Metastatic stage symptoms
Every malignant condition has its «favorite» localization of metastases. Gastric cancer mainly spreads in the abdominal cavity by implantation and through the lymphatic system, tumor seedings in the lungs and bones are not typical for it.
- Development of icteric skin color against the background of a moderate increase in body temperature, persistent nausea, and increasing weakness is a sign of hepatic metastatic damage.
- Abdominal enlargement accompanied by weight loss indicates ascites, formation of free fluid in the abdominal cavity.
- Vomiting with brown masses and black watery faeces are manifestations of bleeding from a major gastric vessel destroyed by tumor masses.
- Ovarian enlargement and tumor conglomerates of the supraclavicular lymph nodes are typical symptoms of the condition.
- Diagnostics of gastric cancer has changed little in the XXI century, it is also based on endoscopy, only made more perfect. Very much depends on the qualifications of endoscopy physicians, because the entire history of the condition is very short.
The first stage of gastric cancer diagnostics
The diagnostics does not begin with an oncologist, gastric cancer is primarily detected by a therapist or surgeon visited by the patient with gastric discomfort complaints. It is also possible that pathological changes are discovered quite accidentally during examination for another conditions, and these changes are metastases, because gastric pathology can only be detected by targeted examination, since abdominal ultrasound does not show either the stomach or the intestine.
The patient visits an oncologist with a suspicion of a malignant tumor, with findings of the endoscopic examination performed at a polyclinic and specimen slides of histopathological preparations obtained by biopsy of the tumor piece. At this stage of diagnostics, the malignant process advancement is not assessed and, accordingly, it is still impossible to select the optimal treatment.
The second diagnostics stage
The examination is necessary to develop cancer treatment tactics. It is necessary to find out the size of the tumor in the organ, and to determine to what extent it has managed to spread throughout the body. Therefore, the endoscopic examination will be performed again, since there is no other way to find out the true state of affairs.
Today, a more up-to-date endosonography, an esophagogastroduodenoscopy combined with ultrasound, allows seeing how the tumor is located inside the gastric wall, where the cancer borders lie, and whether the tumor conglomerate invades the neighboring organs.
During the examination, not only is the possibility of stomach removal is evaluated, but life-threatening complications are also predicted, such as bleeding and perforation (wall rupture).
Laparoscopy, an endoscopic examination of the abdominal cavity, is not necessary for all patients. It is certainly required for a large tumor or a cancerous node growing through the stomach wall. With a high degree of malignancy, laparoscopy will allow to identify peritoneal carcinomatosis, that is, metastatic nodules on the mucous membrane lining the internal organs. It is not possible to detect peritoneal dissemination in no other way except for direct visual examination using optics.
Detection of metastases on the peritoneum radically changes the tactics of treatment. With such metastases, only palliative surgery is performed, eliminating the symptoms of pain, and a radical intervention is no longer possible.
If a laparoscopic examination is not performed, then at the first stage of abdominal surgery, the surgeon will conduct an audit, hidden metastases will be detected, and the initial surgical plans will change. With gastric cancer, laparoscopy allows avoiding an unnecessary intervention, and therefore is included in the standard of mandatory preoperative diagnostics.
Identification of cancer metastases
- X-ray polypositional examination of the stomach from several angles will reveal the spread of the tumor upwards to the esophagus and downwards to the duodenum, which is not always possible to follow even on CT.
- In the abdominal cavity, ultrasound helps find out the involvement of the liver and peritoneum in the process, and determine the size of the visible lymph nodes.
- The standard of diagnostics requires a CT scan of the abdominal cavity allowing to discover very small metastases even in «quiet nooks» where ultrasound does not reach.
- Gastric cancer, in addition to the liver and peritoneum, has typical zones of metastatic spreading to the supraclavicular lymph nodes, ovaries, and navel. Therefore, an ultrasound of the cervico-supraclavicular zones and the lesser pelvis is performed with a gynecologist examination.
- To identify metastases in the chest, a CT is performed.
To avoid unpleasant surprises during anesthesia, it is necessary to know the state of the cardiovascular system, and get an anesthesiologist’s consultation.
A malignant gastric tumor greatly disrupts the biochemical balance, so it will be necessary to make a detailed blood test including clotting factors, and to determine by blood elements what nutritive support will be needed before and after the surgery.
Gastric cancer was first successfully operated by Billroth in Austria at the end of the 18th century. Over the past century and a half, therapeutic approaches to most malignant neoplasms have changed, many anticancer drugs have appeared, but only surgery gives hope for a cure of gastric cancer.