Caring for patients with stomach cancer: Understanding the treatment of stomach cancer
The choice of treatment in stomach cancer will depend on the position and size of the cancer and its spread beyond the stomach. It also depends on your general health and your age. Stomach is a solid organ cancer. The only curative treatment of such cancers is the use of surgery to remove the bulk of the tumor. The rest of the treatments are best used as supportive treatments and in patients in whom surgery is not possible.
We work as a team (most of the cancer treating teams do so) to provide you the best treatments possible. Our team consists of a surgical gastroenterologist, a medical gastroenterologist, radiation specialist and a medical oncologist. The team work provides immediate and continued attention to all aspects of treatment.
The main concern of most of our patients is the magnitude of the treatment and the side effects and the possible poor results. It is indeed true that stomach cancer is one of the gruesome cancers that man can suffer from. In the institute, we have focused my attention on three cancers, that kills patients more than any other - stomach cancer, pancreatic cancer and liver cancer. Our team currently has the highest lymph node harvest (43 lymph nodes) in Chennai region, (which is a marker of thorough surgical clearance)
for this surgical procedure and I believe that there is tremendous scope to improve the results to much better levels.
The surgical procedure consists of the following details - removal of the diseased stomach, all of the fatty apron attached to the stomach (the greater and lesser omenta), the lining layer on the pancreas and retroperitoneum, the lymph nodes along the left gastric artery, splenic artery and the hepatic artery.
The removal of the tier 2 lymph nodes are important as our own studies have shown an involvement in 20 % of the patients. This may well indicate why most of the patients with stomach cancer fail to have control of the disease. Our finding during our research made us change our approach and aggressively pursue the Japanese style of lymph node dissection.
The foundation principle of gastric surgery was laid by Maruyama in his classic research paper, which lists where the cancer spreads to the tier 2 lymph nodes.
There are times when we may not be able to provide the surgical clearance of the cancer. We may not do surgery in the presence of distant metastases, invasion of a major blood vessels, such as the aorta, or disease encasement or occlusion of the hepatic artery or celiac axis/proximal splenic artery. Splenic artery involvement is not an indicator of unresectability.
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| Global incidence of gastric cancer. India is one of the higher incidence areas for gastric cancer. Our own research shows increased possibility of gastric cancer in patients with "acidity' symptoms when they are over the age of 35 years |
We work as a team (most of the cancer treating teams do so) to provide you the best treatments possible. Our team consists of a surgical gastroenterologist, a medical gastroenterologist, radiation specialist and a medical oncologist. The team work provides immediate and continued attention to all aspects of treatment.
The main concern of most of our patients is the magnitude of the treatment and the side effects and the possible poor results. It is indeed true that stomach cancer is one of the gruesome cancers that man can suffer from. In the institute, we have focused my attention on three cancers, that kills patients more than any other - stomach cancer, pancreatic cancer and liver cancer. Our team currently has the highest lymph node harvest (43 lymph nodes) in Chennai region, (which is a marker of thorough surgical clearance)
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| Pancreas stripped of all the peritoneal layer to expose the superior border of the pancreas where most important dissections of D2 lymph node dissection takes place |
The surgical procedure consists of the following details - removal of the diseased stomach, all of the fatty apron attached to the stomach (the greater and lesser omenta), the lining layer on the pancreas and retroperitoneum, the lymph nodes along the left gastric artery, splenic artery and the hepatic artery.
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| Complete harvest of the nodes on the superior border of the pancreas The portal vein along with the celiac axis is seen |
The removal of the tier 2 lymph nodes are important as our own studies have shown an involvement in 20 % of the patients. This may well indicate why most of the patients with stomach cancer fail to have control of the disease. Our finding during our research made us change our approach and aggressively pursue the Japanese style of lymph node dissection.
The foundation principle of gastric surgery was laid by Maruyama in his classic research paper, which lists where the cancer spreads to the tier 2 lymph nodes.
There are times when we may not be able to provide the surgical clearance of the cancer. We may not do surgery in the presence of distant metastases, invasion of a major blood vessels, such as the aorta, or disease encasement or occlusion of the hepatic artery or celiac axis/proximal splenic artery. Splenic artery involvement is not an indicator of unresectability.
The spread to lymph nodes, especially when large and fixed to the pancreatic head can also be an indicator of unresectable disease. We do know that if this is only a local invasion and other sites are free of disease, resection of the pancreas can be done to enhance the sure in gastric cancer.
Cancer resection that involves in continuity(en bloc, in medical literature) resection of tier 2 lymph nodes in gastric cancer is called a D2 gastrectomy. Resection of liver hilar lymph nodes (Station 12) and the lymph nodes in the splenic hilum are important parts of the surgical clearance in D2 resection. Surgeries which do not achieve this are called D1+ resections, which are better than classic resections, but do not compare to the D2 gastrectomy.
As I see more and more of these patients, I have come to believe that the problem in our patients is lack of early diagnosis and a reluctance in part of the surgeons, to apply established surgical principles and take the patients through the whole process. We have made sure that our patients get the best treatment possible as is done in the best gastric cancer centers in the world. To keep them on their own feet and to go to live a better life.
Cancer resection that involves in continuity(en bloc, in medical literature) resection of tier 2 lymph nodes in gastric cancer is called a D2 gastrectomy. Resection of liver hilar lymph nodes (Station 12) and the lymph nodes in the splenic hilum are important parts of the surgical clearance in D2 resection. Surgeries which do not achieve this are called D1+ resections, which are better than classic resections, but do not compare to the D2 gastrectomy.
As I see more and more of these patients, I have come to believe that the problem in our patients is lack of early diagnosis and a reluctance in part of the surgeons, to apply established surgical principles and take the patients through the whole process. We have made sure that our patients get the best treatment possible as is done in the best gastric cancer centers in the world. To keep them on their own feet and to go to live a better life.
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