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V Care Foundation is a voluntary support group dedicated providing free help, hope, awareness & education to cancer patients & their families through outreach programs & services that improve the quality of their lives. V-Care has prepared this booklet to help patients & their families understand & deal with cancer &its related conditions. We believe this will help the patient & the family faces the disease together to get in touch with us for any help. The stomach (also called gastric cancer) The stomach is part of the digestive system. It is a hollow organ in the upper abdomen, under the ribs. The wall of stomach has five layers: Inner layer or lining (mucosa): juices made by glands in the inner layer help digest food. Most stomach cancers begin in this layer. Sub mucosa: This is support tissue for the inner layer. Muscle layer: muscles in this layer create a rippling motion that mixes & mashes food. Sub serosa: this is the support tissue for the out layer Outer layer (serosa): the outer layer covers the stomach. It holds the stomach in place. Food moves from the mouth through the esophagus to reach the stomach. In the stomach, the food becomes liquid. The liquid then moves into the small intestine, where it is digested even more. Understanding cancer Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normally, cells grow & divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. Sometimes, this orderly process goes wrong. New cells from when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. Tumors can be benign or malignant. Stomach cancer can affect nearby organs and lymph nodes: - A stomach tumor can grow through the stomach’s outer layer into nearby organs, such as the pancreas, esophagus, or intestine. - Stomach cancer cells can spread through the lymphatic system to lymph nodes all over the body. When cancer spreads from its original place to another part of the body, the doctors call the new tumor “distant” or metastatic disease. Most stomach cancers start in the mucosa. The cancer can grow deeper and infect the other layers. As it grows deeper the outlook for a cure gets worse. Stomach cancers grow slowly over many years. Cancer just doesn’t suddenly appear. As the cancer develops, there are usually changes that occur in the lining of the stomach. These early changes usually do not produce symptoms and are often are unnoticed. Types of stomach cancer These are three main types of stomach cancers: Lymphomas, gastric stromal tumors, and carcinoid tumors. Lymphomas are cancer of the immune system tissue that is sometimes found in the wall of the stomach wall. Carcinoid tumors are tumors of hormone-producing cells of the stomach. Risk factors No one knows the exact cause of stomach cancer. Doctors often cannot explain why one person develops this disease& another does not. Research has shown that people with certain risk factors are more likely than others to develop stomach cancer. A risk factor is something that may increase the chance of developing a disease. Studies have found the following risk factors for stomach cancer. - Age: most people with this disease are 72 or older. - Sex: men are more likely than women to develop stomach cancer. - Race: stomach cancer is more common in Asian, pacific, island, Hispanic, and African Americans than in non-Hispanic white Americans. - Diet: Studies suggest that people who eat a diet high in foods that are smoked, salted or pickled may be at increases risk for stomach cancer. On the other hand, eating fresh fruits and vegetables may protect against this disease. - Helicobacter pylori infection: H. pylori is a type of bacteria that common lives in the stomach. H. pylori infection increases the risk of stomach inflammation and stomach ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer. Although infection increases the risk, cancer is not contagious. You cannot catch stomach cancer from another version that has it. - Smoking: people who smoke are more likely to develop stomach cancer than people who do not smoke. - Certain health problems: conditions that cause inflammation or other problems in the stomach may increase the risk of stomach cancer: - Stomach surgery - Chronic gastric (long-term inflammation of the stomach lining) - Pernicious anemia - Family history: A rare type of stomach cancer runs in some families. - Most people who have known risk factors do not develop stomach cancer. For example, many people have H. pylori in their stomach but never develop cancer. On the other hand, people who do develop the disease sometimes have no known risk factors. - If you think you may be at risk, you should talk with your doctor. You doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups. Symptoms Early stomach cancer often does not cause clear symptoms. As the cancer grows, the most common symptoms are: - Unintended weight loss & lack of appetite - Pain in the area of the stomach (abdomen pain) - Vague discomfort in the abdomen, often above the navel - A sense of fullness just below the chest bone after eating a small meal - Heartburn, indigestion, or ulcer-type symptoms - Nausea - Vomiting, with or without blood - Swelling of the abdomen - Weakness and fatigue Most often, these symptoms are not due to cancer. Other health problems, such as an ulcer or infection, can cause the same symptoms. Anyone with these symptoms should tell the doctor so that problems can be found & treated as early as possible. Diagnosis If you have a symptom that suggests stomach cancer, your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems. He will then do a physical examination, orders x-rays of your esophagus and stomach, do an endoscopy and or a biopsy. Treatment To plan the best treatment, your doctor needs to know the extent of the diseases. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Stomach cancer can spread to the lymph nodes, liver, pancreas, and other organs. Doctor may order more tests. Sometimes staging is not complete until after surgery, where the tumor and nearby lymph nodes are removed. Treatment methods The choice of treatment depends mainly on the size and place of the tumor, stage of disease, & your general health. Treatment for stomach cancer may involve surgery, chemotherapy, or radiation therapy. Many people have more than one type of treatment. Your doctor can describe your treatment choices and the expected results. You & your doctor can work together to develop a treatment plan that meets your needs. Cancer treatment is either local therapy or systematic therapy: - Local therapy: Surgery & radiation therapy are local therapies. They remove or destroy cancer in or near the stomach. When stomach cancer has spread to other parts of the body, local therapy may be used to control the disease in these specific areas. - Systemic therapy: chemotherapy is systemic therapy. The drug enters the bloodstream & destroys or controls cancer throughout the body. - Because cancers treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extents of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next. - Surgery is the most common treatment for stomach cancer. The type of surgery of depends on the extent of the cancer. There are two main types of stomach cancer surgery: - Partial (subtotal) gastrostomy: The surgeon removes the part of the stomach with cancer. The surgeon also may remove part of the esophagus or part of the small intestine. Nearby lymph nodes and other tissues may be removed. - Total gastrostomy: The doctor removes the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, other tissues near the tumor. The spleen also may be removed. The surgeon then contacts the esophagus directly to small intestine. The surgeon makes a new “stomach” out of tissue from the intestine. - It is natural to be concerned about eating after surgery for stomach cancer. During, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal. - The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Many people who have stomach surgery feel tired or weak for a while. The surgery also can cause constipation or diarrhea. These symptoms usually can be controlled with diet changes and medicine. Chemotherapy Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body. Most people who receive chemotherapy have it after surgery. Radiation therapy may be given along with chemotherapy. Anticancer drugs for stomach cancer are usually injected into blood vessel. But some drugs may be given by mouth. You may have your treatment in the hospital, as an OPD patient. Some people may need to stay in the hospital during treatment. The side effects of chemotherapy depend mainly on the specific drugs and the dose. Radiation therapy Radiation therapy uses high energy to kill cancer cells. It affects cells only in the treated area. The radiation comes from a large machine outside the body. Treatments are usually 5 days a week for several weeks. Side effects depend mainly on the dose of radiation & the part of your body that is treated. Radiation therapy to the abdomen may cause pain in the stomach or the intestine. You may have nausea & diarrhea. Also, your skin in the treated are may become red, dry, and tender. Doctors usually advise patients to try to stay as active as they can Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them. Also side effects usually go away after treatment ends. Nutrition It is important to eat well during and after cancer treatment. You need the right amount of calories, protein, vitamins, & mineral. Eating well may help you feel better and have more energy. Nutrition after stomach surgery Weight loss after surgery for stomach cancer is common. You may need to change the types of food you eat. Another common problem after stomach surgery is dumping syndrome. This problem occurs when food or liquid enters the small intestine too fast. It can cause cramps, nausea, bloating, diarrhea, and dizziness. Eating smaller meals can help prevent dumping syndrome. Also, you may wish to cut down on very sweet foods & drinks, such as cookies, candy, soda and juices. Follow-up care Follow- up care after treatment for stomach cancer is important. Your doctor will monitor your recovery. Checkups help ensure that any changes in your health are noted and treatment if needed. Checkups may include a physical exam, lab tests, x-rays, CT scan, endoscopy or other tests. Between scheduled visits, you should contact the doctor if you have any health problems. V care information resources: V care provides helping booklet about cancer their treatments and coping with these include chemotherapy radiation therapy and diet for cancer patients. At any stage of disease, supportive care is available to relieve the side effects of treatment, and to ease emotional concerns. Further information you can meet with one our volunteers or call out troll free help line- V care information resources: V care provides helping booklet about cancer their treatments and coping with these include chemotherapy radiation therapy and diet for cancer patients. At any stage of disease, supportive care is available to relieve the side effects of treatment, and to ease emotional concerns. Further information you can meet with one our volunteers or call out troll free help line-
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Primarni rak jetre započinje u hepatocitima (stanicama jetre). Ovaj tip raka naziva se hepatocelularnim karcinomom ili malignim hepatomom. Djeca mogu razviti hepatocelularni karcinom ili hepatoblastom. Kada se rak jetre širi (metastazira) izvan jetre, stanice raka imaju tendenciju širenja u obližnje limfne čvorove, kosti i pluća. Kada se to dogodi, novi tumor ima istu vrstu abnormalnih stanica kao i primarni tumor u jetri. Primjerice, ako se rak jetre raširi u kosti, stanice raka u kostima zapravo su stanice raka jetre. Bolest je metastatički rak jetre, ne rak kosti. Tretira se kao rak jetre, a ne kao rak kosti. Slično, rak koji se iz drugih organa proširi na jetru različit je od primarnog raka jetre. Stanice raka u jetri, u tom slučaju, su kao stanice u originalnom tumoru. Kada se stanice raka rašire s drugog organa (debelo crijevo, pluća ili dojku) na jetru, liječnici mogu tumor u jetri nazvati sekundarnim tumorom. U SAD-u su sekundarni tumori jetre češći nego primarni tumori. Rak jetre ponekada se naziva tihom bolešću zbog toga što u ranim fazama često nema simptoma, ali kako rak napreduje mogu se pojaviti sljedeći simptomi: Bol u gornjem dijelu abdomena na desnoj strani. Bol se može širiti u leđa i ramena. · Otečeni abdomen (nadutost) · Gubitak na težini · Gubitak apetita i osjećaji sitosti · Oslabljenost ili osjećaj umora · Vrtoglavica i povraćanje · Žuta koža i oči i tamni urin od žutice · Povišena tjelesna temperatura Navedeni simptomi nisu siguran znak raka jetre. Druge bolesti jetre i drugi zdravstveni problemi također mogu uzrokovati simptome. Osoba s navedenim simptomima trebala bi posjetiti liječnika. Samo liječnik može postaviti dijagnozu i liječiti bolest. Ukoliko pacijent pokazuje navedene simptome raka jetre liječnik može provesti jednu ili više pretraga: Tjelesni pregled – liječnik opipava abdomen kako bi provjerio, odnosno, utvrdio kvržice ili promjene u veličini na jetri, slezeni i drugim organima. Liječnik također provjerava prisustvo ascitesa (abnormalne nakupine tekućine u abdomenu). Liječnik može pregledati kožu i oči u potrazi za znakovima žutice. · Krvne pretrage · CT · Ultrazvuk · MRI · Angiogram · Biopsija Stadij raka jetre Ukoliko se dijagnosticira rak jetre, liječnik treba znati stadij ili razmjer bolesti kako bi isplanirao najbolji tretman za pacijenta. Utvrđivanje stadija bolesti zapravo je pokušaj određivanja veličine tumora, da li se bolest proširila i ukoliko je – na koje dijelove tijela, da li se tumor može odstraniti operacijom. Tretman Mnogi pacijenti s rakom jetre žele imati aktivnu ulogu pri odlučivanju o tretmanu. Žele naučiti sve što mogu o svojoj bolesti i odabiru tretmana. Međutim, šok i stres koji pacijenti dožive kada čuju dijagnozu otežava im razmišljanje o svemu što bi željeli pitati liječnika. Često pomaže sastaviti listu pitanja prije susreta s liječnikom. Kako bi zapamtili sve što liječnik kaže, pacijenti mogu uzimati zabilješke ili povesti člana obitelji. U današnje vrijeme se rak jetre može izliječiti samo ukoliko se otkrije u ranoj fazi (prije nego što se proširi) i samo ako je pacijentovo opće zdravstveno stanje dovoljno dobro da podnese operaciju. Međutim, osim operacije postoje i drugi tretmani koji mogu pomoći u kontroli bolesti, pomoći da se pacijenti bolje osjećaju i produžiti im život. Lokalizirani operabilni rak Lokalizirani operabilni rak jetre je rak koji se može odstraniti tijekom operacije te nema dokaza da se rak proširio na obližnje limfne čvorove ili druge dijelove tijela, a laboratorijski testovi ukazuju na dobru funkciju jetre. Operacija kojom se odstranjuje dio jetre naziva se hepatektomija. Opseg operacije ovisi o veličini, broju i lokaciji tumora i o tome koliko jetra dobro radi. Liječnik može odstraniti dio tkiva koje sadrži tumor, cijeli režanj ili veći dio jetre. Kod djelomične hepatektomije kirurg odstranjuje tumor do granice normalnog tkiva koje preuzima funkciju jetre. Kod nekih pacijenata opcija može biti transplantacija jetre. Kod ove procedure kirurg odstranjuje cijelu jetru i zamjenjuje je zdravim organom od donora. Transplantacija jetre je opcija samo ako se bolest nije proširila izvan jetre i samo ako se može pronaći odgovarajući donor. Lokalizirani neoperabilni rak Lokalizirani neoperabilni rak ne može se odstraniti operacijom iako se nije proširio na obližnje limfne čvorove ili druge dijelove tijela. Operacija nije moguća zbog ciroze (ili drugih stanja koja dovode do oslabljene funkcije jetre), lokalizacije tumora unutar jetre ili drugih zdravstvenih problema. Pacijenti s lokaliziranim neoperabilnim tumorom mogu biti pogodni za druge oblike tretmana kojima se nastoji kontrolirati bolest i produžiti život. Uznapredovali rak Uznapredovali rak je rak koji se nalazi u oba jetrena režnja ili koji se proširio na druge dijelove tijela. Iako se uznapredovali rak ne može izliječiti neki pacijenti primaju terapiju kojom se nastoji usporiti progresija bolesti. Drugi pacijenti, nakon razmatranja dobrobiti i štete od terapije odlučuju kako ne žele terapiju. Tretman uznapredovalog raka uključuje kemoterapiju i/ili radioterapiju. · Kemoterapija – predstavlja upotrebu lijekova koji ubijaju stanice raka. Pacijent može primiti jedan lijek ili kombinaciju lijekova. · Radioterapija – koriste se visoko-energetske zrake kako bi se ubile stanice raka. Radioterapija je lokalna terapija, odnosno, djeluje na stanice raka koje se nalaze u tretiranom području. Recidivirajući rak Recidivirajući rak predstavlja bolest koja se vraća nakon inicijalnog tretmana. Čak i kada se čini da je rak u jetri u potpunosti odstranjen ili uništen bolest se ponekad vraća zbog neopaženih stanica raka koje su ostale negdje u tijelu nakon tretmana. Rak se najčešće ponovno pojavljuje u periodu od dvije godine od tretmana