• Symptoms:
• Loss of appetite.
• Trouble swallowing.
• Fatigue or weakness.
• Nausea and vomiting.
• Unexplained weight loss.
• Heartburn and indigestion.
• Black stool (poop) or vomiting blood.
• Feeling bloated or gassy after eating.
• Stomach pain, often above your belly button.
• Feeling full even after eating a small meal or snack.

• Risk factors:

Factors that increase the risk of stomach cancer include:

• Family history of stomach cancer
• Helicobacter pylori (H. pylori)
• Gastroesophageal reflux disease (GERD).
• Gastritis.
• Epstein-Barr virus infection.
• History of stomach ulcers or stomach polyps.
• A diet high in fatty, salty, smoked or pickled foods.
• A diet that doesn’t include many fruits and vegetables.
• Frequent exposure to substances like coal, metal and rubber.
• Smoking, vaping or chewing tobacco.
• Drinking too much alcohol.
• Obesity.
• Several genetic conditions are associated with increased gastric cancer risk, including:
• Lynch syndrome.
• Peutz-Jeghers syndrome.
• Li-Fraumeni syndrome.
• Familial adenomatous polyposis.

• Diagnosis and Tests:

Your provider will review your medical history, ask about your symptoms and perform a physical exam that may involve feeling for a mass in your stomach. They may order several tests to diagnose and stage stomach cancer.

Staging allows your provider to assess how much the cancer has spread. With stomach cancer, staging ranges from 1(one) to IV (four). Stage I means the cancer hasn’t spread beyond your stomach lining. Stage IV means that it’s spread to other organs.

• Upper endoscopy is commonly used to diagnose stomach cancer. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus. It may also have a tool to remove a sample of cells or tissue (biopsy) so a pathologist can view it under a microscope to check for signs of cancer.
• Endoscopic ultrasound is a special kind of endoscopy that can help stage cancer. The endoscope used has an ultrasound probe attached at its tip, that can take pictures of your stomach. It can show if the cancer’s spread from your stomach lining to your stomach wall.
• Radiologic tests, including a CT scan, barium swallow and MRI, can help identify tumors and other abnormalities that may be cancer-related. A PET scan can show if cancer has spread throughout your body.
• Treatment:

Treatment options for stomach cancer depend on the cancer's location within the stomach and its stage. Your health care provider also thinks about your overall health and your preferences when making a treatment plan. Stomach cancer treatments include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy and palliative care.

Surgery:

The goal of surgery for stomach cancer, which is also called gastric cancer, is to remove all of the cancer. For small stomach cancers, surgery might be the first treatment. Other treatments might be used first if the stomach cancer grows deeper into the stomach wall or spreads to the lymph nodes.

Operations used to treat stomach cancer include:

• Endoscopic mucosal resection is a procedure that uses an endoscope to remove carcinoma in situ and early-stage cancer from the lining of the digestive tract. An endoscope is a thin, tube-like instrument with a light and a lens and tools to remove tissue.
• Subtotal gastrectomy is the removal of the part of the stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor.
• Total gastrectomy is the removal of the entire stomach, nearby lymph nodes, and parts of the esophagus, small intestine, and other tissues near the tumor. Then the surgeon attaches the esophagus to the small intestine so the patient can continue to eat and swallow.

Chemotherapy:

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells.

Systemic chemotherapy might be used after surgery if there's a risk that some cancer cells were left behind. This risk might be higher if the cancer grows deep into the stomach wall or spreads to the lymph nodes. Giving chemotherapy after surgery is called adjuvant chemotherapy.

Chemotherapy can be used alone, or it can be combined with radiation therapy.

If surgery isn't an option, systemic chemotherapy might be recommended instead. It might be used if the cancer is too advanced or if you're not healthy enough to have surgery. Chemotherapy might help control cancer symptoms.

Radiation therapy:

Stomach cancer is sometimes treated with external radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Radiation therapy uses high-powered beams of energy to kill cancer cells. The beams can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine gives the radiation treatment to precise points on your body.

Radiation therapy is often done at the same time as chemotherapy. Sometimes doctors call this chemoradiation.

Radiation is sometimes used before surgery as it can shrink the cancer so that it's easier to remove. Giving radiation before surgery is called neoadjuvant radiation.

Radiation therapy might be used after surgery if the cancer can't be removed completely. Giving radiation after surgery is called adjuvant radiation.

Radiation can help relieve stomach cancer symptoms if the cancer is advanced or surgery isn't possible.

Hyperthermic intraperitoneal chemotherapy (HIPEC):

Regional chemotherapy is a method of placing chemotherapy directly into an organ or a body cavity, such as the abdomen, to mainly affect cancer cells in those areas.   

A type of regional chemotherapy called hyper-thermic intraperitoneal chemotherapy, or hot chemotherapy, is being studied to treat stomach cancer and may be offered at certain treatment centers. After the surgeon has removed as much of the cancer as possible during surgery, a chemotherapy drug, such as mitomycin or cisplatin, is warmed and pumped directly into the peritoneal cavity through a thin tube for about 2 hours. The surgeon then drains the chemotherapy from the abdomen and rinses the abdomen before closing the incision.

Targeted therapy:

Targeted treatments use medicines that attack specific chemicals present within cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Your cancer cells are tested to see if targeted therapy is likely to work for you.

For stomach cancer, targeted therapy is often used with systemic chemotherapy. Targeted therapy is typically used for advanced stomach cancer. This might include stage IV stomach cancer and cancer that comes back after treatment.

Immunotherapy:

Immunotherapy is a treatment with medicine that helps your body's immune system to kill cancer cells. Your immune system fights off diseases by attacking germs and other cells that shouldn't be in your body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy is sometimes used to treat advanced cancer.

Palliative care:

Palliative care is a special type of health care that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. Palliative care is done by a team of health care providers. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

Your Shefa-El Orman care team:

At Shefa-El Orman Hospital, doctors from many specialties work as a team to provide comprehensive care for people with stomach cancer. Your care team may include: Medical oncologists, Oncology Gastroenterologists, Radiation oncologists, Pathologists, Dietitians, Palliative care experts and other specialists can be included as needed.

The top-ranked oncology gastroenterologists at Shefa-El Orman use advanced endoscopic ultrasound techniques to accurately identify the stage of your cancer. Your care team has access to the latest imaging techniques, such as PET/CT scans, to help detect cancer and determine its extent.

At Shefa-El Orman, you have access to a full range of treatments, including the latest treatment advances. Your care team will work with you to review your treatment options and develop a treatment plan that best suits your needs and goals.

Minimally invasive surgery. Mayo Clinic surgeons are skilled in all surgical techniques, including minimally invasive surgery, esophagectomy, subtotal gastrectomy, and total gastrectomy.

Carefully selected systemic therapy. The top-ranked oncologists at Shefa-El Orman carefully select targeted therapy and immunotherapy treatments that are most likely to work against your cancer. Pathologists use next-generation sequencing to analyze cancer cells so treatment can be tailored for people with advanced stomach cancer.

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• Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical blood test
• tumor markers (AFP, CEA, СА-19-9) (if clinically indicated)
• inflammation markers (CRP, ESR)
• blood coagulation analysis (aPTT, PT, INR)
• ultrasound of the abdomen, CT/MRI of chest and abdomen (if clinically indicated)
• upper endoscopy with biopsy histopathological examination with immunohistochemistry (if indicated clinically).
• nursing services
• consultation of related specialists
• treatment by chief physician and all leading experts (tumor board)
• explanation of individual treatment plan 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

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• Surgery:
  • Treatment may be partial or total gastrectomy with anastomosis regarding tumor location and extension and treatment plan will be explained by treating physician.
  • staging laparotomy.

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• review of medical records
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers (AFP, CEA, СА-19-9)
• indicators of inflammation (CRP, ESR)
• indicators blood coagulation
• abdominal ultrasound, CT/MRI scans (if indicated clinically).
• gastroscopy with biopsy with histopathology and immunohistochemistry (if indicated clinically).
• analysis of hp (helicobacter pylori)
• preoperative care
• operative
• partial resection of the stomach with anastomosis
• total resection of the stomach with anastomosis
• histological and immunohistochemical examination of the excised tissues (post operative).
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• nutrition recommendations
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results
• Upper gastric and duodenal cancer results
• Any recent laboratory results.

Price from: on request

Type of program: Inpatient

Expected duration of the program: 14 days

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• Radiotherapy or chemo _ radiotherapy:

Related to your clinical state and your plan of management

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI (if indicated clinically) 
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• tumor markers (CEA, СА-19-9)
• indicators of inflammation (CRP, ESR)
• indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according to your treatment plan.
• upper endoscopy and stenting (if clinically indicated)
• feeding jejunostomy (if indicated clinically).
• individual plan of the chemotherapy, the cost of medicines is included
• symptomatic treatment (for side effects of chemo and radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists (nutrition) (tumor board)
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy CT or MRI SIMULATION then planning, make the permanent tattoo marks on the skin to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded linear accelerator radiation therapy room.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

Chemotherapy may be through oral or intravenous route according to your treatment plan, during the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

During radiotherapy, you are under close follow-up daily from doctors and nurses.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results
• Upper gastric and duodenal cancer results

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

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• Chemotherapy, targeted and immunotherapy:

The program includes:

• Initial presentation in the clinic
• case history collection
• general clinical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers (if clinically indicated)
• indicators of inflammation
• indicators blood coagulation
• ultrasound of the abdomen, CT/MRI of chest and abdomen (if clinically indicated)
• gastroscopy with biopsy with histopathology and immunohistochemistry (if indicated clinically).
• Upper endoscopy and stenting or feeding jejunostomy (if indicated clinically) .
• 1 cycle of chemotherapy
• consultation of related specialists
• symptomatic specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• developing of further guidance

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request according to treatment protocol

Type of program: Inpatient or outpatient depending on chemotherapy protocol

Expected duration of the program: 5 days