What is stomach cancer?
The stomach is a major organ of the digestive system located in the upper and middle part of the abdomen (epigastric region). Within the digestive tract, it follows the oesophagus and precedes the duodenum (small intestine).
Stomach cancer is associated with several risk factors including infection with Helicobacter pylori bacteria, smoking, a diet with a high salt and low fruit and vegetable content, a family history of stomach cancer and a genetic predisposition that increases the risk of developing stomach cancer.
In 90% of cases, stomach cancers develop from cells in the inner superficial layer of the stomach (mucosa). These are known as adenocarcinomas. They can develop in any part of the organ - in the upper two-thirds of the stomach in the body or fundus (proximal tumours) or in the lower third of the stomach in the antrum (distal tumours).
Stomach cancers can also develop in the form of neuroendocrine tumours, gastrointestinal stromal tumours (GIST) or lymphomas, but these are rarer and are treated differently from adenocarcinoma.
There were an estimated 6,557 new cases of stomach cancer in France in 2018, of which nearly 66% were diagnosed in men*.
*2018 figures from the French National Cancer Institute.
Diagnosis of stomach cancer
Gustave Roussy is involved in the diagnosis and treatment of stomach cancer, but also manages patients whose diagnosis has been confirmed.
The symptoms are not that specific and can manifest as epigastric pain or even weight loss. As the symptoms are non-specific, a series of tests is required to confirm the diagnosis.
Gastroscopy (fibroscopy) is the initial procedure. It allows the specialist to see the lesion, to locate it precisely in the stomach and to perform biopsies.
CT scans of the chest and abdomen are also recommended. Depending on the presentation, more advanced examinations may be offered, such as exploratory laparoscopy, marker assays, molecular analyses, trans-gastric ultrasound and PET scans, etc.
All the disciplines involved in the treatment of gastric cancer are available at Gustave Roussy. Expert surgical, digestive oncology, interventional radiology and radiotherapy teams have access to state-of-the-art technical facilities (PET and MRI scans, hybrid operating room and robotic surgery, etc.) and can offer the most appropriate treatment for each patient.
Decisions on cancer treatment pathways are taken during multidisciplinary meetings. These meetings involve several doctors from different disciplines including gastrointestinal oncologists, surgeons, radiotherapists and interventional radiologists. A meeting report is compiled for each patient.
Stomach cancer treatments
Stomach cancer has a variable prognosis. Treatment must be adapted and personalised based on the results of the various examinations.
Chemotherapy generally accompanies surgery. The choice of treatment depends on individual patient presentation. It is adapted to the disease stage but also to the patient’s general condition. It also depends on the molecular status of the disease. Numerous studies conducted at Gustave Roussy have led to the fine-tuning of the medical management of stomach cancer.
Surgical resection involves the removal of part or all of the stomach depending on the location of the tumour. This can be achieved using robot-assisted techniques to improve post-operative effects. Nowadays, the advent of robotic surgery allows therapeutic indications to be extended through greater procedural dexterity and 3D visualisation. Patients can return to a normal way of life in most cases.
The Gustave Roussy team is pioneering in this respect and has rare expertise in the robot-assisted surgical management of gastric cancers. The Institute was the first European facility to work with the most efficient model and to develop this innovative treatment.
Targeted therapies are drug-based treatments that target specific mechanisms in cancer cells. Currently, the main targeted therapy drug approved for use in gastric cancer is a HER2 inhibitor. Other molecules are being assessed in ongoing clinical trials.
Management of peritoneal involvement
The peritoneum (the membrane surrounding all abdominal organs) can be affected in the case of stomach cancer. Gustave Roussy's medical and surgical teams are experts in the management of peritoneal involvement and have developed a wide range of intraperitoneal treatments, including PIPAC (chemotherapy applied by aerosol) or HIPEC (hyperthermic intraperitoneal chemotherapy), which is available depending on the clinical situation.
Gustave Roussy specialises in the treatment of peritoneal disorders. All locoregional treatment techniques are available and most of these have been developed in-house.
Percutaneous destruction and radiotherapy
Percutaneous tumour destruction and radiotherapy can be used to treat some secondary lesions.
Percutaneous destruction is a minimally invasive, image-guided technique that destroys the tumour using heat (radiofrequency) or cold (cryotherapy), thereby significantly reducing the risk of complications. The procedure is performed through the skin under general anaesthesia by an interventional radiologist specialising in image-guided treatments.
Stereotactic radiotherapy may be indicated especially for patients with localised secondary involvement.
The efficacy of immunotherapy is heterogeneous in the management of gastric cancers. Your medical oncologist will be on hand to answer any questions about treatment indications.
Clinical trials and advanced therapy medicinal products
Depending on the characteristics and stage of the cancer, Gustave Roussy can invite patients to participate in clinical trials. The advanced therapy medicinal products arising from these protocols give patients access to new molecules and precision medicine based on the molecular characteristics of each tumour. If appropriate, patients will be referred to a therapeutic trial during treatment by their referring oncologist, giving them access to innovative treatments.
Gustave Roussy's Nutrition Unit plays a vital role in the treatment of gastric cancers. Their expertise is used to limit the negative effects of malnutrition by adapting diets for each disease. In the case of gastric cancer, the Unit advocates the return to a normal diet by improving the nutritional quality of meals in hospital and at home.
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