First we will discuss the treatment for localized disease.
Earlier stages of the stomach cancer include the Tis and T1a disease, that is, the disease extending up to muscular mucosa.
Endoscopic mucosal resection is the technique used for the treatment of Tis and T1a disease.
This procedure is performed through an endoscope, in which first a fluid is injected below the lesion, and then the lesion is removed from the sorrounding structures.
As you can see in the figure, only the superficial cancerous portion is removed, while the remaining tissue remains unaffected.
Removal of the stomach is all an option for early stage disease, but is practiced less commonly.
Then comes the T1b disease which infiltrates upto the submucosa.
Gastrectomy is the preferred treatment for T1b disease.
Then comes the T2 disease which extends up to the muscular propria.
And T3, which infiltrates the subserosal tissue. And lastly, T4a which infiltrates the serosa.
Form T2a and T4a, surgery may not be sufficient and may not be possible in many cases, so a combination of chemotherapy, radiation therapy, and surgery may be required.
CancerBro, how is it decided what combination of modalities is to be used?
It is decided by the oncologist on an individual patient basis, depending upon the exact stage of disease, performance status and comorbidities of the patient.
Now lets come to the treatment of the T4b disease, in which the tumor extends through the wall of the stomach to involve adjacent structures.
In this figure, the tumor infiltrates into the large intestine. And here, it invades the pancreas. And here it extends into the spleen.
Here it infiltrates into the kidney. It may also extend into the liver or diaphragm.
Surgery may not be possible in all cases of T4b disease, so in such cases, chemotherapy with or without radiation therapy may be used.
Whereas, if the tumor is surgically resectable, multimodality treatment with surgery, with or without chemotherapy or radiation therapy is used.
In T4b disease also, the decision to move ahead with surgery, or treat the disease with chemotherapy or radiation therapy is taken by the oncologist on an individual patient basis, depending upon the exact stage of the disease, performance status and the comorbidities of the patient. That is the treatment for non-metastatic stomach cancer.
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