Malignant Gastric Tumors: When Is Surgery Necessary?

Malignant tumors of the stomach

1.
In February, the examination revealed a 2 cm gastric ulcer.
After medication, the pain has decreased, but there was no regular follow-up.
By July, the gastric ulcer had grown to 5 cm and was found to be malignant, although there was no blood in the stool, no nausea or vomiting, and the only significant discomfort was acid reflux after eating, with no other severe symptoms.
Should surgery be considered?
2.
If it is only stage I gastric cancer, is surgery necessary? Thank you for your guidance.

A Jin, 30~39 year old female. Ask Date: 2008/09/08

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
Current pharmacological treatments for gastric ulcers and gastroesophageal reflux disease are effective in alleviating symptoms, but they do not address malignant tumors.
Some tumors may be asymptomatic while continuing to grow, and if left untreated, they can spread, metastasize, cause bleeding, or lead to obstruction.
2.
The management of gastric cancer generally involves considering the degree of differentiation of the cancer cells, the extent of tumor invasion, the size of the tumor, and the overall health status of the patient.
Surgical intervention is typically the primary treatment option; however, for some small, early-stage cancers, endoscopic mucosal resection or endoscopic submucosal dissection may be viable options after evaluation.
Given that your tumor ulcer is 5 centimeters, it is advisable to have a thorough discussion with your physician regarding treatment options.
Wishing you good health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2008/09/08

More Info

When it comes to malignant gastric tumors, the decision to proceed with surgery is multifaceted and depends on several critical factors, including the tumor's size, location, histological type, and the overall health of the patient. Based on your situation, let's break down the considerations regarding surgery for gastric tumors.

1. Understanding the Nature of the Tumor: In your case, you initially had a gastric ulcer measuring 2 cm, which has since increased to 5 cm and is now associated with malignancy. The growth of the ulcer and its transformation into a malignant tumor is concerning. Even in the absence of alarming symptoms such as hematochezia (blood in stool) or emesis (vomiting), the increase in size and the presence of malignancy warrant a thorough evaluation. Malignant gastric tumors can be aggressive, and their potential to metastasize increases with size.
2. Surgical Indications: Surgery is often indicated for gastric tumors, especially if they are confirmed to be malignant. The primary goal of surgical intervention is to remove the tumor and any surrounding tissue that may be affected. In cases of early-stage gastric cancer (Stage I), surgery is typically the mainstay of treatment, as it can potentially lead to a cure. The surgical procedure may involve a partial or total gastrectomy, depending on the tumor's location and extent.

3. Staging and Further Evaluation: Before making a definitive decision about surgery, it's essential to stage the cancer accurately. This may involve imaging studies such as CT scans or endoscopic ultrasound (EUS) to assess the extent of the disease and whether there are any signs of metastasis. If the cancer is localized and has not spread to lymph nodes or distant organs, surgical resection is more likely to be beneficial.

4. Multidisciplinary Approach: The decision to operate should ideally involve a multidisciplinary team, including a gastroenterologist, surgical oncologist, and medical oncologist. They can provide a comprehensive assessment of your condition and discuss the risks and benefits of surgery versus other treatment modalities, such as chemotherapy or radiation therapy, especially if the tumor is deemed unresectable.

5. Patient's Overall Health: Your overall health and ability to tolerate surgery are also crucial factors. If you have significant comorbidities or if the tumor's location poses a high surgical risk, the team may recommend alternative treatments or a more conservative approach.

6. Follow-Up and Monitoring: If surgery is not immediately indicated, regular follow-up with endoscopic evaluations and imaging studies is essential to monitor the tumor's progression. If the tumor shows signs of growth or if symptoms worsen, surgical intervention may become necessary.

In conclusion, given the increase in size and the diagnosis of malignancy, it is advisable to consult with a surgical oncologist to discuss the potential for surgical intervention. Early-stage gastric cancer typically requires surgical resection, and timely intervention can significantly impact outcomes. If you are hesitant or have concerns about the recommendations, seeking a second opinion from another specialist can provide additional clarity and reassurance. Remember, the management of gastric tumors is complex, and a tailored approach based on individual circumstances is crucial for optimal care.

Similar Q&A

Understanding Gastric Adenocarcinoma: Early Treatment and Care Options

Hello, I have a 92-year-old female patient who recently experienced a sudden onset of massive hematemesis. After intubation and biopsy, she was diagnosed with gastric adenocarcinoma. Currently, her weight and mental state are stable. I would like to understand what the prognosis ...

Dr. Lin Zongzhe reply Oncology
Hello! 1. Early-stage gastric cancer surgery still offers a chance for recovery, but the risks associated with surgery must be assessed by a qualified physician before making a decision. 2. If surgery is not performed, supportive therapy can be considered; chemotherapy and radiat...

Laparoscopic vs. Traditional Surgery: Choosing the Best Option for Tumor Removal

Dear Doctor, Hello. For the past six months, my father has been suffering from gastric bleeding caused by a tumor. Due to this issue, he has sought treatment at multiple hospitals, but he has been unable to receive proper care. His temper has been getting increasingly irritable,...

Dr. He Zhenming reply Surgery
Based on the description, gastrointestinal stromal tumors (GISTs) smaller than 3 centimeters are mostly benign; however, these tumors are prone to bleeding, and laparoscopic resection may be considered. Dr. He Zhenming.

Understanding Tumors: Assessing Malignancy and Treatment Options

Hello: A family member has had a tumor behind the right ear for nearly 25 years, which has gradually increased in size and is currently about 10 cm. However, it has not affected their health (only the appearance). I would like to understand if this type of tumor could be malignan...

Dr. Lin Zongzhe reply Oncology
Hello: 1. Clinically, the determination of whether a tumor is malignant can be based on several clues: (1) Tumor doubling time: the time required for the tumor volume to double; generally, malignant tumors double in volume in a matter of days to months. (2) Margins and surroundin...

Managing a Benign Liver Hemangioma: When No Symptoms Require Action

Hello Dr. Yeh: I recently underwent an upper gastrointestinal endoscopy, and the report mentioned that a benign hemangioma in the left lobe of my liver is slightly compressing the stomach. The doctor who performed the endoscopy seemed to emphasize this point. I have no discomfort...

Dr. Ye Qianyu reply Family Medicine
Hello, based on your description, it is suspected that the liver tumor is compressing the gastric body. Since the nature of the liver tumor is unknown, it is difficult to predict changes. Additionally, it is important to know the size of the liver tumor; even if it is benign, if ...