Stomach (Gastric) Cancer
Dr. Konstantinidis MD, PhD, FACS - General Surgeon & Director of Bariatric, Laparoscopic & Robotic Surgery of Athens Medical Center.
Although its incidence has declined in recent decades, stomach cancer still threatens a significant number of patients with its treatment being challenging, both because the cancer rarely gives symptoms in its early stages and because of the knowledge and experience required for its surgical removal.
Dr. Konstantinidis and his Surgical Team are pioneers internationally, performing surgery assisted by the state-of-the-art robotic system Da Vinci Xi at Athens Medical Center, with impressive oncological outcomes and low complication rates.
What is Stomach Cancer?
Stomach cancer, also known as gastric cancer, is a relatively common type of cancer, but the number of people being diagnosed is declining. It is rare in people under the age of 50 and it affects men more than women.
What is adenocarcinoma?
The most common type of stomach cancer is known as adenocarcinoma. Adenocarcinoma is responsible for about 90% of all cases of stomach cancer.
Adenocarcinoma is a type of cancer that originates in the glandular tissue and especially om the so-called epithelial tissue, which covers the surfaces and cavities of the organs of the body.
As all our organs are lined with epithelial tissue, adenocarcinomas can affect any organ where there is epithelial tissue, not just the stomach.
Gastric adenocarcinoma originates from cells that produce mucus and form the inner layer of the stomach, called the mucosa.
What other types of Stomach Cancer are there?
Adenocarcinoma is the most common type of stomach cancer but not the only one. There are other, rarer types of stomach cancer and their treatment and prognosis differ from adenocarcinomas.
Other types of stomach cancer may include:
Gastric lymphoma – These are cancers of the immune system, such as Non-Hodgkin’s lymphoma, which are found in the stomach.
Sarcomas and other gastrointestinal stroma tumors (GISTs), such as leiomyosarcoma, leiomyoblastoma, angiosarcoma, fibrosarcoma, etc.
Neuroendocrine tumors (NETs) – They are a rare and slow-growing type of cancer that originates from cells of the nervous and endocrine systems.
What are the symptoms of Stomach Cancer?
Often, stomach cancers give no symptoms in the early stages. When they do, these include:
- pain or burning sensation in the abdomen
- feeling of indigestion
- a feeling of fullness, even after a small meal
- nausea and / or vomiting
- loss of appetite and / or weight loss
- swelling of the abdomen
- unexplained fatigue or weakness
- blood in vomit
What are the risk factors for developing Stomach Cancer?
There are several factors that increase the risk of developing stomach cancer. The main ones are the following:
- age (people over 60)
- helicobacter pylori infection
- diet high in pickles, smoked and salted foods and low in fresh fruits and vegetables
- excessive alcohol consumption
- excessive weight or obesity
- malignant anemia (low red blood cells)
- chronic gastritis (inflammation of the stomach)
- family history of stomach cancer
- partial gastrectomy for ulcer (after about 20 years)
- hereditary colon cancer
How is Stomach Cancer diagnosed?
There are many advanced diagnostic methods that can help diagnose stomach cancer, such as:
- Fecal Occult Blood Test (FOBT)
- Upper gastrointestinal endoscopy to detect abnormal cells
- X-rays of the digestive system
- Test for helicobacter pylori, a bacterium that can cause ulcers and stomach cancer
- Stomach tissue sample biopsy
- Endoscopic Ultrasound (EUS)
- Computed Tomography (CT)
- Positron Emission Tomography (PET), in specific cases
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How is Stomach Cancer treated?
The treatment for stomach cancer is basically surgery and it involves a procedure called gastrectomy.
Depending on the type, size, and location of the tumor, gastrectomy may involve removing part of (partial) or the entire stomach (total) along with the adjacent lymph nodes to ensure that the area is clear of cancer cells.
Minimally invasive surgery is currently recommended by internationally recognized surgical teams as a means of improving postoperative outcomes in patients undergoing gastrectomy for stomach cancer, especially when the disease is at an early stage.
The gastrectomy can be performed with open surgery or with a minimally invasive method, i.e. with laparoscopy and its evolution, robotic surgery.
Robotic gastrectomy improves on the advantages of a minimally invasive technique, without the technical difficulties that accompany the traditional laparoscopic method and the heavy toll of open surgery.
In addition to gastrectomy, patients with stomach cancer may also receive other treatments, such as:
- Targeted therapies
- Biological therapy
What is Laparoscopic Gastrectomy?
Laparoscopic gastrectomy involves the removal of part of or the entire stomach and it is performed through small incisions that are opened into the abdomen, through which special laparoscopic tools are inserted.
One of them, the laparoscope, includes a small camera on its end, through which the surgeon gains view inside the organs.
Because a large incision is not made, as is the case in the conventional, open surgery, laparoscopic gastrectomy has the following comparative advantages for the patient:
- less postoperative pain
- shorter hospitalization
- faster recovery and return to daily life
- optimal cosmetic result
Unfortunately, conventional laparoscopic techniques are not widely accepted due to the technical difficulties that arise, especially from inexperienced groups, and especially during lymph node dissection.
Although laparoscopic lymph node dissection has been shown to be feasible endoscopically when performed by experienced laparoscopists (Uyama et al. 1999, Tanimura et al. 2006 Pugliese et al. 2006), it remains a technically difficult procedure, associated with increased rates of intraoperative problems. such as bleeding, especially during the preparation around the large vessels (hepatic, abdominal and splenic arteries).
As there is an ever-increasing literature suggesting that extensive lymphadenectomy can be performed with low morbidity (Wu et al. 2006; Roukos et al. 1998; Hartgrink et al. 2004), internationally renowned oncology centers recommend robotic surgery as a means of facilitating gastrectomy and lymph node dissection for cancer.
What is Robotic Gastrectomy?
Robotic gastrectomy is an evolution of the laparoscopic surgery for stomach cancer, enhancing the advantages of the latter and neutralizing its weaknesses, thanks to the assistance of a state-of-the-art robotic system.
Dr. Konstantinidis has been performing robotic gastrectomy since the beginning of the Robotic Surgery program in 2006 and now with the latest Da Vinci Xi robotic system.
To date, Dr. Konstantinidis’ team’s experience confirms that the robotic system significantly facilitates the recognition of the anatomy, the mobilization and preparation of the stomach, the detection and dissecting of the lymph nodes and the avoidance of events and dangerous complications during the operation.
What are the advantages of robotic gastrectomy?
Robotic gastrectomy is a minimally invasive method and is accompanied by all the relevant advantages, such as:
- less postoperative pain
- minimal blood loss
- shorter hospital stay
- rapid recovery and return to daily activities
- optimal cosmetic result
Its biggest advantage, however, is that it minimizes the risk of complications and the impact on the patient’s body.
Due to the high image resolution provided by the robotic system, as well as the incomparable precision and ease of movement of the robotic arms, the surgeon can navigate comfortably even in the most inaccessible and difficult anatomical areas, such as the gates of the spleen and liver, and major vascular structures, such as the aorta and the celiac axis.
These points can be approached safely without bleeding events and with the assistance of the robot it is possible to dissect all the lymph nodes in the area, without unnecessary injuries to healthy tissues.
Thus, the risk of causing dangerous injuries to nearby organs, such as the liver, spleen and esophagus is minimized.
At the same time, thanks to the unparalleled precision of the robotic arms, it is possible to carry out demanding anastomoses, such as esophagojejunal anastomosis (when the stomach is removed, the upper side must be joined to the esophagus and the jejunum in order for food to pass smoothly).
Indicatively, when the tumor is high then part of the esophagus may need to be removed during the gastrectomy. This is a rather difficult anastomosis, which with the robot is performed through the already opened incisions, without the need for a thoracotomy as in the case of open surgery.
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Why choose Dr. Konstantinidis?
Dr. Konstantinidis and his Surgical Team have extensive experience in the treatment of stomach cancer by performing robotic gastrectomy since 2006, at Athens Medical Center.
Dr. Konstantinidis collaborates with doctors of all related specialties, such as Anesthesiologists, Pathologists, Gastroenterologists, who are all pioneering scientists and are distinguished for their medical work.