Stomach Cancer (cont.)
Diagnosis and Staging
Several procedures are used in the diagnosis and staging of stomach cancer. A diagnostic test establishes the presence of the disease, while staging determines its extent and helps to guide treatment decisions.
- Gastrointestinal (GI) endoscopy allows a direct view of the area of concern. The doctorcan alsotake a sample of tissue (biopsy) to confirm the diagnosis.
- Once doctors establish the diagnosis, further tests are performed, including the following:
- Upper gastrointestinal endoscopy with ultrasound umaging (EUS)
- A PET scan and CT of the chest, abdomen, and pelvis in all but the earliest or lowest-stage cancers of the stomach.
- Laboratory testing including analysis of the cancer for specific mutations and genetic amplifications in advanced cases.
Stomach Cancer Treatment
The treatment of stomach cancer depends on the results of tests and your overall health.
- People with advanced heart and lung disease may not tolerate aggressive therapy.
- In many cases, the stomach cancer may have advanced too far for any available treatment to work.
- You will require surgery to be cured.Your stomach is removed entirely, and your esophagus is attached to your small intestine.
- Surgery may relieve symptoms of obstruction. The upper end of your stomach is connected to your small bowel, bypassing the area of obstruction.
- Companion treatment with either chemotherapy or radiation may improve your survival following surgery.
- After your stomach has been removed, your doctor willmonitor your disease with repeat CT scans of your abdomen and gastrointestinal endoscopy to make sure the cancer does not return.
- Early stomach cancer may be amenable to even local removal through the endoscope in centers with experience with that technique.
- Patients with cancers found to have an operable or resectable stage of stomach cancer and who are well enough for major surgery should undergo an adequate removal of as much of the stomach as necessary to ensure adequate clear margins. In some people this will involve removal of a portion of the stomach, while in others the entire stomach must be removed. Lymph nodes next to the stomach as removed during these operations as well.
- In the stomach cancers found at an early stage, treatment can result in half of patients living cancer free for more than 5 years.
- The more advanced or higher the cancer stage, the greater the likelihood of the cancer recurring elsewhere after surgery, and the greater the likelihood that treatments involving chemotherapy and radiation will be recommended.
- Stage 4, or metastatic stomach cancer patients are usually only offered surgery to relieve symptoms of obstruction- or blockage. Chemotherapy and radiation may prolong survival but it is rare for a patient to live more than 2 years, and sometimes a great deal less.
- Sometimes monoclonal antibody therapy may be given alone or in combination with chemotherapy in cases of advanced stomach cancer.
- After your stomach cancer has been removed, and if necessary other treatments given and completed, and you are felt to be free of disease, your doctor will monitor your disease with repeat scans, laboratory testing, and gastrointestinal endoscopy to make sure the cancer does not return.
Medically Reviewed by a Doctor on 8/20/2014
Robert J Fingerote, MD, MSc, BSc
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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