Gastric Cancer Therapy

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Gastric Cancer Therapy
Gastric Cancer Therapy
Video: Gastric Cancer Therapy
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Gastric cancer: therapy & aftercare

The therapy depends primarily on how far the tumor has already spread, whether lymph nodes are affected or metastases have formed. A distinction is made between curative treatment with the aim of removing the cancer and palliative treatment with the aim of alleviating symptoms, extending life and maintaining the best possible quality of life. The term “supportive therapy” summarizes various measures that help to alleviate the side effects of cancer and therapies…

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  • more on the subject
  • Advice, downloads & tools
  • Curative treatment
  • Palliative treatment
  • Supportive treatment (supportive therapy)
  • Whom can I ask?
  • How are the costs going to be covered?
  • Aftercare & Rehabilitation
  • How are the costs going to be covered?

Curative treatment

If the cancer has not yet spread, it should be removed as completely as possible. For this purpose, the stomach is mostly or completely removed (resected). Very small tumors can be operated on while sparing the stomach (preserving organs). For large tumors, surgery alone is often not enough. The treating physicians decide together in a so-called tumor conference which procedure is appropriate in each individual case.

Endoscopic treatment

Tumors discovered very early can often be removed with an endoscope (endoscopic resection). As with gastroscopy, the instruments and a camera are inserted into the stomach through a tube. Only the tumor is removed, the stomach is preserved. Regular checks are then carried out to determine whether the tumor has grown again (relapse). Bleeding can occur as complications, and the stomach wall can be punctured or severed. In these cases, if the complication cannot be controlled during treatment, an emergency operation must be performed.

surgery

Tumors discovered very early can often be removed with the (endoscopic resection). As with gastroscopy, the instruments and a camera are inserted into the stomach through a tube. Only the tumor is removed, the stomach is preserved. Regular checks are then carried out to determine whether the tumor has grown again (relapse). Bleeding can occur as complications, and the stomach wall can be punctured or severed. In these cases, if the complication cannot be controlled during treatment, an emergency operation must be performed. surgery

If the tumor has not yet spread and has not grown into the surrounding tissue, the tumor tissue is removed as completely as possible by total or partial resection of the stomach and the surrounding lymph nodes. The esophagus or the rest of the stomach is connected to the small intestine to enable natural passage of food. After a total stomach operation, a stomach replacement is usually created from the body's own tissue (e.g. sections of the small intestine). This can usually only take in small amounts of food. Possible side effects include bleeding and swelling in the digestive tract. Seams can rarely leak or come loose.

Removal of the stomach is a major procedure that involves opening up the abdominal cavity. Therefore, the recovery phase takes some time. After the operation, a natural diet is started carefully. Usually the patient initially receives a nutrient solution via the vein (parenteral nutrition). If necessary, a tube can also be placed temporarily, through which food concentrates are administered directly into the intestine (enteral nutrition). If the tumor grows again after an operation, another operation can be carried out, provided the relapse is localized. If this is not possible, radiation combined with chemotherapy can be given.

Preparatory or accompanying treatment for the operation:

  • Chemotherapy: In the case of locally advanced gastric cancer, chemotherapy before (neoadjuvant) and after (adjuvant) the operation can improve the healing success. Medicines (cytostatics) are used to inhibit the tumor from growing.
  • Radiochemotherapy: If no chemotherapy is administered before the operation, a combination of chemotherapy and radiation (radiochemotherapy) can be useful after the operation.

Palliative treatment

If the tumor has already metastasized, healing is no longer possible. In these cases, the aim of treatment is to slow down tumor growth, extend life and maintain quality of life for as long as possible. The growth of the tumor can be inhibited with drugs that work (systemically) throughout the body. This can be done with chemotherapy alone or in conjunction with antibody therapy.

  • Chemotherapy: So-called cytostatics are used. These drugs are designed to prevent cancer cells from dividing and thus slow down tumor growth. However, they also have an effect on healthy cells that divide at a similar rate. Possible side effects are hair loss, nausea and vomiting, diarrhea, damage to the bone marrow, changes in the blood count, anemia, infections, hand-foot syndrome and inflammation of the oral mucosa (mucositis). Some of these side effects can already be treated preventively.
  • Antibody therapy: The human epidermal growth factor receptor type 2 (HER2) sits on the cell surface and causes increased cell division. This receptor can be particularly common in certain tumor cells. If this is proven in the tissue samples, one speaks of a positive HER2 status. This is the case in around a quarter of all gastric cancers. Then treatment with an antibody that blocks HER2 can slow or stop cell growth. In conjunction with chemotherapy, this therapy can increase survival.

Supportive treatment (supportive therapy)

The term supportive therapy ("Best Supportive Care") summarizes measures that help to alleviate side effects of cancer and therapies.

Exhaustion / chronic tiredness (fatigue)

Fatigue is exhaustion and persistent tiredness that goes beyond the usual extent and persists even after periods of rest and sleep. This is often associated with listlessness, weakness and a lack of resilience. If treatment causes acute fatigue, symptoms may subside after the end of therapy. A targeted training program often helps. Several studies have shown that exercise is very effective against fatigue.

Pain management

Different substance groups are used depending on requirements:

  • Medicines that numb a specific area (local anesthetics)
  • anti-inflammatory and non-inflammatory pain medication,
  • Opioid pain relievers (opioids) with different strengths.

Concomitant medications can help the pain relievers work and reduce side effects such as constipation. Pain can have consequences for the body and mind. For example, they can intensify anxiety and depression, which in turn affect the perception of pain. In these cases, psychotropic drugs can be helpful.

Narrowing of the food routes

In patients who cannot be operated on, the tumor can grow to such an extent that it narrows the stomach and obstructs the passage of food. In some cases, surgery can expand the stomach (e.g. by implanting a stent) or bypassing the tumor-related bottleneck. Targeted irradiation of the tumor may also be an option. This is to destroy cancer cells and shrink the tumor. Alternatively, a feeding tube can be inserted for artificial feeding.

Gastric bleeding

Bleeding caused by advanced gastric cancer can either be stopped in an endoscopic procedure, controlled by occlusion of the blood vessels (radiological embolization), or irradiated. As a last resort, removal of the stomach can be considered.

Water retention in the abdominal cavity (ascites)

If the peritoneum is badly attacked by the tumor, water from the tissue collects in the abdominal cavity. Large amounts of fluid press on the internal organs. Regular punctures can be used to relieve the strain. A hollow needle connected to a tube is inserted into the abdominal cavity under local anesthesia. The antibody catumaxomab can also be administered into the abdominal cavity. It specifically attacks tumor cells on the peritoneum.

Learn to eat again

Life without a stomach often requires completely new eating habits. In most cases, only small amounts can be ingested, but with some people the amount increases again over time. Certain foods are no longer well tolerated, "eating mistakes" can lead to nausea, vomiting and pain. With a consciously planned diet, all the necessary nutrients can be supplied to the body. Therefore, patients should receive detailed nutritional advice before they are discharged from hospital.

Whom can I ask?

Treatment of patients with gastric cancer should only be carried out in a specialized center.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. You can find more information under What does the hospital stay cost?

Aftercare & Rehabilitation

After completing the treatment, your physical condition, weight and blood count will be checked at regular intervals. This is important because many of those affected are restricted in their diet after the operation and there is a risk of insufficient supply of certain nutrients (e.g. vitamin B12). If necessary, additional examinations such as ultrasound, computed tomography, x-rays, or endoscopy may be required.

Most often, rehabilitation is recommended after therapy is completed to speed up the recovery and recovery process. Special rehabilitation clinics respond to the individual situation of the patient and provide assistance. This also includes psychological and social problems or physical sequelae of cancer.

How are the costs going to be covered?

In order to receive medical rehabilitation benefits, those affected must submit a rehabilitation application. Different social insurance agencies are responsible for approving medical rehabilitation:

  • Accident insurance carriers (e.g. AUVA),
  • Pension insurance carriers (e.g. PVA),
  • Health insurance carriers.

You can find more information about rehabilitation under Rehabilitation and Cure.

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