Stomach cancer

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

The different therapeutic possibilities can be:

• Subtotal gastrectomy: consists of the removal of part of the stomach containing the tumor to treat problems derived from the tumor, such as tumor bleeding, obstruction or even pain not controlled with medication.
• Gastric bypass (gastrojejunostomy): this surgery is performed in those tumors that block the passage of food thus preventing the possibility of oral feeding of the patient. In this surgery the tumor 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 the medical treatment that consists of the application of chemical substances to the organism. Chemotherapy can mainly be administered intravenously or orally, although there are other forms of administration.

Depending on the time of administration of the treatment it is called:

• Neoadjuvant treatment: this is the administration of chemotherapy prior to possible surgery. The aim is to reduce tumor 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 clinical benefit.

The Department of Medical Oncology of the Clínica Universidad de Navarra has a specialized Area Nurse who is in permanent contact with the patients to minimize the side effects derived from the medication.  In addition, a telephone follow-up is carried out during treatment to detect possible toxicities and alleviate them in an early and effective manner.

Monoclonal antibodies are drugs directed against specific proteins that act on specific receptors.

Receptors are small molecules or molecular complexes located on the cell surface. Upon activation, a cascade of events occurs, creating a response to the activation.

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

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

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

There are several types of radiotherapy:

• External: employs beams of ionizing radiation (electromagnetic waves) generated by radiation equipment remote and external to the patient (linear accelerators).
• Internal (brachytherapy): this is a special radiation technique based on the introduction of a radioactive source (radioisotope) into the tumor or into the tumor bed itself (healthy tissue close to the tumor that remains after its removal and which has a high risk of containing residual microscopic disease).

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

In patients with advanced disease it can be an effective therapy to alleviate pain (analgesic radiotherapy), bleeding (hemostasis 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 evaluation with the Palliative Medicine Service in order to achieve an adequate symptomatic management as well as the possibility of expressing and orienting the possible emotional effects that this disease causes in the patient and his 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.