Gastro-oesophageal malignancy

Gastro-oesophageal cancer develops due to abnormal growth and multiplication of the cells lining the inner layer of the stomach or oesophagus. Cancer is the uncontrolled growth of abnormal cells. The accumulation of these extra cells forms a mass of tissue called a tumour. Cancer can be of different types depending on the cells of origin, such as hormone making cells, cells of the inner lining or the immunological cells. The cancer can spread to the other parts of the body (malignant). They first spread to the lymph nodes and then further spread through the lymphatic system. In latter stages, it may spread to other organs such as liver, bones and lungs through blood.

Lymph nodes are the small kidney shaped structures which are the sites for formation of the body’s defence cells, lymphocytes. Lymph is a clear fluid that flows through lymph vessels and lymph nodes. The interstitial fluid (fluid found between the cells) bathes all the cells and carries excretory products, bacteria and viruses from the cells and helps remove them from the body’s tissues.

Treatment depends on the type and the stage or spread of the cancer. Your age and general state of health is also an important consideration for the doctor in determining the treatment modality. Treatment involves surgery, chemotherapy and radiation therapy. Surgery is the most common treatment for a gastro-oesophageal malignancy.

Surgery

Gastro-oesophageal cancer can spread to other tissues and organs, therefore removal of the cancerous tissue is essential. The type of surgery depends on the location of the cancer, and the extent of spread. The common surgeries performed for the management of gastro-oesophageal malignancies include:

• Endoscopic Mucosal Resection: It is done only when the cancer is detected at an early stage, where the chance of it spreading to the lymph nodes is less. In this procedure cancerous tissue is removed from the stomach using an endoscope, a long flexible tube with the camera at the end. During the procedure an endoscope is passed through the mouth and surgical tools are also passed through it to remove the cancerous tissue. The surgery is done using these tools and does not involve any cuts on the body.
• Subtotal Gastrectomy:  As the name suggests in this surgery a part of the stomach is removed. It is mostly used when the cancer is only in the lower part of the stomach or the upper part of the stomach. During the procedure only part of the stomach is removed, sometimes a part of the oesophagus is also removed along with it. Nearby lymph nodes may also be removed. The remaining part of the stomach is then re-attached to the small intestine.
• Total Gastrectomy: In this surgery the whole stomach is removed along with nearby lymph nodes, and new stomach is recreated by the small intestine. This is usually done when the cancer has spread to the whole of the stomach. Sometimes nearby organs such as the spleen are also removed if the cancer has spread to them.

Chemotherapy and radiation may also be given after the surgery to kill the few cancer cells that may have been left after the surgery and to prevent the recurrence of the disease.

Possible complications of surgery include bleeding, formation of blood clots, and damage to nearby organs. You may also develop frequent heartburn, abdominal pain (especially after eating), and vitamin deficiencies.

After the surgery, follow up is very important since the recurrence of the disease is a possibility. In case of any suspicion the doctor will ask for certain tests to confirm his findings. Absorption of vitamin B12 occurs through the upper part of the stomach. If the upper part of the stomach is removed by surgery Vitamin B12 levels are closely monitored and Vitamin B12 injections are given when required. The doctor may refer you to a nutritionist to plan your diet and you need to eat more often and small meals as the size of the new stomach is small.