Stomach cancer

Sometimes, even when the tumour is in very advanced stages, palliative surgery is performed. The aim of this surgery is to alleviate or prevent tumour-related symptoms.

The different therapeutic possibilities are as follows:

• Subtotal gastrectomy: this consists of the removal of part of the stomach containing the tumour to treat problems derived from the tumour, such as tumour bleeding, obstruction or even pain that is not controlled with medication.

• Gastric bypass (gastrojejunostomy): this surgery is performed on tumours that block the passage of food, thus preventing the patient from eating by mouth. In this surgery, the tumour lesion is not removed, but a bypass is made from the upper part of the stomach to a new connection in the small intestine so that food can pass through this route.

If the patient is not suitable for surgery or the symptomatology is not so severe, other less aggressive techniques are used to achieve adequate symptomatic control.

Chemotherapy is a medical treatment that involves the application of chemicals to the body. Chemotherapy can mainly be administered intravenously or orally, although there are other forms of administration. Depending on when the treatment is administered, it is called:

• Neoadjuvant treatment: is the administration of chemotherapy, it is carried out prior to possible surgery. The aim is to reduce tumour size and thus facilitate surgery.
• Adjuvant treatment: is the administration of chemotherapy after surgical resection. The aim is to eliminate possible microscopic disease and prevent recurrence of the disease.
• Palliative treatment: is the administration of treatment in a palliative manner. The intention is to reduce the burden of the disease and thereby derive a clinical benefit.

The Department of Medical Oncology at the Clínica Universidad de Navarra has a specialised Area Nurse in permanent contact with patients to minimise the side effects derived from the medication. It also carries out telephone monitoring during treatment to detect possible toxicities and mitigate them in an early and effective manner.

Monoclonal antibodies are drugs that target specific proteins that act on specific receptors. Receptors are small molecules or molecular complexes located on the surface of cells.

Monoclonal antibodies act by inhibiting the activation of these receptors, thereby preventing the proliferation or growth of tumour cells.

Gastric irradiation together with chemotherapy is a fundamental strategy for the cure of selected patients with gastric cancer. Precise irradiation techniques are essential to minimise adverse effects on abdominal organs.

In situations of abdominal or retroperitoneal relapse after initial surgery and radiotherapy, proton therapy, or intraoperative radiotherapy, can achieve greater local disease control in these patients.

There are several types of radiotherapy:

External. This uses beams of ionising radiation (electromagnetic waves) generated by remote radiation equipment external to the patient (linear accelerators).

Internal, also known as brachytherapy. It is a special radiation technique based on the introduction of a radioactive source (radioisotope) into the tumour or the tumour bed itself (healthy tissue close to the tumour that remains after removal of the tumour and which has a high risk of containing residual microscopic disease).

Proton therapy. This therapy, due to its lower toxicity, is especially indicated for the treatment of tumours that are difficult to access or close to organs at risk. The Clínica Universidad de Navarra has a Proton Therapy Unit.

Other. In patients with advanced disease, it can be an effective therapy for pain relief (analgesic radiotherapy), bleeding (haemostatic radiotherapy) or local control.

In addition to all of the above, we must not forget the emotional aspect of cancer patients. At the Clínica Universidad de Navarra we have the possibility of carrying out a joint assessment with the Palliative Medicine Service in order to achieve adequate symptomatic management as well as the possibility of expressing and guiding the possible emotional effects that this disease has on the patient and their family.

The combination of an adequate symptomatic and emotional control has shown a better tolerance to medication and a better coping with the adverse events that occur during the evolution of this process.