Stomach Cancer Treatment in Delhi Gurgaon India – Best Cancer Specialist

The stomach is a J-shaped sac-like organ that connects the esophagus to the duodenum (the first part of the small intestine). It serves as a mixing chamber and holding reservoir for ingested food.

stomach normal anatomy

 

 It mainly consists of 5 parts – Cardia, Fundus, Body, Antrum, and Pylorus; and 5 layers – Mucosa, Submucosa, Muscularis Propria, Subserosa, and Serosa.

cross section from the stomach wall

 

  Adenocarcinoma (affecting mucosal cells that lines the innermost lining of the stomach) is the most common type of stomach cancer.

 

How is the Staging of Stomach Cancer done?

Stomach cancer TNM staging helps to determine the disease prognosis, and to select an appropriate treatment strategy.

T Staging

Tis – Pre-cancerous or cancer cells present only in the epithelium of gastric mucosa

Tis or carcinoma in situ, cancer limited to epithelium

 

T1 – Tumor invades mucosa or submucosa.

 

T1a-involvement of lamina propria or muscularis mucosa
T1a-involvement of lamina propria or muscularis mucosa

 

T1b-involvement of submucosa
T1b-involvement of submucosa

 

T2 – Tumor invades the muscular layer (muscularis propria)

T2-infiltration into muscularis propria

 

T3 – Tumor invades in the subserosal connective tissue layer

T3-infiltration into subserosa

T4a – Tumor invades the outermost serosa layer without affecting any nearby lymph node

T4a-infiltration into serosa

 

T4b – Tumor invades adjacent structure/organs without affecting any nearby lymph node

In this figure, the tumor infiltrates the colon.

T4b-extends to involve the colon

 

And here it extends into the pancreas.

T4b-infiltrates the pancreas

 

Here the tumor involves the spleen.

T4b-infiltrates into the spleen

 

And here it infiltrates into the kidney.

T4b-infiltrates into the kidney

 

It may also infiltrate into the liver or the diaphragm.

 

T4b-infiltrates into diaphragm

 

N Staging

N1 – Tumor has spread to 1 or 2 nearby lymph nodes

N2 – Tumor has spread to 3 to 6 nearby lymph nodes

N3a – Tumor has spread to 7 to 15 nearby lymph nodes

N3b – Tumor has spread to >/=16 nearby lymph nodes

 

M Staging

M0 – Tumor has not spread to distant sites

M1 – Tumor has spread to non regional nodes or distant organs such as lungs, bones, brain, etc

Tumor may spread to liver.

metastasis to liver

 

Tumor deposits in the peritoneum.

metastasis to peritoneum

 

Multiple nodular deposits in lungs.

metastasis to both lungs

 

Tumor deposit in left supraclavicular node.

spread to left supraclavicular lymph node

 

Periumbilical tumor deposit.

metastasis to periumbilical region

 

Pelvic deposits in the rectovesical pouch or pouch of Douglas.

pelvic deposits in the rectovesical pouch

 

Involvement of one or both the ovaries.

Krukenbergs tumor - metastasis to ovary

 

Very rarely, it may also spread to brain or bones.

Once T, N, and M categories are determined, this information is combined to assign an overall stage (from 0 to IV).

STAGE TNM  
0 Tis N0 M0  
IA T1 N0 M0  
IB T2 N0 M0  
  or  
  T1 N1 M0  
IIA T3N0M0  
  or  
  T2 N1 M0  
  or  
  T1 N2 M0  
IIB T3 N1 M0  
  or  
  T2 N2 M0  
  or  
  T1 N3a M0  
  or  
  T4a N0 M0  
IIIA T4b N0 M0  
  or  
  T4a N1/2 M0  
  or  
  T3 N2 M0  
  or  
  T2 N3a M0  
IIIB T4b N1-2 M0  
  or  
  T3-4a N3a M0  
  or  
  T1-2 N3b M0  
IIIC T4b N3a-3b M0  
  or  
  T3-4a N3b M0  
IV Any T Any N M1  

 

What is the Treatment of Stomach Cancer?

The stomach cancer treatment mainly depends on the stage, location of the tumor, performance status of the patient, the presence of certain genetic abnormalities, along with other factors.

Here we discuss the treatment of stomach cancer depending on the stage of the disease.

Tis to T1a

Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is considered preferred treatment approach depending on the extent of disease. 

T1b

Surgical removal of partial (subtotal gastrectomy) or entire stomach (total gastrectomy) depending on the involvement.
Chemotherapy with/without radiotherapy if surgically unresectable or inoperable.

T2-T4 Any N

Surgical resection in combination with chemotherapy with/without radiotherapy is the preferred treatment.
Chemotherapy with/without radiotherapy if surgically unresectable or inoperable.

Any T Any N M1 (Metastatic disease)

Chemotherapy and/or targeted therapy is the mainstay of treatment.
Radiotherapy, surgery, or other palliative treatment may be employed to relieve the symptoms.

 

What Endoscopic Treatments are available for early stage Stomach Cancer?

endoscopy for stomach cancer

 

Several types of endoscopic treatment can be employed for very early stage stomach cancers. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) is alternative to surgery with similar efficacy and safety for early-stage gastric cancer confined to gastric mucosa.

Other treatments like endoscopic tumor ablation and endoscopic stent placement aim mainly to relieve symptoms of more advanced staged gastric cancers.

 

What is the role of Surgery in Stomach Cancer?

cancer surgery treatment

 

Surgery is the treatment of choice for some earlier stage cancers that can be completely removed. Surgery can also be employed for higher stage disease that have not spread to distant parts and if the patient is medically fit.

Sometimes, surgery is combined with other treatments such as chemotherapy and/or radiation therapy as per physician discretion and patient’s condition. Surgery for stomach cancer may be partial or total gastrectomy. It may be a D1 resection or D2 resection depending upon number and stations of lymph nodes removed.

 

What is the role of Targeted Therapy in Stomach Cancer Treatment?

targeted therapy for stomach cancer

 

Targeted drugs are designed to target a specific gene or protein characteristic of the stomach cancer cells. With the advancement in diagnostic techniques, genetic abnormalities for gastric cancer have been identified that can be targeted with the help of targeted drugs. Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy.

For example, Trastuzumab targets the HER2 protein and Ramucirumab targets receptor for VEGF. They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.

 

Is Immunotherapy an option for Stomach Cancer Treatment?

immunotherapy  for esophageal cancer

 

Immunotherapeutic agents activate the immune system to recognize and kill cancer cells. Immune checkpoint inhibitors target PD-1, a protein on T-cells that normally helps keep these cells from attacking cancer cells. This activates the immune system to kill the PD-L1 expressing cancer cells.

Pembrolizumab may be used as the second-line or subsequent line therapy for MSI-H or dMMR positive unresectable/metastatic gastric tumors that have progressed on prior treatment and for which no satisfactory alternative treatment option is available. 

 

Best Stomach Cancer Specialist in Delhi

Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating stomach cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.

He has a vest experience of treating stomach cancer patients in all stages of disease. He is well versed with Immunotherapy, Targeted therapy and Chemotherapy for Esophageal Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.

Call +91 9686813020 for appointment.