Stomach Cancer
Let's first understand what is meant by a cancer. It
is a malignant (bad or fatal) tumor (growth or swelling).
This lump or sore arises for reasons we don't know
and spreads from the original spot to neighboring tissues.
It can compress, bend, or extend to other organs and
interfere with their function. The single most important
feature about a cancer is that it spreads (metastasizes)
through the vascular system to organs remote from where
it starts. Most often it spreads to the liver and the lungs.
A cancer whose growth cannot 'be arrested ultimately
causes the death of its host.
Cancer of the stomach is particularly difficult to recognize.
The earliest symptoms of the disease are so vague
and indefinite that the patient's own awareness of being
sick can be tardy. Thus, one third of the patients when
first seen are already at a stage beyond the possibility of
salvage. The other unfortunate fact about stomach cancer
is that it spreads widely; that is, it invades the lymph
glands and the tissues, so even the most radical surgery
cauaot always be effective. The patient with an advanced stomach cancer is one of the most miserable whom the
surgeon encounters because of rapid emaciation, loss of
desire for food or activity, extreme weakness and lassitude,
and nausea and pain. The best hope is in early
diagnosis and complete surgical removal.
Why do you say this is a cancer?
The only way to make a preliminary diagnosis is by
an X-ray examination of the stomach. The X ray shows
a tumor or a type of ulcer that can be cancerous. The
X-ray diagnosis is usually accurate, but only a biopsy can
reveal whether the growth is cancerous.
Can the X ray be wrong? What else could it be?
You mean by that, can this be something else, something
not as bad. That is possible but we can't be too
optimistic because the X-ray interpretation is correct in
about 90 percent of the cases. Occasionally it turns out
to be an innocent tumor or even an unusual type of
ulcer. I've also seen one patient whose operation revealed
the X-rayed tumor to be an abscess caused by a chicken
bone caught in the wall of the stomach.
Will you do other tests? What is a gastroscopy?
Sometimes a real doubt exists, not so much about the
kind of tumor it is but whether or not the patient should
be operated on at all. In such cases the inside of the
stomach is examined by a lighted tube inserted through
the mouth. With this instrument, called a gastroscope, it
is possible actually to look at the tumor and frequently
to remove a piece of it for microscopic examination.
Requiring only local anesthesia, a gastroscopy can be
done as an office procedure, and the patient can go home
immediately thereafter.
Can you tell whether the growth has spread?
This physical examination may give no indication whether the tumor has spread to the liver, the lining of
the abdominal cavity or the deep neck glands.
Can blood tests tell whether the growth is still limited?
Anemia can result simply from any bleeding tumor;
it does not indicate anything one way or the other about
the spread or kind of growth. Other blood tests can be
significant; thus, the alkaline phosphatase level in the
blood is usually increased if a cancer has already spread
to involve the liver.
Will you be able to take it out?
That cannot be determined before the operation.
What happens if it cannot be removed?
If the cancer is not removed, because it is too far advanced
to make resection possible, the surgeon ordinarily
tries to make some sort of an internal rerouting, a new
internal opening between two areas (called an anastomosis a joining together) so that the obstruction to
digestion and swallowing will be avoided. In such cases
the outlook is indeed gloomy. An occasional patient shows
a long spontaneous survival, and some appear to be
helped by radiation treatment or with certain anticancer
drugs.
Why do you advise operation if the outlook is so gloomy?
One never knows, by statistics, what will happen to
the individual patient. The patient may have a surgically
salvageable situation. He may even have one of those
rare tumors (so-called lymphomas) of the stomach that
respond well to X-ray treatment.
Why don't you do very radical surgery and take out
everything that's involved?
That radical and superradical approach have been evaluated. The risk is large and the surgical salvage small.
For the most part that method has been abandoned as an
approach to the cure of the usual type of stomach cancer.
What are the chances of long term survival if you can
take it out? What happens if it is not removed?
If the cancer can be completely removed, about 20-25 percent will live five years. If the intra-abdominal
situation is not suitable for surgery, most patients live
less than one year.
Is it true that once you open up and can't do anything,
the individual succumbs sooner than if he
had not been operated on ?
That is street corner gossip. The "look see" surgery
that does nothing but a biopsy is quite harmless. The
growth and extent of the cancer are the lethal factors, not
the operation.
Can one live without most of the stomach? Will he be
able to go back to his job?
One can live well without most of the stomach. Initially
there will be a dietary adjustment; small frequent
meals of high nutritional value are recommended. After
that almost anything can be eaten, though not in full eightcourse
dinners. This adjustment may take between four
and twelve weeks. He should go back to work when fully
recovered. When possible it is best for patients to resume
all their previous activities for as long as they can.
If the survival period is to be short, shouldn't he stay in
the hospital or a nursing home rather than go back to the
family? Won't it be depressing for the youngsters?
This is entirely your decision and is determined by
how your family functions. But the patient ordinarily can't
stay in the hospital beyond the time actually required
for his treatment. It is sad that hospital beds are at a premium. The administration and in service programs
help to avoid using the surgical unit as an unjustified
substitute for the home. A nursing facility outside the
surgical pavilion can be discussed with social workers,
who have great experience with the personal and practical
aspects of these soul searching problems. You certainly
should make a decision within the family first and then
find out what is available. Don't worry, the patient won't
be discharged until the necessary arrangements have been
made.
But how can we manage the patient at home?
This is done with the aid of the Home Care facilities
available in almost all communities. A special bed, if
needed, dressings and appliances of all sorts will be supplied.
In addition, medication will be provided to control
symptoms. There will even be a physician on call to help
with emergencies. A visiting nurse service is of great
help.
Since this disease is so common, what can be done to
make the diagnosis earlier?
This disease is particularly common in Japan, about
four times the rate in the United States. There they have
developed a diagnostic technique that entails the swallowing
of a small camera that takes about twenty simultaneous
pictures within the stomach. The films are then
reviewed to find any disease in the stomach. This is
utilized as a case finding method in asymptomatic patients.
We don't know what causes cancer of the stomach, but
studies suggest it relates to smoked fish in Iceland and
to hot tortillas in Chile. Early diagnosis really depends on
an informed public and an alert physician.
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