Treatment

The treatment of gastric cancer is tailored to each individual and may consist of surgery, precision cancer medicines, chemotherapy, and radiation therapy. The specific treatment can depend on the stage and genomic profile of the cancer. Optimal treatment will often require more than one therapeutic approach and is likely to involve several different types of physicians. These physicians may include a gastroenterologist, a surgeon, a medical oncologist, a radiation oncologist, or other specialists. Care must be carefully coordinated between the various treating physicians.

Regimen: Bed Rest

Diet : Balanced Diet

• Avoid spicy and fatty food

• Avoid eating smoked and pickled foods and salted meats and fish

• Avoid smoking and alcohol, tea, coffee and citrus fruit • Drink plenty water

1. Endoscopic Resection.

For early gastric cancer (EGC), endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), has been an optimal modality in selected patients. The indications for endoscopic resection are based on observational studies on the natural history of EGC in the general population. Considering the more aggressive behavior in young patients with GC, the risk-benefit analysis of endoscopic resection should be finished before implementation. A study including 3741 patients with differentiated-type EGC showed that the lymph node metastasis rate in young patients was lower than that in older patients who fulfilled the endoscopic resection criteria, which validated the safety of endoscopic resection in these patients. However, for undifferentiated EGC, which has been considered an expanded criterion for ESD in general patients, no literature is available to validate the safety of ESD in young patients. One study that included EGC containing undifferentiated-type histology cancers reported a higher lymph node metastasis rate in young patients than in older patients (38. 3% vs. 13%). In addition, GCYA with a high proportion of diffuse-type tumors is partially associated with genetic alterations. Therefore, endoscopic resection for young patients with EGC with extended indications may not guarantee a good prognosis.

2. Surgery

Surgery is still the only chance for long-term survival for GCYA that can be curatively resected. Although Sun et al. reported that positive margins result in a significantly unfavorable outcomes for patients with relatively early-stage tumors but not for those with advanced diseases, some studies using multivariate analysis have indicated that status of resection margins, combined organ resection, and nodal involvement are independent prognostic predictors for GCYA. These results may support an attitude that is worth verifying in future research that a more extensive surgery should be performed in young patients to achieve R0 resection and more lymph node harvest, with the advantage that these patients may be more likely to tolerate aggressive surgery. Alternative treatment strategies involving neoadjuvant chemotherapy or chemoradiation also need to be explored in young patients, although these strategies have proven to be effective in general-aged GC patients in pivotal clinical trials.

3. Systemic Chemotherapy

In clinical practice, GC patients always present with unresectable advanced or recurrent disease, especially for young patients. For general-aged GC patients, the standard treatment regimen is systemic chemotherapy, based on the results of randomized controlled trial. Although GCYA only accounts for a minority of cases in these RCTs, another study that was focused on young patients found that standard chemotherapy may have similar efficacy for these patients. With favorable general conditions and organ function, GCYA patients experienced less adverse events, which may facilitate intensive therapy. With regard to subsequent treatment outcomes after first-line chemotherapy, data were limited in GCYA patients. GCYA patients with diffuse-type GC tend to have peritoneal metastasis after first-line chemotherapy, and early detection is much more difficult than metastasis in other organs, which may worsen the outcomes.

• Taxol

• Taxotere

• 5 – Flourouracil

• Xeloda (capecitabine)

• Lonsurf (Trifluridine/tipiracil)

• Lynparza (rubraca)

• Cyramza (ramucirumab)

4. Targeted and Immune Checkpoint Therapy

After publishing the ToGA trial, trastuzumab in combination with chemotherapy was considered to be a standard option for patients with HER2-positive advanced GC. However, considering the histology of GCYA, the majority of tumors may be negative for HER2. According to the HER-EAGLE study, only 9. 2% HER2 positivity was detected in patients before age 55. Based on the KEYNOTE trials, pembrolizumab shows promising antitumor activity in patients with heavily pretreated PD-L1-positive or MSI-H/dMMR advanced GC. Unfortunately, most GCYA patients belong to the genomically stable or microsatellite stable/epithelial-mesenchymal transition subtype in molecular classifications. Other checkpoint inhibitors have not shown any promising benefit in the treatment of GC. Therefore, patients with GCYA may not be good candidates for existing molecularly targeted agents and immune checkpoint inhibitors, which desire novel-targeted therapy developed by different approaches.

5. Palliation

Many patients present with distant metastases or direct invasion of organs, obviating the possibility of complete resection. In the palliative setting, radiotherapy may provide relief from bleeding, obstruction, and pain in patients with advanced disease, although the duration of palliation is short (mean, six to 18 months)^. Surgical procedures such as wide local excision, partial gastrectomy, total gastrectomy, or gastrointestinal bypass also are performed with palliative intent, to allow oral intake of food and alleviate pain.

Current research is focusing on the role of combined chemoradiation therapy followed by surgical resection for palliation of late gastric carcinoma. Chemotherapy can function as a radiation-sensitizer and, when used in conjunction with radiotherapy, achieves better local-regional control and tumor debulking than when used separately. Studies using this combination approach followed by surgical resection have reported positive results on overall survival rates. Other palliative procedures such as endoscopic laser treatments, endoluminal stenting, and placement of a feeding jejunostomy also may be performed.

Conclusion: -

GC is a growing threat in young adults, with many questions but few answers, and the threat has not always been taken seriously. What risk factors can result in a malignancy in such a short period are not known exactly, and even inherited predisposition may account for only a small proportion of cases. Although a similar or better survival outcome can be obtained in GCYA patients, this is mainly due to youth itself, with fewer comorbidities and better tolerance of aggressive treatment. With regard to the molecular mechanisms, precision treatment, and cost-effective screening methods, there are many questions awaiting our answers that require the efforts of all general people, policy-makers, clinicians, and researchers.

Human tumors (new formations) have been known since ancient times. Hippocrates also described certain forms of tumors. Bone neoplasms were found in the mummy of ancient Egypt. Surgical methods of tumor treatment were used in medical schools in ancient Egypt, China, India, Inca Peru, etc.

Russia has developed a clear system of cancer care. This is a set of measures aimed at preventing tumors, their early detection and development of the most effective treatment methods.

In terms of morbidity and mortality in Russia, stomach cancer ranks 2nd among malignant neoplasms (morbidity is about 40 per 100 thousand population). Men are about 2 times more likely to get sick than women. The disease rarely develops in persons under 40 years of age. The peak of incidence is 50-59 years old.

The nurse is one of the main persons who create the comfort and positive psychotherapeutic background of the medical institution. The nurse's behavior should prove to the patient that everything necessary is done for him in the hospital, confirm it with facts and gain the patient's trust and sympathy. Gentle treatment of the patient must necessarily be combined with a steady hospital regime, with the requirement to observe discipline. The nurse should set an example of diligence, restraint, equal treatment of all patients, discipline.

References:

exasoncology. com/types-of-cancer/gastric-cancer/treatment-management-of-gastriccancer/

aafp. org/afp/2004/0301/p1133. html#sec-2

https: //www. mayoclinic. org/diseases-conditions/stomach-cancer/symptomscauses/syc-20352438

https: //en. wikipedia. org/wiki/Stomach_cancer

https: //www. cancer. org/cancer/stomach-cancer/about/what-is-stomach-cancer. html

Harison Medicine book

Davidson Medicine book

A. W. Smith, K. M. Bellizzi, T. H. Keegan et al., “Health-related quality of life of adolescent and young adult patients with cancer in the United States: the Adolescent and young Adult Health Outcomes and Patient Experience study, ” Journal of Clinical Oncology, vol. 31, no. 17, pp. 2136–2145, 2013.

" Gastric Cancer in Young Adults". Revista Brasileira de Cancerologia. 46 (3). July 2000. Archived from the original on 3 July 2009.

^ " Health profile: United States". Le Duc Media. Archived from the original on 14 January 2016. Retrieved 31 January 2016.

^ " Health profile: China". Le Duc Media. Archived from the original on 3 January 2016. Retrieved 31 January 2016.

^ " Stomach Cancer: Death Rate Per 100, 000". Le Duc Media. Archivedfrom the original on 13 September 2014. Retrieved 13 March 2014.

^ " Stomach cancer statistics". Cancer Research UK. Archived from the original on 7 October 2014. Retrieved 28 October 2014.

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