Gastric cancer staging

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The following is the stage analysis and conventional treatment plan for gastric cancer published on the American cancer website.

TNM staging system for gastric cancer

One tool doctors use to describe cancer staging is the TNM system. Doctors use the results of diagnostic tests and scans to answer the following questions:

Tumor (T): How deep does the primary tumor spread to the stomach wall?

• Lymph nodes (N): Has the tumor spread to the lymph nodes? If so, where and how much?

• Metastasis (M): Has the cancer spread to other parts of the body?

Based on the above results, determine the stage of each person’s cancer. There are five stages: period 0 (zero) and periods I to IV. This stage provides common methods for describing cancer, so doctors can work together to plan the best treatment.

The following are more details of the TNM gastric cancer staging:

Tumor (T)

Using the TNM system, use “T” plus a letter or number (0 to 4) to describe how far the tumor has entered the stomach wall. Some stages are also divided into smaller groups, which can describe tumors in more detail. The specific tumor staging information is as follows:

TX: Primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a primary tumor in the stomach.

T: This stage describes a condition called cancer (cancer) in situ. Cancer is only found in cells on the surface of the stomach lining called the epithelium, and it has not spread to any other layers of the stomach.

T1: The tumor has grown to the lamina propria, muscularis mucosa or submucosa, which is the inner layer of the stomach wall.

T1a: The tumor has grown into the lamina propria or muscularis mucosa.

T1b: The tumor has grown to the submucosa.

T2: The tumor has grown to the muscularis laminae, the muscle layer of the stomach.

T3: The tumor has entered the connective tissue outside the stomach through all layers of the muscle, but it has not grown to the peritoneum of the abdomen or entered the serosa.

T4: The tumor has grown through all layers of muscle into the connective tissues outside the stomach, and has grown to the peritoneum or serous membrane or organs around the stomach.

T4a: The tumor grows to the serosa.

T4b: The tumor has grown into the organs around the stomach.

Lymph node (N)

The “N” in the TNM staging system is a lymph node, a tiny bean-shaped organ that helps fight infection. Abdominal lymph nodes are called local lymph nodes. Lymph nodes in other parts of the body are called distal lymph nodes. The overall prognosis for patients with gastric cancer is based on how many regional lymph nodes are affected by the cancer. If less than 2 lymph nodes have cancer invasion, the prognosis is better than if there are more than 3 to 6 or more than 7 lymph nodes containing cancer cells.

NX: Regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to regional lymph nodes.

N1: The cancer has expanded to 1 to 2 regional lymph nodes.

N2: The cancer has expanded to 3 to 6 regional lymph nodes.

N3: The cancer has expanded to more than 7 regional lymph nodes.

N3a: The cancer has spread to 7 to 15 regional lymph nodes.

N3b: The cancer has spread to more than 16 regional lymph nodes.

Transfer (M)

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body and is called distant metastasis.

MX: Remote transfer cannot be evaluated.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part or part of the body.

Cancer staging

Doctors determine the stage of cancer by combining T, N, and M classifications.

Stage 0: This is also called carcinoma in situ. Cancer is only found on the surface of the epithelium. Cancer has not progressed to any other level of the stomach. This stage is considered early cancer (Tis, N0, M0).

Stage IA: The cancer has grown to the inner layer of the stomach wall. It did not spread to any lymph nodes or other organs (T1, N0, M0).

Stage IB: In these two cases, gastric cancer is called stage IB:

• Cancer has progressed to the inner layer of the stomach wall. It has expanded to 1 to 2 lymph nodes, but there is no metastasis (T1, N1, M0).

• Cancer has developed into a muscle layer on the outer layer of the stomach wall. It did not spread to lymph nodes or other organs (T2, N0, M0).

Stage IIA: For any of the following, gastric cancer is called stage IIA:

• Cancer has grown to the inner layer of the stomach wall. It has spread to 3 to 6 lymph nodes with no distant metastases (T1, N2, M0).

• Cancer has developed into a muscle layer on the outer layer of the stomach wall. It has spread to 1 to 2 lymph nodes, but there is no distant metastasis (T2, N1, M0).

• Cancer has passed through all layers of muscles and entered the connective tissues outside the stomach. It did not grow into the peritoneum or serosa or spread to any lymph nodes or surrounding organs (T3, N0, M0).

Stage IIB: For any of the following, gastric cancer is called stage IIB:

• Cancer has progressed to the inner layer of the stomach wall. It has spread to 7 or more lymph nodes, but there is no distant metastasis. (T1, N3, M0).

• Cancer invades the muscle layer outside the stomach wall. It has spread to 3 to 6 lymph nodes, but there is no distant metastasis (T2, N2, M0).

• Cancer has grown through all layers of muscle into the connective tissues outside the stomach, but it has not grown into the peritoneum or serosa. It has spread to 1 to 2 lymph nodes, but there is no distant metastasis (T3, N1, M0).

• Cancer has entered the connective tissues outside the stomach through all layers of the muscle. It has grown into a peritoneum or serosa, but it has not spread to any lymph nodes or surrounding organs (T4a, N0, M0).

Stage IIIA: For any of the following, gastric cancer is called stage IIIA:

• Cancer has developed into the outer muscle layer of the stomach wall. It has spread to 7 or more lymph nodes, but there is no distant metastasis (T2, N3, M0).

• Cancer has grown through all layers of muscle into the connective tissues outside the stomach, but it has not grown into the peritoneum or serosa. It has spread to 3 to 6 lymph nodes, but not to other organs (T3, N2, M0).

• Cancer has entered the connective tissues outside the stomach through all layers of the muscle. It has grown into a peritoneum or serosa and has spread to 1 to 2 lymph nodes, but not to other organs (T4a, N1, M0).

Stage IIIB: gastric cancer is called stage IIIB in any of the following situations:

• Cancer has grown through all layers of muscle into the connective tissues outside the stomach, but it has not grown into the peritoneum or serosa. It has spread to more than 7 lymph nodes, but has not invaded the surrounding organs (T3, N3, M0).

• The cancer has entered the connective tissues outside the stomach through all layers of the muscle and has grown into the peritoneum or serosa. It has spread to 3 to 6 lymph nodes, but it has not spread far
(T4a, N2, M0).

• Cancer has grown through all layers of muscle into the connective tissues outside the stomach and has grown into nearby organs or structures. It may spread to 1 or 2 lymph nodes, but there is no distant metastasis (T4b, N0 or N1, M0).

Stage IV: Stage 4 gastric cancer describes any size of cancer that has spread beyond the body, beyond the area surrounding the stomach (any T, any N, M1).

Recurrent cancer: Recurrent cancer is cancer that recurs after treatment. This may be a local recurrence, which means that it has recurred where it started. Or it may be a distant transfer, which means it has been transferred to another part of the body.

Japanese gastric cancer staging system

Gastric cancer is more common in Japan and other parts of Asia and South America than in the United States. There are different methods of staging gastric cancer in Japan, depending on the location of the cancer’s lymph nodes around the stomach. This is different from the US system that uses the number of lymph nodes instead of location.

Stomach cancer surgery can be described by the Japanese system. Determined by the type of surgery to remove gastric lymph nodes. In the “Treatment Options” section, learn more about gastric cancer surgery.

• D0: no lymph node clearance

• D1: The lymph node closest to the stomach is removed

• D2: remove lymph nodes in a wider area

Treatment plan for gastric cancer

Treatment Overview

In cancer treatment, different types of doctors often work together to create an overall treatment plan for patients who combine different types of treatment, which is called a multidisciplinary team. For gastric cancer, the team may include the following doctors:

• Gastroenterologist, a doctor specializing in gastrointestinal tract, including gastrointestinal and gastrointestinal

• Surgeon or surgical oncologist, a doctor who specializes in treating cancer with surgery

• Medical oncologists, doctors specializing in the treatment of cancer with drugs

• Radiation oncologist, a doctor specializing in radiation therapy for cancer

The cancer care team also includes various other health professionals, including doctor assistants, oncology nurses, social workers, pharmacists, consultants, nutritionists, etc.

Gastric cancer can be treated by surgery, radiation therapy, chemotherapy, targeted therapy or immunotherapy. Usually a combination of these treatments is used. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and patient preference and overall health.

Surgery for gastric cancer patients

Surgery is the removal of tumors and some surrounding healthy tissue during surgery. The type of surgery used depends on the stage of the cancer (see Cancer Staging).

For very early stage (T1a) cancer, some doctors may recommend a non-surgical treatment called endoscopic mucosal resection. This is to remove the tumor with an endoscope.

In the early stages (stage 0 or I), when the cancer is still only in the stomach, surgery is used to remove part of the stomach cancer and nearby lymph nodes. This is called a minor or partial gastrectomy. In partial gastrectomy, the surgeon connects the rest of the stomach to the esophagus or small intestine.

If the cancer has spread to the outer wall, with or without spreading to the lymph nodes, you can use surgery plus chemotherapy or chemotherapy and radiation therapy (see below). The surgeon can perform a major gastrectomy or total gastrectomy, which is to remove all the stomach. During total gastrectomy, the surgeon connects the esophagus directly to the small intestine.

Gastrectomy is a major operation and may have serious side effects. After the operation, the patient can only eat a small amount of food at a time. A common side effect is a group of symptoms called dumping syndrome, including cramps, nausea, diarrhea and dizziness after eating. This happens when food enters the small intestine too quickly. Symptoms usually alleviate or disappear within a few months, but for some people, these symptoms may be permanent. Patients who have cleared their entire stomach may need regular injections of vitamin B12 because they may no longer be able to absorb this essential vitamin through the stomach.

During surgery, the lymph nodes are often cleared because the cancer may spread to the lymph nodes. This is called lymphadenectomy. It is still controversial how many lymph nodes should be deleted. In addition to the United States, in Europe, especially in Japan, doctors tend to have more lymph nodes removed.

When cancer is diagnosed as stage IV, surgery is generally not recommended as the main treatment (see Metastatic Gastric Cancer below).

Radiation Therapy for gastric cancer

Radiation therapy uses high-energy x-rays or other particles to destroy cancer cells. Radiation treatment plans (plans) are usually repeated for a certain amount of treatment over a period of time. Gastric cancer patients usually receive external radiation therapy, which is radiation given by a machine outside the body. Radiation therapy can be used before surgery to reduce the size of the tumor or destroy any remaining cancer cells after surgery.

Side effects of radiation therapy include fatigue, mild skin reactions, stomach upset, and difficulty defecating. After treatment, most of the side effects will disappear.

Chemotherapy for gastric cancer

Chemotherapy uses drugs to destroy cancer cells, usually by preventing the cancer cells from growing and dividing. Chemotherapy was provided by a medical oncologist.

Systemic chemotherapy drugs enter the bloodstream and reach cancer cells throughout the body. Common methods of administering chemotherapy include using swallowed (oral) pills or capsules or an intravenous (IV) tube placed in a vein.

A chemotherapy plan (plan) usually consists of a certain number of cycles given over a period of time. Patients can receive 1 drug or a combination of different drugs at the same time.

The purpose of chemotherapy can be to destroy the cancer remaining after surgery, to slow the growth of tumors, or to reduce cancer-related symptoms. It can also be combined with radiation therapy. Currently, there is no single standard chemotherapy regimen worldwide. However, most chemotherapy used for gastric cancer is based on at least two drugs: fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Newer drugs similar to 5-FU, such as capecitabine (Xeloda) and cisplatin-like drugs, such as oxaliplatin (Eloxatin), seem to be equally effective. Other commonly used drugs include docetaxel (Docefrez, Taxotere), epirubicin (Ellence), irinotecan (Camptosar) and paclitaxel.

The side effects of chemotherapy depend on the individual and dose used, but they may include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. Once treatment is complete, these side effects usually disappear.

Targeted drug therapy

Targeted therapy is a treatment for cancer-specific genes, proteins, or tissue environments that contribute to cancer growth and survival. This type of treatment prevents the growth and spread of cancer cells, while limiting damage to healthy cells.

Recent studies have shown that not all tumors have the same target. To find the most effective treatment, your doctor may perform genetic tests to determine the genes, proteins, and other factors in the t
umor. This helps doctors better match each patient with the most effective treatment possible. In addition, many studies are now underway to learn more about specific molecular targets and new therapies directed at them.

• HER2 targeted therapy

Patients with advanced HER2-positive gastric cancer may benefit from receiving trastuzumab (Herceptin) chemotherapy. Herceptin is a type of HER2 targeted therapy. For patients with HER2-positive metastatic or recurrent gastroesophageal cancer, ASCO, ASCP, and CAP are recommended to combine chemotherapy and HER2 targeted therapy. If the cancer is HER2 negative, HER2 targeted therapy is not your treatment option, your doctor will provide you with other options for treating cancer.

• Anti-angiogenesis therapy

For patients whose tumors have become resistant after receiving first-line chemotherapy, a drug called Ramucirumab (Cyramza) was approved as an additional treatment in 2014. Ramucirumab is a targeted therapy called anti-angiogenesis. It focuses on preventing angiogenesis, which is the process of making new blood vessels. Since tumors require nutrients for angiogenesis and transmission, the goal of anti-angiogenesis therapy is to “starve” the tumor.

Immunotherapy treatment in gastric cancer

Immunotherapy, also known as biological therapy, aims to enhance the body’s natural defenses against cancer. It uses materials made by the body or laboratory to improve, target or restore immune system function. This is an active area of ​​gastric cancer research.

Deal with cancer symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to eliminate cancer, an important part of cancer treatment is to relieve a person’s symptoms and side effects. This method is called palliative treatment or supportive treatment, and it includes supporting the patient’s physical, emotional, and social needs.

Palliative treatment is a treatment method focused on reducing symptoms, improving quality of life, and supporting patients and their families. Anyone, regardless of age, type and stage of cancer, needs palliative care. When palliative treatment is started as early as possible during cancer treatment, the effect is best. People often receive cancer treatment and treatment to relieve side effects at the same time. In fact, patients receiving these two therapies often have milder symptoms and a better quality of life, and report that they are more satisfied with the treatment.

Palliative care varies widely and usually includes medications, nutritional changes, relaxation techniques, emotional support and other therapies. You can also receive treatment options similar to eliminating cancer, such as chemotherapy, surgery, or radiation therapy.

Metastatic gastric cancer

If the cancer spreads from its primary site to another part of the body, doctors call it metastatic cancer (stage IV). If this happens, it is a good idea to talk to a doctor who has experience in treatment and seek consultation. Because doctors can have different views on the best standard treatment plan. In addition, clinical trials may be an option.

The goal of treatment at this stage is usually to prolong the life of the patient and deal with the symptoms of cancer because metastatic gastric cancer is not considered curable. Any treatment, including chemotherapy or radiation therapy, is considered palliative treatment. Surgery is rarely used, and the main treatment is usually chemotherapy. Studies have shown that palliative chemotherapy can improve the survival and quality of life of patients with gastric cancer.

Opportunity for remission and health recovery

The remission is when the body cannot detect cancer and has no symptoms. This may also be referred to as “no evidence of disease” or NED.

Relief may be temporary or permanent. This uncertainty has caused many people to worry that the cancer will return. Although many reliefs are permanent. Understanding your relapse risk and treatment options may help you prevent relapse more effectively.

If the cancer does recur after first-line treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence) or in another place (remote recurrence).

When this happens, an inspection cycle will begin again to understand as much as possible about the relapse. After the test is completed, you and your doctor will discuss your treatment plan. The treatment plan usually includes the above treatment methods, such as surgery, chemotherapy and radiation therapy, but they can be used in different combinations or given at different rates. Your doctor may also recommend participating in clinical trials that are studying the treatment of this recurrent cancer. No matter which treatment plan you choose, palliative care will be important to relieve symptoms and side effects.

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