevent gastric cancer is early detection and eradication of H. pylori infection. Good sanitation, hygienic practices, and clean water supply are measures when implemented on a large scale, can reduce H. pylori infection, and eventually gastric cancer. Read More...
5. What are the treatments available for Gastric cancer?

Surgery is the main treatment for this disease, which consists of removal of the portion of the stomach involved with a margin of normal stomach, all the lymph glands which are around the region of the stomach removed, and rejoining of the stomach to the intestine below.

When the tumour is large, and has gone through the stomach wall or there are enlarged nodes seen on CT scan, chemotherapy is used to shrink the tumour and the nodes followed by surgery. Typically 4 cycles of chemotherapy at 2-3 week intervals are required. Read More...
6. What types of surgery are available for Gastric Cancer?

There are 3 types of operations. If the tumour is involving the lower part of the stomach, removal of only the lower half of the stomach is required, this is called a distal radical gastrectomy.

If the upper part of the stomach is involved, the upper half of the stomach along with a small portion of the food pipe that joined the stomach is removed followed by rejoining the food pipe to the lower stomach- a proximal radical gastrectomy. If the entire stomach is diseased, a radical total gastrectomy is necessary. Typically these operations are performed by open methods, however, for early cancers, we perform these operations by laparoscopy and robotic surgical techniques. Read More... Gastric Cancer Surgeon
7. Can stomach cancers be operated by robotic surgery?

Robotic Surgery is the latest and most sophisticated treatment for stomach cancer.

It is a form of keyhole surgery using tiny [8mm] incisions to introduce special instruments connected to a robot, which is a computerized device, which is completely under the surgeon’s control. Patients with early gastric cancer which is not spread beyond the lining of the stomach and can be operated by a robotic surgery. It offers several advantages including:
  • More precise surgery
  • Shorter length of stay
  • Less blood loss
  • Earlier return to normal work
  • Cure rates similar to open and laparoscopic surgery
Read More...
8. What happens if my cancer has spread beyond the stomach at surgery?

Stomach cancer is known to spread to the liver and the lining of the belly- known as the peritoneum.

Spread to the liver cannot be cured by surgery. Chemotherapy is required to shrink the liver tumours in addition to stomach cancer. In patients in whom the lining is involved, chemotherapy can be instilled during surgery by a keyhole technique- this is called PIPAC [Pressurised IntraPeritoneal Aerosol Chemotherapy], wherein chemotherapy is dispersed under pressure into the belly, this leads to the destruction of the cancers in the lining. This is followed by further chemotherapy through the normal route followed by surgery eventually.
If there is involvement of the peritoneum after chemotherapy, your doctor might recommend an operation called cytoreductive surgery and HIPEC [HyperthermicIntraPEritoneal Chemotherapy]. This involves removal of the diseased portion of the stomach and the involved lining followed by washout of the belly with a heated chemotherapy solution to destroy any remaining cancer cells.
Read More...
9. What happens after I have my surgery?

Typically you will stay in the hospital for just 3 - 4 days after surgery especially if you had robotic surgery.

If a PIPAC procedure alone has been performed, you will be discharged the day after surgery; for HIPEC you will require 10 days of hospitalization. Once the detailed report of the tumour, which was removed, is available [in about 7 days], your doctor will discuss with you regarding the need for chemotherapy to further improve your chances of cure. You will usually be able to go back to work 4-6 weeks after your surgery. Read More...
10. Do I need to have check-ups after my treatment is complete?

Yes, regular follow up is recommended. This is done 3 monthly for the first 2 years and 6 monthly for the next 3 years after surgery.

Once you cross 5 years, it is very unlikely your cancer will come back, and you are considered 'cured'. At each visit, simple blood tests, an examination by your doctor, and scans if symptoms suggest any abnormality are required. Read More...