Dr.(Major) R.S RENGAN M.S., D.N.B., Dip Laproscopic Surgery (University of Strasbourg)
Senior Consultant, General & Laparoscopic surgery For Appointment: 94440 42294
Apollo First Med Hospital,Chennai.
Specialized centre for Gastrointestinal Surgery, Breast, Thyroid Endocrine, Vascular, Cancer & Cosmetic surgery
The abdomen is that part of our body that lies below our chest up to the waist. It contains all the organs needed for digestion including the stomach, small and large intestines, pancreas, liver, and gallbladder and also includes the kidneys and spleen. In the abdomen the liver is present in the right side, the spleen and pancreas to the left. The kidneys are present both in the left and right sides
- When food enters the stomach from the esophagus, the outer muscle layer contracts and relaxes to mix the food.
- Glands in the mucous layer (innermost layer) secrete acid to break down and start the process of digestion of food.
- Other glands in the mucosa secrete enzymes that work with the stomach acid to break down the food.
PARTS OF THE STOMACH
- The cardia is the small area in the upper portion of the stomach near the esophagus.
- This region has a ring of muscular tissue called the cardiac sphincter. It is a valve like structure that prevents the stomach contents from going back up into the esophagus.
- The area where the esophagus and stomach join is called the gastro esophageal (GE) junction.
- The fundus is the area below the cardia that serves as a temporary storage area for food.
- The body is the main part of the stomach where the food becomes mixed and broken down.
- The antrum is the lower part of the stomach which holds the broken down food, until it is ready to be released into the intestine
- The pylorus is the narrow, bottom part of the stomach near the small intestine.
- Present in this region is the pyloric sphincter, which is a ring of muscle that acts as a valve to control the emptying of stomach contents into the intestine.
WHY THE STOMACH IS DIVIDED INTO THESE PARTS?
It is because many diseases occur in specific regions of the stomach. For example ulcers of the stomach are rare in the fundus and cardia. Knowledge about them is useful in detecting the disease easily and helps in early treatment.
PEPTIC ULCER DISEASE
We all know by now that hydrochloric acid is responsible for the food to break down in the stomach. It also helps in defense by killing the bacteria and other harmful substances that enters the stomach. In some individuals, due to impairments in blood supply to the stomach, or to overproduction of acid, this defense system does not work as well as it should. These people can get peptic ulcers.
So what is meant by a peptic ulcer?
An ulcer means a break in the lining of a mucous membrane, in this case, the stomach. A peptic ulcer of the stomach is called a gastric ulcer and of the duodenum, a duodenal ulcer.
What can cause these ulcers?
- Infection with a type of bacteria called Helicobacter pylori (H. pylori)
- Use of some drugs like aspirin.
- Cigarette smoking also is an important cause of ulcers as well as failure of ulcer treatment.
- Cancers of the stomach that produce excess acid.
What are the symptoms of these ulcers?
- Burning pain in the middle or upper stomach a few hours after meals or at night. These symptoms often are relieved by taking food or antacids or even vomiting that neutralizes stomach acid.
- Nausea or vomiting. Vomiting is often induced by the patient.
In serious cases there can be,
- Dark or black stool (due to bleeding)
- Vomiting blood (that can be coffee-ground in color)
- Patient may not eat because the food brings pain. So he starts losing weight.
How serious can a peptic ulcer get?
- Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood vessels near the stomach.
- Perforation (a hole in the wall of the stomach). Erosion of the stomach wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity. The first sign is often sudden intense abdominal pain.
- Perforation and penetration are when the ulcer continues into adjacent organs such as the liver and pancreas
- Gastric outlet obstruction is the narrowing of pyloric canal by scarring and swelling of gastric antrum and duodenum due to peptic ulcers. Patient often presents with severe vomiting
What are the tests to be done in case of an ulcer?
- Your doctor may be able to confirm you have an ulcer just by listening to your symptoms. But to confirm the diagnosis few tests May be necessary.
- First, your doctor may ask you to take an acid-blocking medication, such as those used to treat heartburn, for a short period of time to see if symptoms improve.
- In case your symptoms don’t improve, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small tube (endoscope) through the throat and into the stomach to look for the problem
- Doctors will frequently treat for ulcers without confirming the diagnosis using endoscopy. However if the cause is not likely to be from drugs, then it is very likely to be from H. pylori. Many doctors will now test for and treat H. pylori, in addition to giving medications to reduce the symptoms.
TREATMENT FOR PEPTIC ULCERS
The goal of ulcer treatment is to relieve pain, heal the ulcer, and prevent complications Drugs given include,
- Antacids neutralize existing acid in the stomach. It is a safe and effective treatment.
- There are certain proteins which stimulate the production of acid in the stomach. A group of drugs which target this protein are called H2 blockers. They are effective in ulcer healing but have a limited role in eradicating H. pylori without antibiotics. Therefore, ulcers frequently return when H2 blockers are stopped.
- Another group of drugs are called the Proton Pump Inhibitors include commonly known drugs like Omeprazole, Pantoprazole etc.
- Treatment of H.Pylori with antibiotics
With modern treatment, patients with peptic ulcer can lead normal lives without lifestyle changes or dietary restrictions. Cigarette smokers have been found to have more complications from ulcers. Eradication of the bacteria H. pylori not only heals ulcers but also prevents the recurrence of ulcer disease. In many patients , reflux is also present. Reflux of acid from stomach to the oesophagus can cause erosion of oesophagus. This may lead to cancer of oesophagus after few years. Reflux is often treated medically. Reflux disease is often associated with a type of hernia called Hiatus hernia. Hiatus hernia occurs due to a hole in the diaphragm through which the stomach can protrude. In some cases, however surgery is indicated. The laparoscopic surgeon will perform a surgery known as FUNDOPLICATION using laparoscopy. This surgery will prevent the reflux disease from affecting the oesophagus. It is a complex surgery and it is recommended that you choose an experienced surgeon.
- In our body, the basic unit that makes up every organ is called the ‘cell’. These cells are formed by division of older cells and then these older cells die thus making the new cells take their place. This is a normal behavior.
- But sometimes the old cells do not die owing to numerous known and unknown causes. These old cells begin to pile in a certain part of the body forming a tissue. This tissue is almost always abnormal and defined as a ‘cancer’.
WHAT IS MEANT BY BENIGN AND MALIGNANT GROWTHS?
Benign tumors are tumors that only grow locally LIMITED TO THE TISSUE FROM WHICH THEY ARISE. They do not spread. Malignant tumors are tumors that are capable of spreading by invading adjacent organs and also to distant sites. Therefore by definition, the term “cancer” applies only to malignant tumors. Cancer in the stomach is an abnormal growth of cells present in the lining of the stomach, usually the cells in the inner layer. Over time, the cancer may invade deep into the stomach wall. A stomach cancer can grow through the stomach’s outer wall into nearby organs, such as the pancreas, esophagus, intestines or the liver. Stomach cancer cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, through which they can travel to all the tissues of the body. This process is called metastasis. The cancer cells may invade or attach to other tissues and grow to form new tumors called metastases that may damage those tissues.
WHAT ARE LYMPH NODES?
A lymph node is an oval-shaped organ that is distributed throughout the body and linked by lymphatic vessels. Lymph nodes are major sites of the cells of the immune system. Lymph nodes act as filters or traps for foreign particles and are important in the proper functioning of the immune system. They can become enlarged in various infections and diseases which may range from minor conditions, such as a throat infection, to life-threatening such as cancers. In cancers, the condition of lymph nodes is so significant that it is used for cancer staging, which decides the treatment to be employed, and for determining the further course of the disease.
WHAT CAN CAUSE STOMACH CANCER?
Some people have increased chances of developing stomach cancer than others. This is determined by the presence or absence or certain risk factors.
- Helicobacter pylori infection:
H. pylori is a bacterium that commonly infects the inner lining (the mucosa) of the stomach. Infection with H. pylori can cause stomach inflammation and peptic ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer.
- People who smoke
- People who have certain inflammatory conditions for a long period
- Family history of stomach cancer
- A diet high in salty and smoked foods and low in fruits and vegetables.
- Lack of daily exercise
- Persons who are obese
SYMPTOMS OF STOMACH CANCER
- Constant pain in the stomach area
- Nausea and vomiting
- Difficulty in swallowing solid food items and as the cancer grows worse even swallowing liquids can’t be tolerated.
- Weight loss and loss of appetite
- Feeling full or bloated after a small meal
- Vomiting blood or having blood in the stool
DIAGNOSING STOMACH CANCER
If a person’s symptoms are suggestive of stomach cancer, the doctor will check to see whether they are due to cancer or to some other cause.
- Physical examination
The doctor feels the abdomen for a hard mass, presence of fluid or other changes.
A thin tube is inserted by way of the mouth through the esophagus into the stomach. It has a special tool to take a sample of a suspicious area. This tissue is inspected in a lab for cancer cells; this procedure is known as ‘Biopsy’ Next the cancer is staged. That means determining the tumor size, the extent of its growth, whether it has invaded nearby tissues or spread to different organs. This staging is important for deciding the plan of treatment.
WHAT IS THE TREATMENT FOR STOMACH CANCER?
- The choice of treatment depends mainly on the size and location of the tumor, the stage of disease, and general health of the patient
- Present treatment options for stomach cancer include surgery, chemotherapy, or radiation therapy. Sometimes more than one type of treatment may be necessary. For example, chemotherapy may be given before or after surgery.
The type of surgery for stomach cancer depends mainly on where the cancer is located. The surgeon may remove the whole stomach or only the part that has the cancer.
- Partial (subtotal) gastrectomy for tumors at the lower part of the stomach:
The surgeon removes the lower part of the stomach with the cancer. The remaining part of the stomach is attached to the intestine. Nearby lymph nodes and other tissues may also be removed.
- Total gastrectomy for tumors at the upper part of the stomach:
surgeon removes the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, and other tissues near the tumor. Rarely, the spleen also may be removed. The surgeon then connects the esophagus directly to the small intestine.
Removal of Lymph nodes
- The first priority of surgery for gastric cancer must be to remove the entire primary tumor such that there is no macroscopic or microscopic tumor remaining.
- In a type of surgery called D2 gastrectomy, the stomach with the tumor is removed along with an average of 27 lymph nodes.
- These lymph nodes are present mostly along the major blood vessels.
- Modern treatment concepts always advocate the need of D2 gastrectomy along with chemotherapy and radiotherapy for adequate clearance of the tumor.
- Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy is usually given with chemotherapy to treat stomach cancer
- Chemotherapy uses drugs to kill cancer cells. It may be given before or after surgery. After surgery, radiation therapy may be given along with chemotherapy.
- Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly.
- The drugs that treat stomach cancer are usually given through a vein. Usually a a combination of drugs is given.
NUTRITION AFTER TREATMENT OF CANCER STOMACH
The patient feels weak and many times finds it difficult to consume food in the normal way. The food may pass into the intestine too rapidly causing discomfort. Sometimes the patient may develop symptoms of nausea, diarrhea,vomiting, and bloating sensation due to the drugs given for chemotherapy. To prevent these symptoms, it may help to make the following changes:
- Plan to have smaller meals at frequent intervals(some doctors suggest 6 meals per day)
- Cut down on very sweet foods and drinks
- Drink liquids before or after meals
Regular checkups ARE A MUST after treatment for stomach cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Also, checkups help detect health problems that can result from cancer treatment. If you feel the need to contact a surgeon, do not hesitate to call Home of Healing Surgical Centre.