Stomach Cancer Treatment in Delhi, India

The most commonly diagnosed kind of stomach cancer is called adenocarcinoma. There are two kinds of adenocarcinoma:

1. Intestinal - better prognosis than diffuse; it is eligible for targeted therapy

2. Diffused - grows quickly, harder to treat

Other types include:

1. Gastric Lymphomas

2. Gastrointestinal Stromal Tumours (also known as GIST)

3. Carcinoid tumours

While stomach cancer can be asymptomatic, some stomach cancer symptoms include:

• Bloating

• Abdominal pain or discomfort

• Heartburn

• Vomiting of blood

• Blood in stool

• Difficulty in swallowing

• Loss of appetite

• Loss in weight

• Yellowing of skin and eyes

The cause of gastric cancer is unknown. It is a mix of environmental triggers, diet, lifestyle, genetics, previous illness & infections, and microbiology. Sometimes, there is no cause for stomach cancer.

Stomach cancer stages are classified according to The American Joint Committee on Cancer's TNM system:

1. T category - Refers to the size of the tumour and the extent of it

2. N category - Refers to how far cancer has spread to the lymph nodes

3. M category - Refers to whether the cancer has reached other parts of the body.

Based on the findings, a stage is determined. The stages are:

1. Stage 0 - Cancer affects only the stomach's inner lining. It is treatable by surgery since no lymph nodes are affected.

2. Stage 1 - Two or three layers of the stomach are infected, and a couple of lymph nodes might be affected. It has yet to spread to other organs.

3. Stage 2 - Tumour reaches the deeper layers and lymph nodes. It has not spread to organs yet.

4. Stage 3 - The tumour grows in the deeper layers of the stomach. It can spread to the lymph nodes, but no organs are affected. 

5. Stage 4 - Cancer in the stomach is present, and its spread to other organs is likely and severe.

Until cancer has not spread to other organs, it is staged between 0 and 3. When it spreads to other organs, it is classified as stage 4.

Diagnosis of stomach cancer is made by:

• Endoscopy - refers to a thin, long tube with a light and camera used to look inside a person's digestive tract.

• Biopsy - refers to a collection of tissues and cells that can be studied in a lab

• Blood Tests - help find abnormalities in organ function.

• Endoscopic Ultrasound - the thin, long tube has a camera, light and ultrasound that helps capture information about the digestive tract. This has a very limited role in very early tumours

• Laparoscopy - a procedure where small incisions are made, and a laparoscope is used so that the doctor can use that to get a view of the abdomen. This particularly helps pick up a small tumour spread in the liver of the abdomen which would be missed even on PET-CT. This can potentially change management plans for about 20% of patients completely.

• Imaging tests - refers to images that are used to make a diagnosis. It includes PET-CT scans.

The best course of action is complete removal. Options include:

• Upper Endoscopy - a procedure where very early and precancerous growth and tumours in the stomach are removed using an endoscope. This applies to a very small the proportion of patients.

• Gastrectomy - refers to a procedure where parts of the stomach or the whole stomach are removed along with the removal of surrounding lymph nodes. 

Other options include:

• Chemotherapy uses medications that shrink the size of cancer cells.

• Radiation Therapy uses radiation like high-powered energy beams to destroy cancer cells. This applies to very few patients with stomach cancer.

• Targeted Therapy uses drugs that affect a cancer cell's proteins or genetic information that helps it grow and spread.

• Immunotherapy uses a person's immune system to fight off infections. Medications are given to boost the immune system to help fight against cancer.

The risk of having stomach cancer can be more in cases of medical issues like an infection of the stomach, Intestinal metaplasia, inflammation of the stomach, pernicious anaemia, familial adenomatous polyposis or gastric polyps. The risk also increases when the person has increased consumption of a diet containing excessive salt, smoked foods and low in fruits and vegetables.

The person having a bad habit of smoking cigarettes could also be at a higher risk of developing stomach cancer. Stomach cancer can also occur genetically in case any family member previously had this condition.

Complications of stomach cancer are:

• Spreads to other organs

• Gastrointestinal bleeding

• Bowel obstruction

• Gastric perforation

There is no sure way to prevent stomach cancer. However, it may help to:

• Eat a balanced diet

• Eat fresh fruits and vegetables regularly

• Exercise regularly

• Quit smoking- Smoking doubles the chances of gastric cancer.

• Reduce intake of salty, smoked and highly processed foods

• Monitor and reduce alcohol consumption

Stomach cancer progresses over the years. Its symptoms often mimic other conditions, making it difficult to diagnose the disease until it is screened for or too late.

The prognosis of treatment for stomach cancer depends on the stage at diagnosis. Tumours caught very early have the best prognosis. Overall, outcomes of more advanced tumours tend to be poor, though the outcomes with treatment are improving with some advancements in our knowledge about this cancer.

• Considering the overwhelming effects of stomach cancer, early detection and eradication are utmost essential to get trapped yourself into the safer zone.
• Stomach cancer initially starts to develop in the layers of the stomach and usually migrates to other regions over the years.
• Common symptoms occur when cancer starts growing such as stomach pain, difficulty in swallowing, Nausea, and vomiting, weight loss or sometimes blood vomiting.
• We perform some special tests to confirm your stomach cancer diagnosis. Some of these tests are a physical examination and medical history, laboratory tests, Biopsy method, Gastroenterology, Endoscopy, and Imaging.
• So now if you have been diagnosed with stomach cancer, our surgeon along with the cancer team approaches you with best treatments after considering your age, general state of health, personal preferences into account.
• The treatment options depend on two main factors such as Location of cancer and Spread of cancer. The treatment methods we usually follow are chemotherapy, radiation therapy, surgery, and immunotherapy.
• Some may see immediate results and benefits after undergoing the treatment while for others the treatment may provoke some side effects.

When treatments are not going to help you out and if you have reached the advanced stage there are still things which you can do to maintain or improve your quality of life.

General statistics give the survival of stomach cancer stage wise in a five-year survival rate approximation.

Stage 1 Stomach Cancer

Stage 1A: No penetration. The survival rate is more than 70%.

Stage 1B: 1 – 2 nearby lymph nodes or the main muscular layer of the stomach wall is affected, and the survival rate is 57%.

Stage 2 Stomach Cancer

Stage 2A: One or two lymph nodes and the main muscular layer or to 3 – 6 lymph nodes are affected or penetration through the main muscular layer to subserosa. The survival rate is 46%.

Stage 2B: Outer covering of stomach or to main layer muscular layer and 3 – 6 lymph nodes or to 7 or more lymph nodes are affected. The survival rate is 33 %.

Stage 3 Stomach Cancer

Stage 3A: Main muscular layer and 7 or more lymph nodes or subserosal layer and 3 – 6 lymph nodes are affected. Survival rate 20%.

Stage 3B: 7 or more lymph nodes are affected or penetration through serosa into a nearby organ. The survival rate is 14%.

Stage 3C: penetration to serosa and 7 or more lymph nodes affected or nearby organ and 3 or more lymph nodes are affected. The survival rate is 9%

Stage 4 Stomach Cancer

Cancer reaches far away organs, and the survival rate is as low as 4%.

The statistics are not the only predictor. Expert advice from Dr. Rudra Acharya will provide you with a better insight into your cancer and the journey forward.

If proper treatment is not undergone to lock the inevitable multiplication of your disastrous cancer cells, it causes two major issues such as serious life-threatening complications and drastic stage-wise metastasis.
The most common complications of this cancer are:

• Gastrointestinal bleeding
• Gastric perforation
• Small Bowel Obstruction

Coming to the stage-wise metastasis, this is the pattern the cancerous cells follow to slowly decay your vital organs.

Stage 1: cancer at this initial stage spreads to the main muscular layer of the stomach wall and to one or two nearby lymph nodes.

Stage 2: At this stage, cancer spread to three to six lymph nodes and to the outer covering of the stomach layer and all set to affect nearby organs.

Stage 3: The cancerous cells jump to nearby organs like spleen, intestine, liver, pancreas, or major blood vessels.

Stage 4: This is the most advanced stage in which cancer starts to attack secondary sites such as the brain, lungs, liver, or bones which is of more metastatic.

In this way, untreated cancer cells evade your whole body and reduce your chances of survival within a short period of time. If you are so anxious about having this cancer, fix an appointment immediately with Best Oncologist In India and get rid of cancer while it is in the initial stage rather than struggling for life in the metastatic stage.

Reviewed by Dr. Vivek Mangla, Director - Gastrointestinal and Hepatopancreatobiliary (GI & HPB) Surgical Oncology, Cancer Care / Oncology, Surgical Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery on 06-Jun-2023.

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How common is gastric (stomach) cancer?
Worldwide, about 1 million people are diagnosed with gastric cancer. It is ranked as the 5th most common cancer. In India, it accounts for about 60,000 new cancer cases (6th most common) and about 53,000 deaths.

How is this diagnosed? This is diagnosed after an endoscopic biopsy.

What is the treatment for stomach cancer?
Stomach cancer treatment depends upon the stage of the disease. For early or locally advanced disease, this is surgery or chemotherapy with or without radiotherapy. For stage 4 disease, this is chemotherapy with or without targeted therapy. Sometimes, immunotherapy is also used with or without chemotherapy.

How is the choice of treatment determined for stomach cancer patients?
Treatment decisions are based on factors like the cancer stage, tumour location, the patient's overall health, and the presence of specific genetic mutations.

Is surgery the primary treatment for stomach cancer?
Surgery is often the main treatment for stomach cancer, with the goal of removing the tumour and nearby lymph nodes. This is possible in the early stage or what we call a locally advanced disease.

What types of surgeries are performed for stomach cancer?
Common surgeries include gastrectomy (removal of part or all of the stomach) with lymphadenectomy (removal of lymph nodes) and palliative surgery for symptom relief.

Can stomach cancer be treated with chemotherapy?
Yes, chemotherapy is often used to shrink tumours before surgery, kill cancer cells, or manage advanced cases of stomach cancer.

Is radiation therapy effective for stomach cancer treatment?
Radiation therapy can be used to destroy cancer cells, either alone (to prevent bleeding) or in combination with surgery and chemotherapy.

What is targeted therapy in stomach cancer treatment?
Targeted therapy drugs specifically target cancer cells' abnormalities, such as overactive proteins, to inhibit their growth.

Are immunotherapy options available for stomach cancer patients?
Immunotherapy drugs like checkpoint inhibitors can stimulate the immune system to recognise and attack cancer cells.

Can stomach cancer be treated with alternative or complementary therapies?
While some patients explore alternative therapies, they are not considered primary treatments and should be discussed with a healthcare provider and, at this time, lack credible scientific evidence.

Is precision medicine used in stomach cancer treatment?
Precision medicine analyses a patient's genetic profile to identify targeted treatment options, which can be beneficial in advanced cases of stomach cancer.

What is neoadjuvant therapy in stomach cancer treatment?
Neoadjuvant therapy refers to treatment administered before surgery to shrink tumours or improve surgical outcomes.

Can stomach cancer spread to other organs, and how is metastatic cancer treated?
Stomach cancer can metastasise to other organs. Treatment for metastatic stomach cancer may involve chemotherapy, targeted therapy, and immunotherapy.

Is stomach cancer treatment different for early-stage and advanced-stage cases?
Yes, treatment approaches vary based on the stage of the cancer. Early-stage cases may require surgery alone, while advanced stages often involve multimodal therapies.

Can nutritional support be part of stomach cancer treatment?
Yes, nutritional support, including dietary changes and supplements, can be important for managing malnutrition and the side effects of treatment.

What are the potential side effects of chemotherapy used for stomach cancer treatment?
Side effects may include nausea, vomiting, fatigue, hair loss, changes in appetite, and gastrointestinal issues, depending on the treatment used.

Are there long-term effects or complications of stomach cancer treatment?
Some treatments may lead to long-term complications, such as digestive problems, nutritional deficiencies, and potential effects on quality of life.

Is follow-up care necessary after completing stomach cancer treatment?
Yes, regular follow-up appointments are essential to monitor for cancer recurrence and manage any lasting side effects.

What is the success rate of stomach cancer treatment?
The success rate varies depending on the stage, type of treatment, and individual factors. Early detection and treatment offer better outcomes and possibilities of cure in many patients.

Is stomach cancer treatment influenced by a patient's age or overall health?
Age and overall health play a role in treatment decisions, and older adults may have tailored treatment plans to manage comorbidities.

Are there patient support groups for stomach cancer survivors and those undergoing treatment?
Yes, support groups can provide valuable emotional support, information sharing, and coping strategies for stomach cancer patients

FAQs reviewed by Dr. Atul Sharma Principal Director-Medical Oncology, Cancer Care / Oncology