Which gastric cancer treatment should be chosen
The most important treatment options are explained in moredetail below.
Tumors that have been detected very early may be removed with the endoscope. This is a thin flexible hose whose moving head is equipped with light source and camera. As with gastroscopy, the doctor guides the endoscope through the mouth, down the esophagus and into the stomach. With the help of instruments that are inserted through the endoscope, the tumor can be removed. The procedure is usually performed under mild anesthesia.
However, since stomach cancer often causes symptoms only in advanced stages, it is very rarely diagnosed so early that endoscopic therapy is used.
The aim of the surgery is to completely remove the tumor and the adjacent lymph nodes and to heal the disease. By removing the surrounding lymph nodes, it can be ensured that the cancer cells can not spread through the lymph channels in the body. The procedure takes place under general anesthesia. Depending on the location and spread of the tumor, the surgeon will either remove all or part of the stomach. In tumors of the stomach entrance and the lower part of the esophagus must be removed.
In order for patients to be able to eat as normally as possible after the operation, the digestive system must be restored. If only part of the stomach has been removed, the surgeon connects the residual stomach to the small intestine. When the whole stomach has to be removed, the small intestine is connected directly to the esophagus. The surgeon can make a type of gastric replacement from small intestinal loops, which takes on the function of a food storage. The secretions important for the digestion, however, can not form this gastric substitute. Patients must therefore change their eating habits after a stomach operation.
The tissue removed is then examined in the tissue tissue, and it is checked whether the tumor could be completely removed. This is the case when the cut edges are free of tumor cells. From the results of these investigations, the further therapy results.
If a tumor can not be surgically or only partially removed, it must be additionally or alternatively treated with drug therapies or radiotherapy.
Chemotherapy is used to administer drugs ( cytostatic drugs ) that inhibit cell division and thus the growth of cancer cells throughout the body. In order to achieve the best possible effect against the tumor cells while keeping side effects low, a combination of several cytostatics is usually used in the treatment of gastric cancer.
Patients often receive chemotherapy before undergoing gastric surgery. For some of the patients, this is continued after the operation.
Before the operation, the tumor should be reduced so that it can be completely removed. After surgery, chemotherapy can help kill any remaining cancer cells in the body and improve patients’ long-term prognosis. If gastric cancer is more advanced, chemotherapy, in conjunction with targeted therapy , can slow or temporarily halt tumor growth and relieve tumor-related symptoms.
Chemoradiation is a combination of radiotherapy and chemotherapy . If chemotherapy was not available before surgery and if the tumor or adjacent lymph nodes could not be completely removed, the physician may recommend chemoradiotherapy. It can help to improve the long-term prognosis of the disease.
Targeted therapies are another type of cancer treatment. These drugs act at the cellular level to specifically target certain biological properties or mechanisms of the tumor, such as promoting tumor cell growth or blood vessel formation to supply the tumor.
On the basis of specific features of the tumor, eg the presence of gene mutations or the expression of specific genes, the likelihood of the efficacy of a targeted drug can be estimated before the start of therapy. Such prediction parameters are called biomarkers. By intervening in the various signaling pathways of the tumor metabolism or inhibiting the nutrient supply of the tumor, tumor growth is counteracted. 5 Targeted therapies are used in some patients, especially in advanced gastric carcinoma with distant metastases.
Active principles of targeted therapies
Targeted therapies can have their effect essentially via two different points of attack:
Inhibition of Signaling
Tumor cells need external signals to grow and multiply. Various targeted anticancer drugs inhibit these growth signals and thus tumor growth. Inhibition of neovascularization
Like any healthy cell, tumor cells also need oxygen and nutrients to grow and multiply. At a certain size, the tumor forms new blood vessels ( “angiogenesis” ). The so-called “angiogenesis inhibitors” inhibit so-called neovascularization and thus prevent the tumor from growing.
Immuno-oncological therapies are not directed against the tumor, but use the natural abilities of the body’s immune system to fight cancer. Tumor cells can evade detection by the immune system or suppress the immune response by releasing chemicals. Pathways that enable cancer cells to bypass the body’s immune system are blocked by immuno-oncological therapies. Thus, the immune system is sustainably mobilized and is thus able to recognize and destroy cancer cells. Its own anti-cancer cell immune response is reactivated.
Currently, immuno-oncological substances for the treatment of gastric cancer are still being researched in clinical trials . However, in the near future, they could represent another treatment option for some of the affected patients.