The stomach is a muscular tube located in the left upper abdomen. The upper part of the stomach into which the oesophagus enters the stomach is called the cardia or stomach entrance. At the lower end is the stomach outlet, also known as the pylorus, which merges into the duodenum. Further sections of the stomach are the stomach arch (fundus), the stomach body (corpus) and the gastric atrium (antrum). The stomach is lined by the mucous membrane of the stomach. A kind of mucus layer protects the gastric mucosa from the influence of aggressive gastric acid formed in special glands. In the stomach, the food paste is mixed by the movements of the stomach, bacteria are killed and proteins are coarsely crushed by the enzyme pepsin, which is also formed in the stomach wall.
The experts for stomach cancer treat all malignant tumors of the stomach. The most common type of stomach cancer is gastric carcinoma, which originates from the mucous membrane of the stomach. The following malignant tumors of the stomach are relatively rare:
- Gastrointestinal stromal tumors (GIST) originate from connective tissue (connective tissue tumor, soft tissue tumor).
- MALT lymphomas originate from lymphatic tissue.
- Leiomyosarcomas originate from the muscle cells of the stomach wall.
- Stomach metastases are metastases of tumors of other organs.
In addition to malignant tumors, gastric cancer specialists also treat patients with benign gastric tumors, for example:
- Adenomas originate from glandular tissue and can become malignant.
- Gastric polyps are relatively common and originate from the gastric mucosa; they can become malignant.
- Corpus gland cysts remain benign.
The specialists for gastric cancer also treat accompanying symptoms of gastric cancer and side effects of gastric cancer therapy. These include, for example:
- Treatment of cancer pain
- Treatment of exhaustion and permanent fatigue that can be caused by the cancer itself or the treatment itself
- Treatment of tumor-induced constrictions in the stomach
- Treatment of gastric bleeding
- Treatment of water retention in the abdominal cavity (ascites)
Through the patient interview (anamnesis) and the physical examination, the doctor receives information about the complaints, previous illnesses and medication taken. However, in order to detect or rule out cancer in the stomach, further imaging examinations must be carried out. The following diagnostic procedures are used by gastric cancer specialists:
- With a gastroscopy or an oesophagogastroduodenoscopy, changes in the mucous membrane of the stomach, such as stomach cancer, can be detected and the oesophagus and duodenum can be assessed.
- Tissue samples (biopsies) can be taken as part of a gastroscopy, which are examined in the laboratory to determine whether a gastric cancer is actually present and what type of cancer it is.
- High-resolution video endoscopy
- Magnification (optical and digital magnification of the area to be examined) and computer-assisted chromoendoscopy (tissue areas are stained) for better recognition of tissue changes
The spread diagnosis can be used to determine the extent to which stomach cancer has spread to neighbouring and other organs (metastases). The gastric cancer specialists use the following techniques for this purpose:
- Ultrasound examination (sonography) of the abdominal cavity
- Computed tomography (CT) of the chest, abdomen and pelvis
- Endoscopic Ultrasound Examination (EUS)
- Ultrasound examination of the neck
- Magnetic resonance imaging (MRI) in patients for whom CT examination is not possible
- Bone scintigraphy for identification of bone metastases
- Laparoscopy in advanced gastric cancer
- PET-CT (positron emission tomography computed tomography)
- Barium meal examination for a more accurate assessment of the gastric entrance
- Determination of tumor markers within the framework of clinical studies
The tumor stage (tumor staging) can be estimated on the basis of the spread diagnosis using the TNM classification and the course of the disease. The staging, together with the result of the fine tissue examination (grading), serves as the basis for planning the therapy.
The range of services offered by an expert in gastric cancer includes, for example, the following treatment methods:
- The range of services offered by an expert in gastric cancer includes, for example, the following treatment methods:
- Endoscopic removal (resection) of prematurely detected tumors
- Radiochemotherapy (chemotherapy in combination with radiation) after gastric cancer surgery or for tumors that could not be completely removed or have grown again.
- Partial removal of the stomach (subtotal gastric resection)
- Complete gastric removal (gastrectomy)
- Preparatory chemotherapy before gastric cancer surgery (neoadjuvant chemotherapy) for advanced tumors that are still suitable for surgery (operable tumors).
- Accompanying chemotherapy after gastric cancer surgery (adjuvant chemotherapy)
- Accompanying chemotherapy during gastric cancer surgery (perioperative chemotherapy) according to the FLOT-regime (a certain combination of cytostatic drugs)
- Removal of parts of the esophagus and parts of the stomach in stomach cancer at the transition from esophagus to stomach
- Systemic (whole-body) palliative treatment with targeted substances (antibodies) and chemotherapeutics to limit tumor growth, prolong life and improve quality of life
- Surgical removal or radiation of metastases
- Inserting stents (tubes) to keep the food passage open
- Inserting a feeding tube for artificial feeding
- Radiation of tumors which cannot be surgically removed but which block the food route
- Endoscopic haemostasis, radiological embolization (occlusion of blood vessels from the inside) or radiation of gastric hemorrhages
- removal of the stomach when gastric bleeding cannot be stopped in any other way
- Puncture for the removal of tissue fluid (ascites) from the abdominal cavity
- Treatment with new drugs or methods within the framework of clinical studies
- after-care treatments
- Psycho-oncological care
The treatment of a patient with stomach cancer belongs into the hands of specialists for stomach cancer and should be done in hospitals that have extensive experience with stomach cancer. The German Cancer Society certifies these oncological treatment centers, which ensures high quality in the care of patients with gastric cancer. Experts in gastric cancer are specialists in gastroenterology, oncology, radiotherapy, radiology, surgery and pathology. In tumor conferences, they discuss the cancer of a patient and jointly develop a treatment strategy adapted to the patient, taking into account current guidelines. They are familiar with all diagnostic and therapeutic procedures.
- Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie e.V. (2018) Magenkarzinom. Leitlinie. onkopedia leitlinien
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2019) S3-Leitlinie Magenkarzinom „Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs“. Langversion 2.01 (Konsultationsfassung) –Januar2019, AWMF-Registernummer: 032/009OL
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2013) Magenkrebs. Ein Ratgeber für Patientinnen und Patienten
- Schünke M et al. (2018) Prometheus. Innere Organe: LernAtlas der Anatomie. Thieme, Stuttgart