Stomach cancers are one of the most dreaded cancers in oncology practice. This is because most of them are innocuous in presentation and are detected late. Early signs include loss of weight, decreased appetite and dark smelly stools (malaena). Later signs include vomiting (sometimes with blood), bloating of abdomen and sometimes a lump in the abdomen.
Treatment includes mainly surgery and chemotherapy, sometimes with radiation also. Surgery depends on the location of the cancer as well as the histological subtype of the cancer. Cancers in the lower part of the stomach are treated with a distal gastrectomy that is removal of the distal part of the stomach and surrounding tissue. Higher tumours may need a total gastrectomy or in some cases an esophago-gastrectomy, where part of the esophagus is removed with the stomach. Chemotherapy plays a strong role in these tumours.
Small intestinal cancers are rare, but most commonly found in the duodenum. Depending on their location, surgery may be a simple resection of the tumour or in certain cases, a whipples surgery where a part of the pancreas, bile duct and gall bladder may be removed.
Bile duct cancers also have a poor outcome, which depends on the location of the cancer, the closer the location to the pancreas, the better the outcome. The main modality of treatment is surgery which includes removal of the bile duct, gall bladder and surrounding nodal tissue. Sometimes a segment of the liver or part of the pancreas may also need excision. Post surgical usage of chemotherapy has shown some benefit.
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