What is a gastric tumor?
The stomach is an organ situated on the upper left side of the stomach between the esophagus and the duodenum. Gastric tumors result from abnormal proliferation of cells on the inner surface of the stomach due to genetic factors and various environmental factors, forming a mass by uncontrollably growing. These tumors may be benign or malignant. Malignant tumors may spread to the lymph nodes around the stomach or other organs of the body.
What are the symptoms?
Difficulty in swallowing, anemia, loss of appetite, weight loss, pain on the upper side of the abdomen, vomiting may be the first symptoms. However, it should be kept in mind that gastric tumors may be very insidious at the early stages and progress without any symptoms, and may have progressed to advanced stages when the symptoms show up.
What are the risk factors?
- Eating high-salt and smoked foods.
- Smoking and alcohol use
- Old age: It usually occurs over the age of 55 years. Many patients are 60-70 years old.
- Gender: It is more than twice as prevalent in males than females.
- Bacteria: A bacterium, called Helicobacter Pylori or H. Pylori, is thought to have an effect on gastritis, ulcers and various gastric tumors. If H. Pylori is detected in the patient during gastric endoscopy, it should be removed from the stomach with antibiotics.
- Family history: Although gastric cancer appears to be associated with some types of familial cancer, it is also seen in individuals with no history of cancer in the family.
- Obesity: Obesity has been shown to increase the likelihood of developing gastric cancer, especially in males.
- Having undergone a gastric surgery due to ulcers.
How is it diagnosed?
The best method for diagnosis is an endoscopic examination. In this method, the stomach is entered using a fiberoptic cable with a camera at the tip through the mouth and visualized. Since gastric cancer is usually at advanced stages when symptoms arise, in countries such as Japan, all people over 55 years of age without any symptoms undergo endoscopy for screening. By this means, it can be only caught at early stages. There is nothing such as x-ray, blood test to replace endoscopy.
What is the treatment?
The treatment of gastric tumors varies depending on the stage of the disease. In cases where the disease is caught at the earliest stage and even before the tumor transform into cancer, endoscopic removal of the diseased area is possible as a non-surgical solution. However, as the stage of the disease advances, combinations of gastric surgeries and oncologic treatments are required.
What is done in the surgery?
A wide variety of methods have been described for the surgeries of gastric tumors. The most commonly used methods nowadays are:
- Removal of only the tumor area: It is a method used in the case of benign gastric tumors but with a potential to transform into malignancy.
- Distal Subtotal Gastrectomy: It is a type of surgery in which the lower part of the stomach is removed. In general, this part is connected to the small intestine to maintain the continuity of the digestive tract.
- Total Gastrectomy: In this surgery, the entire stomach is removed, the small intestine is connected to the esophagus and adjusted to function as the stomach. Without having a stomach, a human can live for many years under doctor control. Naturally, some vitamin and mineral deficiencies will develop in the body due to the absence of the stomach and the eating capacity will reduce. But keep in mind that nothing to develop with surgery will cause as much damage to your stomach as gastric cancer.
NOTE: No matter which surgery is performed, the lymph nodes around the stomach should be removed in the case of malignant gastric tumors. It should be noted that there may be millimetric tumor cells only visible under the microscope. The success rate of these surgeries increases if they are performed by experienced physicians and in experienced centers.
What are the risks of gastric tumor surgery?
After gastric tumor surgery, 95% of patients are discharged without any problems. However, if the patient is very old and has conditions such as comorbid diseases (such as hypertension, diabetes, heart disease etc.), malnutrition (prolonged fasting and rapid and uncontrolled weight loss impair the healing functions and immune system), the likelihood of suffering some problems increases.
Major complications that may develop:
- Leak: The most important and feared risk is the development of leak due to changing anatomical structures in the gastrointestinal tract. Although it most commonly arises in the first week after the surgery, there are patients known to develop leak one month after the surgery. If a leak develops, it may result in prolonged length of hospital stay, repetitive endoscopic, radiological or surgical interventions, admissions to intensive care, and even death due to intraabdominal infections. In order to prevent the development of leak, it is very important that the surgical technique is developed and standard methods are carried out by experienced surgeons. Smoking, uncontrolled diabetes and untreated pulmonary diseases increase the risk of leak. Despite all these measures, the leak rate in the world’s leading bariatric surgery centers is around 1-2%.
- Bleeding: There is a risk of bleeding after every surgery. It is known that the rate of developing bleeding after gastric tumor surgery is about 1-2%. The use of blood thinners (aspirin, clopidogrel, coumadin, heparin etc.) by the patient for another reason increases the risk of postoperative bleeding. Bleeding may occur into the abdomen (internal bleeding) or into the digestive tract (gastric bleeding). The vast majority of these bleedings stop spontaneously. Sometimes, the patient may require to be given blood and blood products. This may rarely require re-surgery to be able to stop bleeding. Very severe bleedings may be life-threatening.
- Deep vein thrombosis: Patients with tumor in any part of the abdomen are at high risk in terms of developing blood clot in the leg veins, called deep vein thrombosis, resulting in obstruction of various vessels of the body, most commonly in the lungs. In order to avoid this condition, it is of vital importance to wear compression stockings and air compression stockings, to administer blood thinner injections (low-molecular-weight heparin) and to mobilize and walk in the early postoperative period.
- Vomiting: It is known that some of the drugs administered during anesthesia lead to vomiting in the early postoperative period. However, this effect usually disappears spontaneously within the first 1-2 days. In cases of prolonged vomiting and malnutrition, the gastrointestinal tract should be checked for the development of obstruction. In such a case, obstruction should be eliminated with endoscopic or surgical treatments.
- Surgical site infections: Microbial infections may develop in the superficial or deep surgical sites. If an abscess develops, it may require to be discharged and treated with various antibiotics.
- Exacerbation of pre-existing diseases of the patient: In particular lung diseases, hypertension and heart failure may exhibit a slight exacerbation in the early postoperative period. However, in later periods, these diseases will relieve and even heal to a large extent when the patient loses weight.
- Wound dehiscence: Especially in patients with impaired wound healing functions, the surgical wound may not heal on time, causing dehiscence. If the skin barrier in front of it is not impaired, this results in hernia development in the surgical site. However, if the skin in front of it is also opened, this may need to be corrected with re-surgery.
NOTE: Any digestive tract surgery may involve risks not specified here. In addition, the risks of the drugs used, blood and blood products transfusion, anesthesia and hospitalization are not indicated here.
