Palliative surgery for stomach cancer

• Survival rates for stomach cancer

Gastric cancer is a malignant tumor that forms from epithelial cells of the gastric mucosa. Over time, the disease can spread to other internal organs - the esophagus, lungs and liver.

Today, gastric cancer is one of the most common cancers, and the survival prognosis is not always favorable, especially if gastric cancer is detected in late stages. As with many other types of malignant tumors, the outcome of treatment for the disease depends on its prevalence in the body at the time of diagnosis.

If we talk about what age people are most susceptible to such a disease as stomach cancer, then doctors have long noted the prevalence of this disease among older people (over 50-60 years old), but it can also occur in younger people, including occasionally in children.

How long people live with stomach cancer depends not only on doctors, but also on the patient himself, who must pay enough attention to his health and, at the slightest manifestation of symptoms, consult a doctor in a timely manner.

Influence of gastric cancer stage on prognosis and choice of treatment

The successes of chemotherapy have not changed the main thing - it is impossible to cure cancer without surgery. The most favorable prognosis will be only for a very small malignant lesion - no higher than stage 1A, when cancer cells have not penetrated into the muscles of the stomach wall and have not reached the lymph nodes. With this type of cancer, nine out of ten patients can expect a long life without additional drug treatment.

If the cancer has spread beyond the stomach and invaded the surrounding tissue, resection of neighboring organs is performed. Conservative (drug) antitumor therapy improves the overall outcome, allowing eight out of ten patients with stage 2–3 and initially operable cancer to live for more than 3 years, and the majority will not have signs of the disease during these years.

In a very common process, surgery plus chemotherapy improves the prognosis, but only half of patients can hope to live long enough. The prognosis for stage 4 cancer with metastases leaves much to be desired.

Treatment of operable stomach cancer

The best option for chemotherapy in operable patients is the perioperative use of drugs. Treatment begins before surgery. Cytostatics reduce tumor size. After this, the surgeon performs a gastrectomy (removal of the stomach) or gastrectomy, and chemotherapy is resumed.

Advantages of this approach:

• increasing the likelihood of R0 resection (complete removal of the tumor);
• increase in five-year survival rate of patients by 14%.

Adjuvant (postoperative) chemotherapy begins no earlier than one month after surgery. If the patient takes a long time to recover or complications develop, drug treatment may be started later. Chemotherapy is carried out for 6 months.

Our expert in this field:

Ivanov Anton Alexandrovich

Medical director, oncologist-surgeon, candidate of medical
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Why is chemotherapy needed after surgery?

This type of antitumor treatment is called adjuvant; it is aimed at cancer cells circulating in the blood and lymph that can become a source of metastases or relapse.

Clinical studies have shown that taking the chemotherapy drug capecitabine for stages 2–3 gastric cancer within a year after surgery increased by 10% the number of patients who lived for more than 3 years. Six months of combination chemotherapy led to an increase in the group of those who lived more than 3 years without relapse and metastases by 15%.

How is diagnostics carried out?

Due to the fact that the patient is bothered by unpleasant symptoms, stage 4 cancer is very well detected.

Additional diagnostic methods are:

• carrying out physical diagnostics. This stage is carried out by palpation of the problem area. With it, a specialist identifies seals in the area of ​​the anterior abdominal wall;
• performing X-ray diagnostics;
• performing endoscopy. It involves collecting biomaterial from several areas of the stomach;
• implementation of ultrasound diagnostics. It is usually carried out through the abdominal cavity. The patient can also have a special probe installed;
• performing laparoscopy.

Typically, when stage 4 stomach cancer develops in a patient, the doctor diagnoses the following unpleasant signs:

• close location of cancer cells near neighboring organs;
• spread of the tumor to neighboring lymph nodes;
• spread of cancer to nearby organs.

In what cases is chemotherapy useful before and after surgery?

The use of chemotherapy in two blocks - before and after surgery or perioperatively is standard in European countries; Russian oncologists predominantly use postoperative drug treatment, which is due to the organizational characteristics of the state oncology service. For technically inoperable stomach cancer without metastases, 3 courses are carried out according to regimens of 2 or 3 drugs, then, if successful, surgery is performed and chemotherapy treatment continues. The total number of courses is 6.

In studies, this type of antitumor treatment led to an almost twofold increase in the number of patients surviving five years, including without signs of disease relapse.

What are cycles?

Chemotherapy drugs attack not only tumor cells, but also healthy cells in which division processes are actively occurring. After the body has received the next dose of medicine, it needs to “catch its breath” and recover. Therefore, chemotherapy is always carried out in cycles: after the next administration of drugs there is a break. For stomach cancer, chemotherapy drugs are usually administered intravenously, sometimes taken in tablet form. Cycles can last 14, 21 or 28 days.

Chemotherapy drugs

More than a dozen chemotherapy drugs are effective for malignant tumors of the stomach and intestines, almost all of them are used in different combinations. Combinations of three drugs are preferable in terms of results, but their tolerability is somewhat worse, so such regimens are prescribed to patients without chronic diseases with good general health.

In elderly patients with concomitant diseases and poor initial health, you can initially use one drug and, when the condition improves, switch to a two- or three-component regimen.

Euroonco doctors use chemotherapy drugs recommended by the American National Comprehensive Cancer Network (abbreviated as NCCN, USA).

The most commonly used combination of fluoropyrimidine derivatives (fluorouracil, capecitabine) with platinum drugs (cisplatin, oxaliplatin) and the antitumor antibiotic epirubicin or docetaxel. Two-component regimens include fluoropyrimidines with irinotecan or platinum drugs.

Equal effectiveness of all regimens was noted; they differ only in complications and are completely interchangeable, that is, if one regimen is intolerable, you can continue treatment with another.

Long-term (over 24 or 48 hours) administration of fluorouracil through a special infusion system gives better results than rapid intravenous administration (stream) together with the “amplifier” leucovorin. If a daily infusion of fluorouracil is not possible, then it is better to take capecitabine tablets for 2 weeks.

The main condition for the success of chemotherapy is compliance with dosages and intervals between courses.

When is palliative surgery necessary?

The diagnosis of stage 4 gastric cancer is established when the tumor has invasively affected adjacent organs, nearby lymph nodes, or in the presence of metastases to distant organs and tissues. Surgical treatment in such situations is used primarily for the treatment of life-threatening conditions - bleeding from a tumor, perforation (perforation) of the stomach wall, gastric stenosis with the development of severe water and electrolyte disorders and inability to eat, jaundice when the tumor damages the liver and biliary tract.

Bleeding from a tumor during its disintegration or as a result of exposure to gastric juice is manifested by increasing weakness, dizziness, up to loss of consciousness due to a decrease in blood pressure, vomiting of pure blood (with or without clots), or the so-called “coffee grounds” due to for the effects of gastric juice on blood components. With long-term blood loss, weakness increases gradually over several days or weeks, at the same time the visible mucous membranes of the mouth and eyes turn pale, and appetite decreases or completely disappears. With relatively prolonged (several days) bleeding, there may be a urge to defecate with the passage of black semi-liquid or liquid tarry (so-called “melena”) stool.

Bleeding from a tumor can develop suddenly or increase gradually, which is determined by the extent of the tumor process and the involvement of large arterial vessels running along the lesser and greater curvature of the stomach. In many cases, patients with stomach cancer are at home at this time after completing the next course of radiation or chemotherapy. While waiting for an ambulance, it is necessary to put the patient to bed and apply a heating pad with ice to the stomach.

In a surgical hospital, treatment begins with an attempt to stop bleeding using hemostatic agents and installing a Blackmore tube to stop gastric bleeding. At the same time, an infusion of blood plasma preparations begins to prevent disseminated intravascular coagulation syndrome, and in case of massive blood loss, a transfusion of red blood cells is also performed. Minimally invasive interventions are performed with the aim of finding the source of bleeding and local elimination of bleeding, for which endoscopic intervention is performed, which allows clipping and suturing of the bleeding vessel, and electrical or plasma coagulation. All these methods of stopping bleeding in stomach cancer and other complications of cancer are used at Euroonko.

If measures taken to eliminate gastric bleeding are ineffective, emergency surgery is performed.

Perforation (perforation) of the stomach wall is one of the most dangerous conditions associated with stage 4 gastric cancer, requiring emergency surgical treatment. Perforation of the stomach is manifested by very strong, so-called “dagger pain” in the upper third of the abdomen with nausea, vomiting, dry mouth, which may indicate the appearance of a through hole in the wall of the stomach, through which the contents of the stomach enter the abdominal cavity and cause severe inflammation - peritonitis.

Serious complications of gastric cancer at stage 4 of the disease, which occur when large vessels are compressed by metastatic foci, are compression of the inferior vena cava, portal vein of the liver, as well as “obstructive jaundice” caused by compression of the bile ducts.

The main symptom of “obstructive jaundice” is a yellow discoloration of the skin, sclera of the eyes and mucous membranes due to an increase in the level of bilirubin in the blood (hyperbilirubinemia). A high level of bilirubin is life-threatening, as it leads to the development of so-called hepatic encephalopathy and inhibition of all regulatory centers of the brain.

Jaundice is a direct contraindication for planned chemotherapy and radiation therapy. The only radical method of reducing high bilirubin levels is to restore the outflow of bile from the liver through x-ray surgery. Drainage allows you to establish temporary outflow to the surface of the skin (external drainage) or both outward and in the natural direction into the intestines (external-internal drainage). In some cases, when tumor compression isolates several different segments of the biliary tree, for example, both the left and right lobes of the liver, multiple drains may be required.

After the bilirubin level has decreased to normal values ​​and cholangitis has decreased, the drainage is replaced with a stent or stents - special endoprostheses that keep the bile duct open. Simultaneous drainage and stenting are performed only for strict medical reasons; most often these operations are separated by time. In general, drainage and stenting of the bile ducts significantly improves the quality of life of patients.

In 10-15% of patients with stomach cancer, stenosis (narrowing of the lumen) of the cardial or pyloric part of the stomach requires surgical intervention. Symptoms of this condition include difficulty swallowing food when the upper (cardiac) parts are affected, heaviness, a feeling of fullness and vomiting of long-eaten food when the transition from the stomach to the duodenum is involved (pyloric stenosis).

Stenosis in gastric cancer is fraught with the development of life-threatening fluid and electrolyte disorders and worsening cachexia (exhaustion). To restore the passage of food through the gastrointestinal tract, correct and prevent water and electrolyte disturbances in inoperable gastric cancer with pyloric stenosis, a gastroenterostomy operation is performed, i.e. the imposition of an anastomosis between the stomach and jejunum.

In order to correct stenosis in inoperable cancer of the proximal (cardiac) stomach with a transition to the esophagus, if the passage of food is disrupted, gastric stenting can be used - installation of special stents that restore the normal passage of food through the stomach into the intestines. An alternative method of surgical treatment is the application of a gastrostomy - gastrostomy - the formation of an opening in the stomach and anterior abdominal wall to provide nutrition to the patient through a tube. As a result, the symptoms of intoxication are reduced and the patient is provided with nutrition.

Chemotherapy for gastric cancer with metastases

At this stage, cancer is not subject to surgical treatment; an exception is possible only if the stomach is technically removed and metastases to the ovaries without cancerous lesions of any other organs or tissues. For cancer complicated by bleeding, minimal palliative surgery is performed. A patient with a metastatic stage receives chemotherapy according to any standard regimen that he can tolerate.

The use of monotherapy—one drug—gives the worst results. Two-drug regimens with less toxicity are preferred, but in clinical studies only three-drug combinations have demonstrated an increase in survival.

If the patient feels well and does not have concomitant chronic diseases, then it is better to fight for life with three chemotherapy drugs at once. You can start chemotherapy with one drug, and when your condition improves, switch to more effective combinations.

If the effect is good, no more than 6–8 courses are carried out, then the patient is observed. If cancer growth resumes after 3 months, a second line of therapy can be started with the same combination that was used initially. If the process progresses in the next 3 months after completing chemotherapy courses, a complete change in the regimen is recommended; it does not include previously used drugs - most likely, the tumor has become resistant to them.

Main symptoms of stage 4 cancer

Doctors note that stage 4 stomach cancer has the following typical symptoms:

• a sharp decrease in body weight;
• the appearance of general malaise and weakness in the limbs;
• complete lack of appetite and increased body temperature to high parameters.

Additional symptoms indicating the development of stomach cancer are:

• the appearance of heaviness and bloating, especially these symptoms appear in the patient after eating;
• the presence of pain in the stomach and when swallowing;
• the appearance of severe pain in the lower abdomen. Typically, such pain can radiate to the lumbar region, as well as to the sacrum and perineum. This is due to the appearance of metastases in the nerve fibers of the pelvic floor and the development of the inflammatory process in nearby organs and tissues;
• the presence of various impurities in feces. Such impurities may contain blood, pus, or mucus;
• the appearance of fecal discharge during urination or the appearance of urine from the intestinal cavity. Typically, these signs indicate the appearance of a cancerous tumor in the bladder. As a result, a fistula appears in the area between the intestines and the bladder;
• the presence of a constant feeling of the presence of a foreign object in the intestinal area. This indicates that the neoplasm is large and is felt by the patient;
• the appearance of thick, liquid-like vomit. It usually appears when bleeding develops in the internal organs;
• presence of gastric obstruction. With it, the patient refuses to drink liquids and food. Most often localized in the upper gastrointestinal tract;
• a sharp increase in the size of the stomach. This indicates the appearance of metastases in neighboring organs.

Targeted drugs

In addition to classical chemotherapy, targeted drugs are used for malignant tumors of the stomach. They act specifically on specific target molecules that play an important role in the survival and growth of a malignant tumor.

Ramucirumab (Cyramza) blocks the vascular endothelial growth factor (VEGF) receptor on the surface of the cells lining the inside of blood vessels. Tumor cells produce VEGF in order to stimulate the growth of new blood vessels, because they need a lot of oxygen and nutrients.

Ramucirumab is administered as a solution intravenously through a drip over 1 hour, every two weeks on the first day of chemotherapy.

Trastuzumab blocks the membrane protein HER2, which is located on the surface of cells in the gastric mucosa. If there is a lot of HER2, it activates the proliferation of tumor cells. Trastuzumab is administered intravenously in parallel with chemotherapy.

In case of recurrence of stomach cancer

As with primary cancer, surgical removal is considered first. If surgical intervention is technically impossible, then drug therapy is used with or without radiation. The principles of chemotherapy do not change.

Removing part or all of the stomach causes irreparable damage to the body. In addition, a long course of chemotherapy leads to all sorts of complications, and this radically affects the patient’s quality of life. To minimize the toxicity of chemotherapy drugs, the doctor must select them correctly, prescribe optimal doses and frequency of administration.

Find out the exact cost of treatment

In Euroonko clinics, preliminary medication preparation is carried out to reduce complications, and the patient receives a special diet throughout the entire treatment period - nutritional support that promotes rapid recovery. Each of our patients receives an individual program of chemotherapy and rehabilitation support, and this helps to significantly improve treatment results.

We know how to help, even with advanced metastatic stomach cancer. If the patient cannot be cured, at least you can try to prolong his life as much as possible and relieve him of painful symptoms, slow down the growth of the tumor for a while, and reduce its size. Make an appointment with an oncologist.

Oncological hospice in Moscow

How long do people live with various types of cancer at the fourth and final stage?

1. How long do they live with stage 4 lung cancer? If lung cancer is diagnosed at stage four, the average number of patients surviving for five years or more is approximately ten percent.
If non-small cell cancer is detected, the survival threshold ranges from 2-13 percent, and for small cell cancer it is approximately 1%. The prognosis for the longest survival is greatly influenced by the presence of metastases, as well as the pathological process in the pericardium and pleura. The chances are much greater for those patients who have undergone an operation aimed at excision of the lung or part of it.

Specialists at the medical center prescribe radiation therapy to patients with stage 4 cancer affecting the lungs, which helps reduce the volume of the malignant tumor, as well as alleviate the symptoms of the disease. In some cases, in order to achieve better results, chemotherapy sessions are also prescribed in combination with radiation therapy.

In cases where pleural lesions are detected, doctors prescribe regular, that is, daily, procedures that help reduce the volume of fluid in the lungs (thoracentesis).

2. How long do they live with stage 4 liver cancer? The approximate percentage of patients who live more than five years with late-stage liver cancer reaches six. Cancer of this type at a late stage is characterized by foci of malignant neoplasms that are localized in both lobes of the organ. Nearby vessels are also affected.

Cancer in the fourth stage, which affects the liver, progresses very quickly; in three to four months it can develop from the first stage to the last. For cancer of this nature, specialists at this medical institution use the most modern methods of therapy, since the classical ones are ineffective. Doctors prescribe radiofrequency ablation of the tumor or chemoembolization, which significantly improves the condition.

3. How long do they live with stage 4 stomach cancer? A fairly good survival prognosis of five years or more for patients with late-stage cancer that has affected the stomach reaches an average of 15 to 20 percent. The best chances are for patients with cancer of the cardiac region of the stomach, especially if squamous cell cancer is diagnosed, and radiation therapy was prescribed for its treatment.

Gastric cancer at its most severe stage is characterized by damage to nearby organs, regional lymph nodes, and metastasis. To help patients with this disease, hospice doctors prescribe palliative chemotherapy, which stabilizes approximately 45 percent of patients. In some cases, specialists perform surgical treatment to relieve symptoms, as well as eliminate life-threatening conditions (for example, bleeding).

The clinic's doctors practice installing a special stent in the stomach and esophagus, which is necessary for lesions in certain parts of the stomach that extend, among other things, to the esophagus.

About ten to fifteen percent of patients with extremely advanced cancer are given a gastroenterostomy, which helps restore normal passage of food through the gastrointestinal tract. This surgical treatment is prescribed in cases where inoperable cancer with stenosis is diagnosed.

According to indications, specialists perform a gastrostomy on the patient, which allows feeding through a tube.

4. How long do they live with stage 4 pancreatic cancer ? When pancreatic cancer is diagnosed at the most advanced stage of development, the five-year survival threshold is less than two percent if there is no proper treatment, and about 10 percent if a set of necessary measures is applied. In order to improve the condition of patients, as well as alleviate symptoms, doctors carry out surgical treatment in conjunction with a course of chemotherapy.

5. How long do they live with stage 4 colon cancer? For late-stage colon cancer, the five-year survival rate is less than five percent. To help patients, doctors at medical institutions perform operations that are aimed at restoring patency in the intestines. The type of surgical intervention is selected by specialists depending on the degree of negative impact on the organs.

6. How long do they live with stage 4 breast cancer? The longest survival rate for breast cancer is approximately 10 to 15%. To improve the quality of life of patients, specialists prescribe surgical removal of the affected mammary gland, which helps reduce the level of general intoxication of the body and also prevents bleeding. To improve the quality of life of patients with this type, pathologists prescribe chemotherapy.

7. How long do they live with stage 4 prostate cancer? Approximately 30 percent of patients with stage 4 prostate cancer have a life expectancy of five years or more. In order to help patients, this clinic prescribes hormonal and radiation therapy, which can be used both in combination and separately. Surgical treatment of the tumor is effective, as it reduces symptoms and thereby improves the quality of life of patients.

8. How long do they live with stage 4 uterine cancer ? The five-year survival rate for late-stage uterine cancer is three to nine percent. To improve the standard of living of patients, doctors prescribe complex therapy, which consists of palliative surgery, hormonal, and chemotherapy.

Hospice specialists fight all pathological processes that affect the quality of life of patients with oncology. Thanks to this, it is possible to significantly improve their general condition and significantly extend their lifespan. The most severe reasons that worsen the lives of patients include:

• the occurrence of arterial thrombosis, in which acute ischemia develops, as well as gangrene of the lower extremities;
• the presence of severe pain, which is more intense in the presence of metastases;
• vertebral fractures of pathological origin, which lead to immobility;
• impaired hematopoietic function, which leads to anemia and other blood diseases;
• disorders of normal blood clotting, resulting in thromboembolism leading to strokes;
• dysfunction of the liver, which leads to jaundice, etc.

+7-925-191-50-55 hospitalization in a hospice for cancer patients in Moscow

Doctors practicing at the hospice of the European Clinic make every effort to ensure that every patient with cancer has the opportunity to lead as full a life as possible at the fourth stage of cancer. For this, doctors prescribe a comprehensive treatment that is aimed at eliminating various side effects of the disease, reducing pain, and slowing down the development of malignant pathology. Depending on the type of cancer, as well as the affected organs, during the treatment of each individual patient, all necessary procedures aimed at palliative treatment are prescribed.

Due to the fact that the hospice medical staff is fully dedicated to their work, each patient is in a friendly, comfortable and safe atmosphere, which is very important for people with stage 4 cancer.

+7 (495) 506 61 01 –

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Advantages of chemotherapy at Euroonco

• We undertake the treatment of stomach cancer at stages III–IV. We often receive patients who were considered hopeless in other clinics and sent home to “live out their lives.”
• Euroonco doctors work only with original chemotherapy drugs from Europe and the USA.
• We follow American NCCN treatment protocols.
• We provide chemotherapy courses in combination with other modern cancer treatment methods. Maintenance therapy helps to endure the administration of chemotherapy drugs as comfortably as possible and minimize side effects.

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How justified are interventions in stage 4 gastric cancer, since they do not lead to a cure?

The philosophy of providing medical care at Euroonco is that you should always try to help the patient. Human life is precious and should be extended for as long as possible while maintaining the highest possible quality of life. Interventions at a late stage of cancer, including stage 4 gastric cancer, should be undertaken because they can significantly improve the quality of life of patients, reduce intoxication and severity of pain, prolong life and the ability to communicate with family and friends for a significant period. For example, peritonectomy in combination with hyperthermic intra-abdominal chemotherapy in patients with peritoneal carcinomatosis in gastric cancer can increase life expectancy to 18 months. For single isolated metastases of gastric cancer to the liver, liver resection allows achieving 5-year survival in 18–34% of patients.

To treat stage 4 gastric cancer, the Department of Palliative and Symptomatic Therapy uses all possible treatment options for cancer patients: all types of chemotherapy, radiation therapy, which reduces pain, and palliative operations are also performed. In order to facilitate the administration of drugs, it is possible to implant venous and arterial infusion port systems for chemotherapy, regional intra-arterial infusion of chemotherapy drugs, and local therapy are carried out.

Chemotherapy course prices

• Consultation with a chemotherapist— RUB 6,900.
• Carrying out intravesical chemotherapy (without the cost of medications) - RUB 21,500.
• Intraperitoneal chemotherapy (without the cost of medications) - RUB 19,100.
• Immunotherapy (without the cost of medications) - RUB 15,000.
• Intrathecal chemotherapy - RUB 21,000.
• Carrying out hyperthermic intraperitoneal chemotherapy - 280,000 rubles.
• Chemotherapy using an infusion pump for 1 day (without the cost of medications) - RUB 17,900.
• Carrying out anti-PD-1 therapy - RUB 334,000.

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