Gastric Cancer

– The information has been reviewed by Dr. Yang Pei Cheung, George

Epidemiology 

Gastric cancer is responsible for the sixth most deaths among common and fatal cancers in Hong Kong, accounting for about 4% of all new cancer cases. In 2018, 687 people died of gastric cancer. According to data from the Hospital Authority’s Hong Kong Cancer Registry, a total of 1,314 cases of gastric cancer were reported in 2017, accounting for 15.8% of all total cancer cases. The ratio of male to female patients was approximately 1.4:1.

 

What is Gastric Cancer? 

The stomach is a part of the digestive system, which is responsible for secreting gastric acid to digest food and transfer it into the intestine to continue the digestive process. Gastric cancer refers to abnormal changes in stomach cells and the development of malignant tumors.

Symptoms
Symptoms

Early stage gastric cancer may show no obvious symptoms, which are similar to general gastrointestinal discomfort and indigestion. Many patients who show obvious symptoms already have stage 2 or 3 gastric cancer when diagnosed. 

  • Indigestion
  • Loss of appetite
  • Nausea
  • Pain in upper abdomen 
  • Feeling bloated after eating
  • Vomit that includes blood
  • Bleeding or black stools
  • Weight loss
  • Fatigue
Causes & Risk Factors
Causes & Risk Factors

Gene mutations in gastric cells cause normal cells to develop into malignant tumors. In addition, studies have found that patients infected with Helicobacter pylori have an increased risk of gastric cancer.

 

Risk Factors

  • Men are at higher risk than women
  • Age
  • Helicobacter pylori infection
  • Smoking
  • Drinking
  • Genetics
  • Eating habits: long-term consumption of high-salt, pickled, and smoked foods
How is Gastric Cancer diagnosed & Treatment
How is Gastric Cancer diagnosed & Treatment
  • 胃鏡檢查:醫生將光導管狀的內視鏡經病人的口及食道進入胃部及十二指腸進行檢查,觀察胃壁。如有需要,會抽取組織作病理檢查。
  • 影像檢查:正電子電腦掃描能顯示細胞新陳代謝情況,可有效追蹤早期癌細胞病變;電腦掃描可有效偵測極微細的腫瘤及提供腫瘤的立體影像。此外,磁力共振則可清楚顯示軟組織的影像,例如胃壁、胃腔等,三者均應用於診斷胃癌分期及有否出現癌轉移。

 

胃癌的治療方法

一般來說,手術切除為現時最有效治療方,無論在控制癌症或往後消化功能都有都有較理想的效果。如果能及早發現病情,胃癌患者可以透過手術切除胃部,達到根治的作用。除了早期胃癌, 大部分情況下都會結合兩種療法互補,加強療效,降低復發和擴散的風險。

手術切除 切除受癌細胞侵襲的胃部組織,切除範圍視乎腫瘤的大小和位置而定。考慮到癌細胞可能隨著淋巴液擴散到胃部附近的淋巴結,所以亦需一併切除,切除後會為胃小腸進行連接重組。以往胃部手術多以開放式進行,現時在達文西機械臂輔助下,醫生只需開多個細小切口,便能在病人體內精確地切割腫瘤,不會傷及肌肉,副作用亦較少,復原更快。患者一般在手術後翌日即可下床活動,一星期後便能出院。術後飲食:病人在術後一至兩星期須食用流質或軟餐,其後在進食方面便可回復正常,飯類或肉類都可以進食,只須留意將食物切碎,以及避免進食連皮薯仔及菇菌類食材。

放射治療

透過高能量射線,殺死癌細胞組織。另外,亦可於手術切除前使用,以縮小腫瘤再切除。

化學治療

針對已擴散的腫瘤而使用,藥物可隨血液運行全身,攻擊及消滅身體各處剩餘的癌細胞。

輔助治療

第2至第4期胃癌病人完成手術後,會按癌症期數和身體狀況而接受輔助治療,包括化療、放射治療,或兩者混合以清除餘下的癌細胞,最理想的情況是於手術後四個星期內開始。

標靶藥物

如患者對HER2受體呈陽性,便可考慮在化療基礎上加入服用抑制HER2蛋白過度表現的標靶藥物,可有效舒緩病情。

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