Is stomach cancer curable? How Long Does stomach cancer take to kill you?

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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