Cause and Diagnostic

Benign stomach tumours are seldom, while malignant ones are more frequent. The symptoms and diagnostic procedures are similar. A malignant tumor can often only be ruled out after removal and study of tissue sample

Causes

There are many factors that can predispose development of a malignant tumor. However the exact cause is still unknown.

These predisposing factors are diet with high salt content, chronic gastritis, large ulcers, pernicious anemia, smoking, partially removed stomach (partial gastrectomy).

Symptoms

Often in the initial stages the patients' complaints are non-specific, 50% are free of symptoms. Others complain of dyspepsia (which may be mistaken as a symptom of an ulcer), acid regurgitation, difficulties in swallowing, weight loss, weakness pains behind the breast bone, acid regurgitation, hoarseness, and coughing.

Diagnosis

Often a gastric cancer is diagnosed at a late stage. Gastroscopy (endoscopic evaluation of the oesophagus & stomach) and biopsy of the tissue taken from the affected area help to confirm the diagnosis.

The extent of the disease in terms of the depth of the tumour in relation to the stomach wall & its possible spread and any involvement of the surrounding lymph nodes can be assessed by an endosonography.

A radiological examination with double contrast studies can show the changes if any on the surface of the mucous membrane and provides information about the extension of the tumour.

After the diagnosis has been determined, a computer tomography (CT) is done to evaluate the surrounding organs to determine if any metastases have developed in nearby lymph nodes, in the liver or lungs.

Determination of the tumor marker in the blood serum should be done prior to surgery and can be useful for evaluation of on-going procedures

Indications

The surgery is planned after all preliminary evaluations have been completed. The procedure can be one of curative surgery (complete removal of the tumour) or of palliative surgery done to relieve symptoms in cases where complete removal is not feasible e. g. a stomach by-pass..

Surgical Management

If the tumors can be completely removed, either the entire stomach or parts thereof are removed. Decisions concerning procedures are made based mainly on the location of the tumors. The complete removal of adjacent lymph nodes is crucial for the success of the operation. The abdominal cavity is opened with a vertical incision. After removal of the stomach or parts thereof, a section of the small intestine is attached to the remaining stomach or the lowest part of the esophagus - as a Roux-en-Y anastomoses. (Anastomoses: an operative artificial connection between cavities.) It is either hand sewn or stapled

If contrary to all expectations, the tumor cannot be completely removed, e.g. due to the extent of its spread into the surrounding organs or metastases in other organs especially the liver and lungs and the patient's food passageway is disrupted, a gastro (stomach) by-pass can be performed. Here a healthy part of the small intestine, is attached directly to the stomach above the tumour in such a manner that food can by-pass the narrowed passageway caused by the tumor.

Follow-up

Follow up consists of regular gastroscopies of the remaining stomach as well as imaging procedures such as - computer tomography or abdominal ultrasound - to insure that no metastases have developed in the surrounding organs. Tumor markers in the blood serum are useful as a follow-up parameter and provide important information about any reoccurrences.