Stomach Cancer Treatment in Raipur

Stomach cancer is one of those diagnoses that arrives late. A persistent sense of fullness after small meals, vague upper abdominal discomfort or an uncharacteristic loss of appetite are the signs most patients live with for weeks or months before seeking attention. By then, many are already at stage III or IV.

Structured endoscopic programmes detect most gastric cancers at early, curable stages. At Ramkrishna CARE Hospitals, patients receive comprehensive stomach cancer treatment with advanced diagnostics & treatment modalities and dedicated supportive care.

What is Stomach (Gastric) Cancer?

Gastric cancer arises from the cells lining the stomach wall, invading progressively through its layers including mucosa, submucosa, muscularis propria, and serosa and spreading to regional lymph nodes along the stomach's vascular supply or disseminating to the liver, peritoneum, lungs and distant nodes.

Depending on the stage, the cancer may remain confined to the stomach or spread to nearby lymph nodes and other organs. TNM staging classifies by invasion depth (T), nodal involvement (N) and distant metastasis (M). T1 mucosal cancers have excellent outcomes whereas T4 requires multimodal planning. N status is among the strongest prognostic factors, which is why D2 lymph node dissection (minimum 15 to 16 nodes) is the quality standard.

Types of Stomach Cancer

Stomach cancer is classified according to the type of cells from which it develops:

• Adenocarcinoma: Accounts for the majority of gastric cancers and develops from the mucus-producing cells lining the stomach. Classified as intestinal type (H. pylori associated, distal location, older men) or diffuse type (younger patients, poorly differentiated, prone to peritoneal spread, worse prognosis)
• Gastrointestinal stromal tumour (GIST): Rare, KIT or PDGFRA-mutated stromal tumours and treatment involves surgical resection primary and targeted therapy for advanced and high-risk resected disease
• Neuroendocrine Tumours (NETs): Develop from hormone producing neuroendocrine cells in the stomach and can range from slow-growing to aggressive forms.
• Other rare types: Squamous cell carcinoma, adenosquamous carcinoma, and signet ring cell carcinoma (a particularly aggressive diffuse-type adenocarcinoma subtype) are rare gastric tumours that require specialised evaluation and treatment.

Symptoms of Stomach (Gastric) Cancer

Early gastric cancer is almost always asymptomatic. The symptoms that do develop are non-specific and easily attributed to much more common benign conditions like reflux, gastritis and peptic ulcer disease which delays investigation by months:

• Persistent indigestion, heartburn, or upper abdominal discomfort that does not resolve with standard treatment
• A feeling of fullness or bloating after eating small amounts of food 
• Unexplained weight loss or loss of appetite persisting for more than a few weeks
• Black or tarry stools (melaena) from occult upper gastrointestinal bleeding, or vomiting blood (haematemesis) in cases of significant tumour erosion.

Causes of Stomach Cancer

Stomach cancer develops when genetic changes in stomach cells cause them to grow uncontrollably. Several factors can increase the risk of these changes over time. They are:

• Helicobacter pylori infection: The most important modifiable risk factor that is linked to both intestinal and diffuse subtypes through chronic gastritis progressing to atrophic gastritis, intestinal metaplasia, dysplasia and adenocarcinoma
• Dietary factors: High salt and nitrate intake, pickled & smoked foods and low fruit and vegetable consumption are consistently associated with increased risk
• Tobacco use: Smoking independently increases gastric cancer risk by approximately 50 to 100%
• Family History: People with a first degree relative such as a parent, sibling or child who has had stomach cancer have a higher risk of developing the disease
• Inherited conditions: Certain inherited conditions like hereditary diffuse gastric cancer (HDGC) significantly increase the risk of stomach cancer
• Previous stomach surgery or long standing stomach ulcers: People who have had part of their stomach removed or have experienced chronic stomach ulcers may develop long-term changes in the stomach lining that can increase the risk of stomach cancer years after the original condition or surgery.
• Pernicious anaemia: This autoimmune condition reduces the stomach's ability to absorb vitamin B12. It also causes chronic inflammation and thinning of the stomach lining, increasing the long-term risk of developing stomach cancer.

Complications of Stomach Cancer

If stomach cancer is not diagnosed or treated early it can spread beyond the stomach and lead to serious health complications:

• Gastrointestinal bleeding: Occult slow blood loss causing anaemia, vomiting of blood or black stools
• Stomach Blockage: The tumour can block the passage of food, leading to difficulty eating, vomiting and weight loss
• Ascites: Advanced stomach cancer may cause fluid accumulation, leading to abdominal swelling 
• Peritoneal carcinomatosis: Diffuse-type gastric cancer has high propensity for peritoneal seeding causing ascites and bowel obstruction. 

Diagnosis of Stomach Cancer

A combination of endoscopy, biopsy, and advanced imaging is used to confirm stomach cancer and determine its stage:

• Gastroscopy with biopsy: The definitive investigation and visualises the gastric mucosa, samples suspicious lesions, and characterises tumour location and morphology. Biopsies submitted for histopathology, H. pylori testing and HER2 immunohistochemistry
• Endoscopic ultrasound (EUS): Assesses depth of invasion (T stage) and perigastric nodes and is the most accurate T staging modality
• CT staging: Contrast-enhanced CT provides the anatomical staging framework like tumour extent, nodal involvement, hepatic metastases and resectability assessment
• PET CT - uMI 550: Offers whole-body metabolic staging when CT findings are equivocal and for perioperative chemotherapy response assessment. The uMI 550's 2.76mm resolution and Time-of-Flight imaging detect distant nodal, hepatic, and skeletal metastases not seen on CT preventing futile surgery in patients with occult metastatic disease
• Staging laparoscopy: Provides direct peritoneal and liver visualisation before major resection 
• HER2 testing: Present in some gastric adenocarcinomas therefore testing should be performed on all newly diagnosed gastric adenocarcinomas
• PD-L1 and MSI testing: Determine eligibility for first-line checkpoint immunotherapy in advanced gastric cancer.

Treatment for Stomach Cancer

Treatment options are:

• Perioperative chemotherapy - FLOT: According to recent trials perioperative FLOT chemotherapy (fluorouracil, leucovorin, oxaliplatin, docetaxel) works as the perioperative standard for resectable gastric cancer. Four cycles before & four after surgery and the pre-operative phase downstages tumour, treats micrometastases early and tests chemosensitivity
• Gastrectomy with D2 dissection: Distal gastrectomy for antral and body tumours; total gastrectomy for proximal and diffuse-type cancers. D2 lymph node dissection along coeliac, hepatic and splenic arteries (minimum 15 to 16 nodes) is the oncological standard. Laparoscopic gastrectomy with D2 dissection is performed at Ramkrishna CARE Hospitals using HD Endovision and 3D laparoscopy
• Adjuvant therapy: Patients who have surgery may receive chemotherapy to reduce the risk of the cancer returning. In selected patients immunotherapy may also be recommended after surgery
• Systemic therapy for advanced disease: Treatment includes chemotherapy, targeted therapy, immunotherapy or a combination of these. The choice depends on the tumour's genetic and molecular test results
• Radiation therapy: Adjuvant chemoradiation for selected patients with inadequate D2 dissection after resection and palliative radiation for bleeding, obstruction or pain and is delivered on the Elekta Versa HD with IMRT precision protecting kidneys, liver and spinal cord
• Endoscopic resection: ESD or EMR for T1a mucosal gastric cancers meeting strict criteria is curative resection without surgery in appropriately selected patients.

When Should You See a Doctor

Consult a doctor immediately if you experience:

• Persistent indigestion or upper abdominal pain not improving with two to four weeks of antacid treatment
• Unexplained weight loss or loss of appetite
• Difficulty swallowing particularly progressive or associated with weight loss
• Black or tarry stools (melaena) 
• Unexplained anaemia on blood testing.

Why Choose Ramkrishna CARE Hospitals for Stomach Cancer Treatment in Raipur?

The choice of a cancer centre plays an important role in treatment outcomes. Ramkrishna CARE Hospitals provides advanced technology, an experienced specialists team and comprehensive care essential for stomach cancer management:

• Multidisciplinary gastric cancer tumour board: Every case reviewed by surgical, medical, and radiation oncologists, gastroenterologists, radiologists and pathologists before treatment is planned including perioperative chemotherapy versus upfront surgery and treatment sequencing determined collectively
• PET CT staging - uMI 550: 2.76mm resolution and Time-of-Flight imaging detect occult hepatic micrometastases, distant nodal disease and peritoneal deposits altering treatment strategy. Interim PET CT during FLOT assesses metabolic response before surgery
• Laparoscopic D2 gastrectomy with HD Endovision and 3D laparoscopy: 3D laparoscopy provides the magnified, depth-perceiving visualisation of perigastric vascular anatomy that D2 dissection demands 
• Full perioperative chemotherapy programme: FLOT administered with pre-chemotherapy assessment, toxicity monitoring, haematological support and nutritional management and the complete sequence from diagnosis through FLOT to surgery to adjuvant FLOT coordinated within a single programme
• Molecular profiling: HER2, MSI, and PD-L1 testing available in our hospital determining eligibility for targeted therapy and checkpoint immunotherapy in molecularly selected patients
• Precision radiation through Elekta Versa HD: Adjuvant chemoradiation and palliative radiation on the Elekta Versa HD with IMRT precision, protecting kidneys, liver and spinal cord
• Nutritional support throughout treatment: Our nutritional team works from diagnosis through surgery and adjuvant therapy for pre-operative optimisation, post-operative jejunostomy feeding and the dietary adaptation required after partial or total gastrectomy.

Conclusion

Gastric cancer hides behind non-specific symptoms until advanced. When diagnosed early, it is highly curable - surgery alone achieves excellent outcomes for stage I and perioperative FLOT plus surgery cures a meaningful proportion of stage II and III patients. Late diagnosis is manageable with advanced targeted and immunotherapy.

At Ramkrishna CARE Hospitals, Raipur the gastric cancer programme integrates perioperative FLOT chemotherapy, laparoscopic D2 gastrectomy with HD Endovision and 3D laparoscopy, PET CT staging on the uMI 550, molecular-guided systemic therapy and precision radiation on the Elekta Versa HD all available in Raipur for patients across Chhattisgarh.