1.Surgical treatment
Surgery is the main and traditional treatment for gastric cancer, which mainly includes resection of the cancerous lesions in the stomach and clearing the lymph nodes where the cancer is most likely to metastasize, i.e. radical surgery. If radical surgery is not possible, supportive surgery can be performed.
(1) Short-circuit surgery: ①If the primary foci cannot be resected, with pyloric obstruction or imminent obstruction, if there is still normal gastric wall in the middle of the stomach, short-circuit surgery with anastomosis between stomach and small intestine is feasible to relieve or prepare for pyloric obstruction. ②If pancreatic obstruction or imminent obstruction is present, jejunoesophageal short-circuiting is feasible, which can be considered only for those with longer survival period because it often requires open chest to complete.
(2) Jejunostomy: ①After short-circuiting for advanced gastric cancer, the gastric contents often do not enter the intestinal canal through the short-circuiting anastomosis, because the nerves in the gastric wall have been destroyed by the cancer cells and the gastric emptying function is lost, so it is better to perform jejunostomy to leave an enteral nutrition tube for backup during short-circuiting. If the cardia is obstructed or about to be obstructed, jejunostomy can also be performed to keep the nutrition tube.
(3) Endoscopy-assisted percutaneous stoma: Before obstruction, PEG (endoscopy-assisted percutaneous gastrostomy) can be used to place an intra-gastric nutrition tube for upper gastric cancer, and PEGJ (endoscopy-assisted percutaneous transgastric jejunostomy) can be used to place an intra-jejunal nutrition tube for middle and lower gastric cancer. These two types of nutrition tubes are led out from the abdominal wall, which is less painful for patients.
2.Chemotherapy
Chemotherapy (chemotherapy) is a method of treating disease with drugs aimed at killing cancer cells that have spread throughout the body. The purpose of chemotherapy.
(1) To cure the cancer and make the cancer foci disappear.
(2) To control the progression of the cancer if it cannot be cured.
(3) To relieve symptoms if the cancer cannot be cured or progression is controlled.
Multi-drug combination chemotherapy is often more effective than single drug and can reduce the possibility of resistance to a specific drug. Chemotherapy drugs can be given orally, intravenously/arterially, or thoracically/abdominally.
Chemotherapeutic agents do not recognize cancer cells and only kill rapidly proliferating cells non-specifically. Therefore, normal cells with faster proliferation such as bone marrow cells, digestive tract mucosa and hair can also be killed, causing side effects such as bone marrow suppression, vomiting, diarrhea and hair loss (which mostly disappear after chemotherapy is stopped).
3.Targeted therapy
It is called targeted therapy, which can reduce the damage of normal cells and target cancer cells by using the molecular structure unique to cancer cells but not normal cells as the target of drug action. At present, the types and effects of targeted drugs for gastric cancer are limited, and only about 20-30% of patients have these drug targets. Combined with chemotherapy drugs, the 5-year survival rate can be increased by about 5-10%.
4.Radiation therapy
The means of killing cancerous tissues with radiation is called radiotherapy. Although radiation is more likely to damage cancer cells, it also damages normal cells and causes local or systemic radiation reactions. The acute reactions of radiotherapy for gastric cancer include loss of appetite, nausea, vomiting, weakness, weight loss, mucosal damage, bone marrow suppression, white blood cell reduction, and inhibition of secretion of various digestive enzymes such as gastric acid, etc. Late complications include radiation damage to the spinal cord, liver, kidney and stomach, and even gastric perforation may occur in a few patients, but the scope and extent of damage are decreasing with the advancement of radiotherapy equipment and technology.
The main reason for less research and application of radiotherapy for gastric cancer in China is that there is a growing tendency of perioperative chemotherapy plus R0 resection and D2 clearance in China, and there are too few studies on the benefit of radiotherapy in increasing survival rate in this case, which is not convincing.
5.Chinese medicine treatment
For unresectable or recurrent gastric cancer, if radiotherapy and chemotherapy are ineffective, traditional Chinese medicine treatment is feasible. Although it cannot shrink the cancer foci, some patients can have improvement in quality of life, and a few reports show that the survival is not worse than chemotherapy. However, there is no international recognition of the efficacy of herbal medicine, and there is the view that this only indicates that the efficacy of chemotherapy or herbal medicine is poor in advanced patients, and basically the natural survival. Therefore, more high-level clinical studies are needed to determine whether the survival of herbal medicine is longer than the natural survival of patients without treatment, or whether it is no worse than the survival prolonged by chemotherapy, or whether it can enhance the efficacy of chemotherapy drugs.
6.Supportive treatment
Designed to prevent, reduce patient suffering, improve the quality of life, sometimes survival is somewhat prolonged. It includes analgesia, correction of anemia, improvement of appetite, improvement of nutritional status, relief of obstruction, control of ascites, psychotherapy, etc. Endoscopic placement of self-expanding metal stents for patients with advanced unresectable gastric cancer obstruction is less risky and painful. Stenting by percutaneous transhepatic biliary drainage (PTCD) or stenting of the common bile duct when the obstruction is narrowed by compression of enlarged lymph nodes can relieve jaundice and avoid shortening of survival. In case of hemorrhage, a radiologist can be consulted to try vascular embolization to stop the bleeding.