The general principle of cancer surgery is to remove the large area to avoid missing potential cancer cells in other areas around the existing disease. For stomach cancer, specific guidelines apply:
On the right side, the upper part cuts the lesion by about 6cm, the lower part needs to be cut under the pylorus sphincter 2cm (other than the cancers in the pole on the stomach).
Removal of large connective tissue: The goal is to remove the lymph node strings that are the most commonly metastasized in gastric cancer.
Removing lymph nodes: This is a difficult but important job of eliminating stomach cancer cells.
- Removal of invasive or metastatic organs: Following the principle of chase of cancer, all organs with invasive gastric cancer must be thoroughly removed.
The following is a gastric cancer treatment regimen:
1. Remove the tumor entirely
2. Combination of radiation therapy and chemotherapy
3. Incorporate symptomatic treatment, and support the body
1. TARGET TYPES:
1.1. Treatment of early removal of the tumor:
Gastric carcinoma of the gastrointestinal tract usually develops on epithelial epithelial cells that have suffered chronic inflammatory damage. Endoscopic staining (indiocarmin or red curved) allows the detection of clots of dysplasia by imaging of uneven pigments.
- Pancreatic cancer cell biopsy.
- Ultrasound through endoscopy assessing the extent of invasive cancer organization.
If the cancer is still limited to the mucosa (stage T0, N0, M0), the colon cancer can be removed.
- If the tumor is T1 or T2, N0 or N1, M0, cut the gastrointestinal tract, connect the stomach - bowel in the BillrothII style.
1.2. Treatment of late stage surgery:
Gastric cancer in the lower third trimecircle: cut 3/4 or 4/5 of stomach, connect the stomach-bowel in the BillrothII style, combined with metastatic scraper removal.
Gastric cancer in the middle third and third trimesters: it is best to cut the entire stomach.
It was found that total cutting was more beneficial than partial cutting or cutting only at the upper extremity because this method allowed the entire metastatic node organization to be dredged, and thus, in the long run, the rate Recurrence is lower.
1.3. Temporary treatment:
- When opening the abdomen, distal metastasis, the removal of the stomach should be considered, preferably gastrointestinal connection, help the patient to eat temporarily.
1.4. Radiation therapy and chemotherapy:
Radiation therapy reduces the incidence of local recurrence in surgical patients. In the late stage of disease, the combination of 5 fluorotrifacillers with radiation therapy reduces the incidence of tumors and prolongs the survival time. In addition to radiotherapy alone.
Total radiation dose 45 Gy, 180 CGY / day X 5 days / week X 5 weeks, in u and lymphocytes.
- Chemotherapy is used after day 1 or 2 when irradiation.
+ Leucovoiun 20mm / 1m2. TM in 10m.
+ 5Fluorouracil 400 mg / 1 m2 TM for 10 minutes on 1 to 4 injection after leucovoiun. This regimen is repeated with day and dose regimen at week 5 of radiation therapy.
- Next chemotherapy: After 4 to 5 weeks, the number of white blood cells and platelets to recover (BC> 3.5T / l, TC> 150,000) will continue to be treated.
+ Leucovoiun 20 mg / 1m2 TM for 10 minutes on 1 - 5 and Fu 425 mg / 1m2
TM for 10 minutes on 1-5. After Leucovoiun week, repeat 1-2 weeks or ELF treatment
+ Leucovoiun 30 mg / 1m2 TM for 10 minutes
+ Etoposite 500 mg / 1m2 TM for 50 minutes followed by leucovoiun
+ 500 mg / m2% Fu for 10 minutes followed by etoposite
All three types on 1-2-3 days repeat each 21 to 28 days.
1.5. Symptomatic treatment, supporting the body:
Most patients need to re-balance the nutrition, vitamin B12, folic acid, calcium, phosphorus, Fe.
If the narrowing of the esophagus or esophageal stenosis
If the pain varies depending on the extent to which the drug can be reduced from the paracetamol group to the narcotic pain group such as morphin or dolacgan.
4.1.6. Follow up after treatment:
Patients with stomach cancer after surgery need to have a periodical examination every 3 months for the first 3 years, then 6 months in the next 2 years and once a year in the following years. Every year, blood counts, liver function, cardiopulmonary and gastroscopy should be checked, especially when new symptoms appear.
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