Management of gastric carcinoma; comparative analysis of various treatment modalities

ABSTRACT

To find the best treatment modality for carcinoma stomach. Case series study. Combined Military Hospital Rawalpindi. From January 1996 to December 1999. 42 cases of gastric carcinoma are included in this study. The mode of treatment predominantly remained surgical with the aim to cure the patient of this disease. The disease occurred mostly above the age of 50 years. Common clinical features were unexplained weight-loss, malnourishment and anaemia, respiratory tract infections. No specific etiological factor was detected except that, out of 42 patients 35 were smokers or had quit smoking during the past six years. Nearly all were having at least 8-10 cups of hot tea per day. Adenocarcinoma was the most frequently encountered histological type. 03 patients could not be operated upon because of extremely poor prognosis due to multi-organ failure. 12 patients were selected for surgery curative resection was carried out, whereas the remaining 27 were subjected to palliative resections. Five patients died during or within one month of surgical intervention. Out of the remaining 34, only 21 patients reported for follow up. In most of the patients in whom curative resection was performed, the quality of life was reasonably good. At the end of one year, another eight patients had died of tumour dissemination and cachexia, three patients developed tumour recurrence at the anastomotic site, and one patient developed stricture at anastomotic site. Patients with recurrence were sent for radiotherapy. It is concluded that for carcinoma of stomach the only possible treatment is surgery either alone or in combination with radiation and chemotherapy, the most common, preventable etiological factor is smoking, probably in combination with hot beverages in excess. The most common presentation remains weight loss with dyspepsia or weakness and anorexia, commonly effected age group is middle and old age, preoperative nutritional build-up achieves good postoperative results, palliative surgical procedures made the quality of life of the patient better. The prognosis remains extremely poor, in terms of morbidity and mortality