Cancer of the stomach

Unfortunately, stomach cancers gives symptoms usually at a more advanced stage; not early. When it is still small in size it does not bleed, does not cause pain or discomfort, and does not cause any difficulty in swallowing. The diagnosis is established with gastroscopy and biopsy. Along with the diagnosis, other significant information needs to be gathered in order to design the best management strategy: it is crucial to identify the extension of the tumor inside the stomach, but also outside as well. It is important to demonstrate how deep into the wall of the stomach the tumor goes, or whether it has involved tissues outside the stomach, such as lymph nodes. This information comes from the combination of computerized tomography and endoluminal ultrasonography (EUS).

The sole definitive treatment of stomach cancer is surgery, which involves removal of the stomach (gastrectomy), along with all the lymph nodes surrounding the stomach. Many scientific studies have demonstrated the importance of radical lymph node dissection (removal), especially with those nodes invested in the tissues around the left gastric artery and the aorta. A gastrectomy that does not involve resection of all these lymph nodes is considered oncologically insufficient and may predispose such patients to early local recurrence or early metastasis of the cancer.

Because at the time of diagnosis, the stomach cancer may have progressed through the stomach wall into the fatty tissues around it and in the lymph nodes of the left gastric artery close to the aorta, this has to be well recognized before the operation. This extremely important information comes from a diagnostic modality called endoscopic ultrasonography (EUS). EUS will precisely demonstrate the true depth of wall involvement and penetration. In case of more advanced disease, it is prudent for the patient to undergo chemotherapy first, before the operation. This strategy of “neoadjuvant chemotherapy” will “downstage” the disease, or shrink it both in size, as well as in depth of wall penetration, so a subsequent operation will provide maximal radicality. More importantly, this strategy is clearly associated also with improved long term outcome, which means a lower risk of cancer recurrence, or metastasis and a longer survival.