Stomach (gastric) cancer

Gastric cancer is one of the most dangerous oncological diseases, as it is usually diagnosed at the advanced stage. The survival rate by age demonstrates that more than 50% of the older people who suffer from this disease die within a year after the confirmation of the diagnosis. Nowadays stomach cancer is considered to be the most common malignant tumor in the world, though there is a tendency to decrease in the occurrence of this disease. Treating stage 4 stomach cancer is a medical challenge that can be successfully overcome by qualified oncologists. Due to the development of medical tourism, you can start therapy at home or travel abroad in search of better quality and cost options.

Stage 4 stomach (gastric) cancer – Symptoms

Fourth stage gastric cancer spreads beyond the stomach, to other organs or lymphatic nodes. The stomach cancer symptoms are not unique, the most common of them are:

• Abdominal pain. Persistent or worsening abdominal pain, particularly in the upper abdomen. The pain may be dull, aching, or sharp in nature.
• Difficulty swallowing (dysphagia). As the pathology progresses, it causes esophagus narrowing, leading to difficulty swallowing solid foods or even liquids. This can result in a sensation of food getting stuck in the throat or chest.
• Weight loss without obvious reason. This is connected with poor appetite, difficulty swallowing, or metabolism affection (tumor consumes nutrients actively).
• Vomiting, nausea. This may also be accompanied by feelings of fullness or bloating even after eating small amounts of food.
• Weakness, fatigue. These may be due to the cancer itself or related to anemia (low red blood cell count) caused by bleeding from the tumor vessels.
• Blood in the stool or vomit. Stomach cancer is a typical cause of gastrointestinal bleedings, resulting in blood in the stool (black, tarry stools) or vomit (bright red or coffee-ground appearance).
• Lymphatic nodes enlargement. At the 4th stage, the oncological process spreads to lymph nodes, causing them to enlarge and become palpable as lumps or bumps in the abdomen, neck, or other areas.
• Jaundice. In some cases, stage four cancer spreads to the liver, affecting outflow of bile and causing jaundice.

However, such complaints can be caused by other conditions as well, and not all individuals with gastric cancer will experience all of them. If you are experiencing persistent or worsening symptoms, especially if you are at risk for stomach cancer (e.g. you have a family history, Helicobacter pylori infection, stomach polyps or stomach surgeries), it's important to see your doctor for further evaluation and appropriate testing.

Stage 4 stomach (gastric) cancer – Diagnostics

The main diagnostics methods are instrumental examinations. If an advanced malignant process is suspected, the following investigations are performed:

• Radioscopy. The patient drinks a liquid (contrast medium). Then, with the help of an X-ray a doctor assesses the state of the stomach lining in real time.
• Gastroscopy is the endoscopic method, which allows performing biopsy for cytological and histological examination of the tumor. Tissue samples are taken from 3-4 areas of the gastric mucosa, as the malignant process may combine different neoplasms.
• Ultrasound examination and CT are non-invasive diagnostic methods that help to detect metastases and evaluate the type of the tumor growth. PET-CT is even more informative, as it gives the detailed 3d image of gastrointestinal organs, lymph nodes throughout the body and distant organs.
• Laparoscopy is a small surgery. It includes checking the abdominal cavity through a small cut and identifying places of the pathological process which are not available for the examination with the help of noninvasive techniques.

As a result of the examination, doctors will determine the exact tumor type (this can be adenocarcinoma, a carcinoid tumor, lymphoma, neuroendocrine tumor, and a gastrointestinal stromal tumor), find affected lymph nodes and distant metastases. These are essential for making the best treatment regimen for stomach cancer stage 4.

Best clinics for the stomach cancer diagnostics in Germany:

University Hospital Duesseldorf

6013.14

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Helios Hospital Berlin-Buch

0.00

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University Hospital of Ludwig Maximilian University of Munich

0.00

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Stage 4 stomach (gastric) cancer – Treatment

Surgery is an important treatment method in the case of stomach carcinoma. Choice of a surgery type depends on the spreading of the pathological process, size of the tumor, localization of metastases, germination of the malformation in the nearby structures.

Following types of the operations are performed:

• Subtotal gastrectomy (partial removal of the stomach), including the robotic interventions. Despite higher prices, robotic procedures offer numerous benefits.
• Gastrectomy (removal of the entire stomach).
• Endoscopic procedures, such as laser therapy to destroy cancer cells and relieve symptoms.
• Palliative interventions, such as stent placement to improve food passage through the esophagus and intestines.

Gastric cancer can require not only radical, but also palliative care. Resection of the stomach may be carried out, even if the tumor has already spread metastases into the liver, lymph nodes or other structures. Palliative surgeries can improve the patient's quality of life.

Not only the stomach, but other organs also can be removed during the intervention, depending on the clinical situation (e.g., spleen, part of the liver, small intestine). Chemotherapy and radiation therapy are also used, but they are additional methods of treatment, with a minimal impact on the patient's survival.

The costs for the stomach cancer treatment in the specialized centers in Germany are as follows:

• The cost of partial stomach resection for stomach (gastric) cancer is between 23,700 EUR and 50,400 EUR.
• The cost of complete stomach resection and further reconstructive surgery in stomach (gastric) cancer is between 24,000 EUR and 50,500 EUR.
• The cost of cytoreductive surgery and HIPEC for stomach (gastric) cancer is between 52,100 EUR and 92,200 EUR.

Stage 4 stomach (gastric) cancer – Innovative treatment

The latest treatment techniques are actively used for the treatment of stage 4 stomach cancer. Medicine is developing and new drugs or methods of influence on the malignant cells appear every year.

• Polyadenylic acid and polyuridylic acid are used for the immunotherapy of cancer. According to the Korean trials, they help to lengthen the patient’s life, increasing the remission period after the surgery.
• Blockers of the epidermal receptor of the growth factor are new drugs for targeted therapies. They are applied in order to block a protein that stimulates the growth of cancer cells.
• HER2 factor blockers. They are used for targeted drug therapy. They affect only cancer cells, as they have the high content of the protein on their surface. There are drugs in this group, which have been clinically tested and approved for the treatment of advanced gastric cancer.
• Intraperitoneal immunotherapy is administered in case of peritoneal carcinomatosis. The purpose of a treatment is the removal of ascites (accumulation of the large amounts of fluid in the abdominal cavity). The treatment is carried out with the intraperitoneal injection of monoclonal antibodies.

Treatment of stage 4 stomach cancer

Advanced treatments and new drugs are used abroad to control the tumor for a long time, even in stage 4 stomach cancer.

If the cancer has spread throughout the peritoneum and the carcinomatosis index is low, doctors can perform cytoreductive surgery to remove all visible tumors to treat stage 4 stomach cancer. The remaining cancer cells are then destroyed by rinsing the abdominal cavity with a warmed solution of chemotherapy drugs.

End-stage cancer often causes the spread of metastases to the liver. In this case, hepatic artery chemoembolization may be a good treatment option. Doctors block the lumen of the blood vessel with tiny balls, thereby depriving the metastatic tumor of blood supply.

Systemic therapy is important in the treatment of stage 4 cancer. In addition to conventional cytostatic chemotherapy, targeted therapy and immunotherapy are used in developed countries. HER2, VEGF, and TRK inhibitors are used for targeted therapy. Antibody-drug conjugates are also used in advanced clinics. This is a monoclonal antibody against HER2 that delivers chemotherapy drugs attached to it directly to cancer cells.

Many patients require palliative treatment for stage 4 stomach cancer. Doctors use endoscopic procedures to destroy the part of the tumor that is blocking food from moving from the stomach to the intestines. A stent can then be placed in this area.

Best clinics for the stomach cancer treatment in Germany:

Marien Hospital Duesseldorf

Surgical treatment of stomach cancer with partial resection of the stomach with anastomosis

23782.8

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Surgical treatment of gastric cancer with complete resection and subsequent plasty of the intestinal tissue

24021

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Diagnosis and chemotherapy of stomach cancer (1 course)

7439.68

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Asklepios Hospital Barmbek Hamburg

Surgical treatment of stomach cancer with partial resection of the stomach with anastomosis

37517.46

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Surgical treatment of gastric cancer with complete resection and subsequent plasty of the intestinal tissue

33252.72

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Diagnosis and chemotherapy of stomach cancer (1 course)

7011.64

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Helios Hospital Berlin-Buch

Surgical treatment of stomach cancer with partial resection of the stomach with anastomosis

31470.61

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Surgical treatment of gastric cancer with complete resection and subsequent plasty of the intestinal tissue

31224.23

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Diagnosis and chemotherapy of stomach cancer (1 course)

7835.36

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Stage 4 stomach (gastric) cancer – Rehabilitation

Most patients require rehabilitation after the treatment of complex oncological diseases. It includes the following aspects:

• Prevention of complications that may occur as a result of treatment. It can be pneumonia, lymphostasis, thromboembolic or infectious complications.
• Restoration of general health. The elimination of the consequences after surgeries and chemotherapy is carried out. The functions of internal organs are restored with the help of various medical and rehabilitation measures.
• Restoration of occupation. A person must not just stay alive. He must have physical and intellectual capabilities, which are sufficient for employment. 
• Psychological support. First of all, it is required for patients, whose occupational performance was harmed because of the disease. Patients with deterioration of appearance also will benefit from psychological help.
• Restoration of appearance. If necessary, you can use surgical and other methods to restore appearance defects caused by cancer. For example, to carry out the reconstruction of the breast.
• Social and domestic rehabilitation. A person with reduced workability is trained to act in the society and perform everyday tasks in new conditions.

In European clinics, rehabilitation is carried out in a comprehensive manner. The patients are provided with qualitative care here. Doctors' monitoring and conservative treatment allow avoiding complications, which usually happen after treatment of oncological diseases. Psychotherapy, physiotherapy and physical therapy are actively used in specialized centers.

Specialists in different medical spheres take part in the rehabilitation process. These are massage therapists, speech therapists, specialists in physiotherapy exercises, physiotherapists. Social and occupational therapy is carried out, as well. If necessary, in a hospital people are taught how to eat properly, take care of a colostomy, etc.

In Europe, rehabilitation is carried out with the maximum level of comfort for the patient. A person feels the results quite quickly and it improves his motivation and promotes further recovery.

Best clinics for oncological rehabilitation in Germany:

Max Grundig Clinic Buehl

0.00Per day

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Author:

The article was edited by medical expert, board certified Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

National Library of Medicine

American Cancer Society

Cancer Support Community