For early stage gastric cancer, if it is intra-mucosal cancer, endoscopic resection is feasible. Those with sub-mucosal infiltration or lymph node metastasis can be treated with chemotherapy and additional surgery.
Progressive stage cancer emphasizes a comprehensive treatment based on surgery. After decades of development and clinical evidence, the current surgical approach for most resectable gastric cancers is D2 standard radical surgery (for some early gastric cancers, reduction surgery can be performed).
The standard radical surgery for gastric cancer is not only to remove the tumor of the stomach (gastric ulcer requires removal of the large part of the stomach), but also requires complete clearance of the perigastric lymph nodes, removal of the large and small omentum and pancreatic tegument, etc. Therefore, radical surgery for gastric cancer should never be treated as surgery for benign gastric ulcer, and complete clearance of the perigastric lymph nodes is very important in gastric cancer surgery.
How to understand postoperative chemotherapy for gastric cancer?
Chemotherapy is the abbreviation of chemical drug treatment, which many people are afraid of after hearing it, but in fact, it is not necessary.
For whether to have chemotherapy after surgery, generally according to the following principles.
1.Endoscopic resection of early cancer, if there is cancer residue in the cut edge or tumor cells infiltrate into the submucosa need to be supplemented with chemotherapy or additional surgical operation.
2.If the surgically resected gastric cancer is T1N0M0 stage, chemotherapy is not needed;
3.Stage T2N0M0 gastric cancer can be treated without chemotherapy; however, if the cancer cells are hypodifferentiated, lymphatic vessels, blood vessels and nerves are invaded, and the age is less than 50 years old, then chemotherapy is required after surgery;
4.Metastasis in lymph nodes (N) or metastasis in other organs (M) need chemotherapy.
5.Post-operative chemotherapy time: usually starts about four weeks after surgery.
6.Times of post-operative chemotherapy: if the surgery can completely remove the tumor, post-operative chemotherapy should be adhered to 6-8 courses; if the surgery cannot remove the tumor or cut cleanly, post-operative chemotherapy should be mastered according to the patient’s condition and status, with the main focus on improving the quality of life.
How to adjust the diet after gastric cancer surgery?
Post-operative dietary recovery of gastric cancer is one of the key factors to determine the recovery status and life quality of patients after surgery. In principle, when discharged from the hospital, doctors will order to eat less and more meals, chew slowly. In fact, this is not comprehensive, I usually ask my post-operative patients, about 15-20 days after surgery, to slowly transition to eating soft food, that is, not always eat liquid food, otherwise the patient is not enough nutrition, poor physical recovery;
About 20-30 days after surgery, we should resume the basic normal diet, that is to say, three meals a day, each meal should not eat too little, for example, before surgery, each meal can eat 1 bowl, to this time it is best not less than half a bowl, in the middle can add two meals snacks, but do not eat too much crumbs. Because the stomach is very good elasticity and toughness, post-operative 1 month is a period of rapid recovery, if you eat too little now, the capacity of the stomach is small, later recovery is relatively difficult. I am still talking about the principle that there should be a gradual process with the specific situation of the patient.
Why do I need regular review after gastric cancer surgery?
Cancer recurrence is a worrying issue. Generally speaking, the chance of recurrence is highest about two years after surgery, so patients are required to have regular review after surgery. The schedule of review: every three months for 2 years after surgery, every six months for the third to fifth year, and every year after the fifth year. The items of review include: blood test, clinical physical examination, chest radiography, abdominal ultrasound or CT examination, and endoscopy once a year.
How to prevent and treat anemia in gastric cancer patients?
The incidence of anemia after major gastrectomy is about 10%, and there are two main types of anemia: iron deficiency anemia and giant cell anemia.
Iron is an indispensable component of the body’s hematopoietic process, and iron in food is only well absorbed in an acidic environment. After gastrectomy, there will be a decrease or lack of gastric acid, resulting in anemia caused by impaired iron absorption, and treatment should be given with iron along with vitamin C which is mostly effective.
The anemia after total gastrectomy is different from that of major gastrectomy. In addition to the impaired iron absorption due to anemia, the more important cause is the internal factor deficiency. It causes impaired hematopoietic metabolism centered on vitamin B12. Anemia after total gastrectomy is caused by deficiency of iron and vitamin B12, and vitamin B12 stored in the liver is depleted in an average of four years. Patients with total gastrectomy should be supplemented with iron and vitamin B12.
What should I do if I have a burning sensation behind the sternum after gastric cancer surgery?
In patients with proximal gastrectomy, due to the removal of the cardia, the control of food reflux is lost, and digestive juices including bile and pancreatic juice reflux into the esophagus, stimulating the esophageal mucosa and causing reflux inflammation. It manifests as acid reflux, retrosternal pain, vomiting, etc. During gastroscopy, edema, redness and even erosion and ulceration of the mucosa from the anastomosis to the esophagus can be seen.
Treatment should include mucosal protection, local anesthetics (lidocaine), gastrointestinal peristaltic agents (gastrofacial, morpholine) and sedatives, and elevation of the upper body during sleep. Most patients can get better on their own after six months of surgery.
What should be done in advanced stage of gastric cancer?
Advanced gastric cancer refers to gastric cancer that has metastasized and spread or cannot undergo radical surgery. Survival time, symptoms and treatment of advanced gastric cancer are topics of concern for gastric cancer patients. It is difficult to say how long the survival time of advanced gastric cancer is, because there are many factors affecting the survival time, not only the biological characteristics of the tumor and its development, but also the patient’s physical condition, mental factors and family and social environment.
However, from the medical point of view, biological characteristics and development process are very important factors, if the malignancy is very advanced, it is very difficult to survive for a long time. Most of them are patients with optimistic spirit and good family and social environment. Nowadays, the term of long-term survival is not mentioned as a cure for gastric cancer. Therefore, it is most important to maintain a good mood and a good state of mind.