Yeditepe University Hospitals Gastroenterology Surgery Specialist answered the questions about Gastroenterology Surgery.

What is Gastroenterology Surgery?

There may be confusion in society regarding the definition of gastroenterology surgery. The department of internal medicine that deals with the gastrointestinal system and performs endoscopic procedures intensively is the department of gastroenterology. The branch specialization that treats surgical diseases in this gastroenterology department is gastroenterology surgery. Gastroenterology surgery specialists do a minor in gastroenterology surgery after general surgery. Gastroenterology surgery specialists try to treat cancers from the mouth to the anus, especially malignant cancers of the esophagus, stomach and intestinal cancers and other disorders that require surgical correction, bile ducts, liver, pancreas and spleen diseases, intra-abdominal surgical diseases.

What are the Symptoms of Stomach Cancer?

Stomach cancer is a very insidious type of cancer. 90 percent of these cancers progress without any symptoms. The stomach is a large organ in the form of a one-liter flask. In order for cancer to cause any complaints, it must either cause systemic complaints or several problems must occur in that area. But the first symptom is usually meat intolerance. In addition, if it is ulcerous cancer, stomach cancer may present with bleeding from the mouth. However, stomach cancer may also manifest itself with complaints such as stomach pains, pain that awakens at night, weight loss, loss of appetite, and bleeding from the anus. Because stomach cancer is a very insidious disease, community screening is very important. Stomach cancer screening with endoscopy (stomach gastroscopy) and colon cancer screening with rectal colonoscopy should be done for all people over 50 years of age, regardless of whether they have complaints or not.

Do Gastritis Problems Pose a Risk for Cancer?

If chronic gastritis is not treated, it increases the risk of stomach cancer. Other conditions increase the risk of stomach cancer. Genetic familial predisposition, gastric polyps, chronic gastritis, blood group "A", Helicobacter Pylori gastritis, and family history pose a risk for stomach cancer.

Is Rapid Weight Loss a Sign of Stomach Cancer?

Although 90 percent of the patients have no complaints and some of them have never smoked or used alcohol, they can develop stomach cancer. Sometimes, patients can consult a doctor the complaint of weight loss without any complaints. For this reason, if a person loses more than 15 percent of his/her total weight in the last three months involuntarily without dieting, a cancer screening should be done on his/her body. Since it may be cancer associated with the lung, brain, kidney, liver, abdominal organs, and bone marrow, these should be screened and investigated.

Can Stomach Cancer Be Diagnosed with Endoscopy?

Stomach cancer can be diagnosed most commonly with the endoscopic method called "Upper GI endoscopy". With the pathology taken from here, the type of stomach cancer, how aggressive the cell is, and how much of the stomach it involves can be understood. However, endoscopy alone is not sufficient for diagnosis and staging. After examination, family history (anamnesis), tomography, and other screening methods (PET, colonoscopy, liver, intra-abdominal, and lung screening) if necessary, staging of the patient is performed. Thus, the diagnosis and stage of cancer are clarified.

How to Treat Stomach Cancer?

The main treatment method for stomach cancer is surgery. There is no cure for stomach cancer without surgery. However, cancers of the gastrointestinal tract have four stages, and due to the unique characteristics of each of these four stages (stage 1, stage 2, stage 3, and stage 4), there are various treatment methods. While there is no surgical option in a stage 4 cancer that has spread everywhere, in general terms, hot chemotherapy can be applied in stage 4 cancer that has only reached the inside of the abdomen, the intra-abdominal membrane, and is limited to the stomach and its surroundings. Endoscopic treatment methods are used in microscopic stomach cancers, defined as stage 1 and stage 0, which are below stage 1. Surgical treatment especially closed laparoscopic surgery, is applied in stage 2 and stage 3 stomach cancers. In some patients, it is seen that both endoscopy and laparoscopy are used together.

Is There a Chance of Treatment in Every Stage of Stomach Cancer?

There are treatment options for every stage of stomach cancer. However, in the case of cancer, the 5-year survival rate in stomach cancer is over 90 percent for stage 1, while these rates may decrease to 70-50 percent in stage 2 and stage 3. 5-year life expectancy may decrease to 50 percent in stage 3 AND advanced stage 3 cancer. It was stated in the literature that, if complete removal can be achieved with hot chemotherapy in stage 4 cancers, the life expectancy of patients, who previously had a chance to live 3-5 months, now increases to 27 - 44 months.

Does Stomach Cancer Metastasize?

As in all cancers, metastasis in stomach cancer is a feared situation for patients. When some stomach cancer patients consult a physician, the disease may have metastasized and cancer may have spread to the lymph nodes around the stomach, liver, abdominal organs, and lungs. In these conditions, appropriate treatments can be performed after the situation is determined by imaging methods.

What are the New Approaches in the Surgical Treatment of Stomach Cancer?

There have been many new approaches in the treatment of stomach cancer in recent years. In the past, mortality rates were higher because stomach cancers were detected at very late stages. However, because of the ease of access to endoscopy and colonoscopy nowadays, early-stage stomach cancers are more commonly encountered in our country.

Do Symptoms Change According to Stages in Stomach Cancer?

Symptoms of stomach cancer may vary depending on the stage, the type of tumor, and the location of the tumor in the stomach. For example, in tumors between the esophagus and the gastric valve, patients may consult a physician with complaints such as regurgitation of swallowed food, nausea, vomiting, obstruction, and inability to swallow, while patients with ulcerated tumors on the smaller side of the stomach may present with bleeding. Tumors on the gastric outlet cover, on the other hand, manifest themselves as vomiting of undigested food that has waited. Complaints of early satiety and abdominal pain are encountered in tumors growing towards the spleen on the larger side of the stomach, and complaints of back pain that awakens at night are encountered in stomach tumors in the region close to the pancreas. However, it is almost impossible to detect stage 1 stomach cancer without an endoscopy.

Whom with Stomach Cancer Can Undergo Laparoscopic Surgery?

Laparoscopic surgery in stomach cancer can be applied to almost all stomach cancer patients in accordance with the general laparoscopy principles. However, laparoscopic surgery can be applied if the patient does not have an additional problem with the liver or if there is no lung disease that will cause a serious problem of carbon dioxide retention in the lungs, if the person's life will not be at risk due to inflating the abdomen, bleeding problems will not arise, and there will be no need for the removal of 4 or 5 organs.

In laparoscopic surgery, the abdomen is first entered with a camera through a 1 cm incision. The liver, spleen, peritoneal surfaces, intraperitoneal surfaces, small intestines, and fatty tissue on the small intestines and stomach are observed one by one. If distant metastases are observed in that area, chemotherapy is administered to the patient. In patients without metastases, surgery is performed. First, the fatty tissues and lymph tissues around the stomach are cleaned together with the vascular structures. In some patients, the entire stomach is removed, and in some patients, 75 to 85 percent of it is removed. The most important point to be considered here is the removal of the surrounding fatty tissues and lymph tissues along with the stomach itself.

What are the Advantages of Laparoscopic Surgery in Stomach Cancer for the Patient?

The hospital stay is shorter after laparoscopic surgery for stomach cancer. Patients can return to their daily life after 3-5 days. However, heavy physical activities are not allowed for the first 3-5 months. Since it is not possible to eat heavy foods after the operation due to the newly formed small intestinal tract in a person whose entire stomach has been removed, additional liquid diets are preferred. One of the most important advantages of laparoscopic surgery is that the patient suffers less pain.

Does the Age of the Patient Affect the Result of Laparoscopic Surgery in Stomach Cancer?

In terms of laparoscopic surgery in stomach cancer, the general health of the patient is more important than the age of the patient. If the patient does not have a lung or heart problem, it does not affect the success of laparoscopic surgery. At this point, the experience of the physician and the technological infrastructure is also extremely important.

What are the Points to Be Considered After Stomach Cancer Surgery?

It should not be forgotten that chemotherapy to be applied after stomach cancer surgery is a form of life-saving treatment. In addition, it is important to pay attention to the dietary treatments given. However, heavy physical activities should also be avoided. Physician control (both the surgeon and oncologist) is essential for the first 2 years and every 3 months after the operation.

What to Do to Prevent Stomach Cancer?

If a person has chronic gastritis, gastritis due to Helicobacter pylori bacteria, reflux, or ulcer, he/she should definitely receive treatment. However, it is important to change eating habits. It is important to stay away from roasted meat, and kebab-type dishes, to take care not to consume salty products, and to adopt healthy eating habits in general. In addition, as in all types of cancer, avoiding excess weight, not being inactive, and adopting a positive life philosophy is effective in preventing stomach cancer. In addition, it is necessary to stay away from areas with air pollution, water pollution, and soil pollution and not to consume the foods of those regions.

Is There a Connection Between Nutritional Habits and Stomach Cancer?

The relationship between stomach cancer and nutrition has also been proven by research. For example, the incidence of stomach cancer is significantly higher in communities where high-salt foods such as smoked fish and meat (pickled), processed meat containing nitrite, and canned food are consumed. The best example of this is Japan. In migrants going to other countries from Japan, which is one of the countries where stomach cancer is most common in the world, the incidence of stomach cancer decreases over decades and regresses to the frequency of stomach cancer in the country where they have settled. This shows how effective the diet is in the formation of this disease.

In addition, alcohol and smoking are among the most important causes of stomach cancer, as in all other types of cancer. Consumption of organic fruits and vegetables and consumption of boiled meat reduces the risk of stomach cancer.

Is There a Genetic Transmission of Stomach Cancer?

Stomach cancer is one of the cancers with the genetic transmission. The "E-cadherin" gene mutation plays an important role in the development of stomach cancer.

Do Gastric Polyps Pose a Risk for Stomach Cancer?

Gastrointestinal cancers are usually cancers that develop on the basis of polyps. These polyps develop especially in the large intestine. It takes an average of two years for the said polyps to become polyps containing cells that will contain cancer. For two years, the body offers an option. It almost says, "Take this polyp from my body and throw it away". If this is treated, the risk of stomach cancer and colon cancer can be eliminated. However, if that polyp is not removed, endoscopy controls are not performed, and if it is ignored, that polyp may grow and turn into cancer. For this reason, polyps must be controlled and cleaned with methods called a polypectomy.

Intestinal polyps should be removed when detected. Depending on the type and number of polyps, the procedure may vary.

Polypectomy: It is the removal of the polyp from the large intestine with forceps or a wire loop. If the polyp is larger than 1 centimeter, the procedure can be performed by injecting a liquid to remove and isolate the polyp from the surrounding tissues.

Minimally invasive surgery: Polyps that are too large or cannot be safely removed during a screening of the large intestine and rectum are usually removed laparoscopically.

Colon and rectum removal: In the presence of a rare inherited disease such as FAP, surgery may be required to remove the colon and rectum (total proctocolectomy). For people with such familial health problems, the best way to prevent colon cancer is to have the colon and rectum completely removed.