Dissertation abstracton medicine on the topic Non-epithelial tumors of the stomach. Diagnostics and treatment tactics

As a manuscript

DUBININ Sergey Anatolievich

NONEPITELIAL GASTRIC TUMORS.

DIAGNOSTICS AND TREATMENT TACTICS. 14.00.27 - surgery

MOSCOW - 1997

Work is done

at the Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences and the Moscow City Oncological Dispensary.

SCIENTIFIC LEADERS:

Laureate of the State Prize of the Russian Federation,

doctor of Medical Sciences, Professor V.A.KUBYSHKIN

Doctor of Medical Sciences V.D. CHKHIKVADZE

OFFICIAL OPPONENTS:

Doctor of Medical Sciences, Professor V. P. PETROV Doctor of Medical Sciences, Professor Yu. I. Patyutko

Leading organization -

Moscow Research Oncological Institute P.A. Herzen.

Defense will take place "£" 4997 g

at "at the clock" at the meeting of the Dissertation Council D.001.19.01 at the A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences at the address: 113811, Moscow, B. Serpukhovskaya st., 27, conference hall.

The thesis can be found in the library of the Institute of Surgery. A.V. Vishnevsky RAMS.

Scientific Secretary of the Dissertation Council, Cand. honey. sciences

Shulgina N. IV

RELEVANCE OF THE PROBLEM

Non-epithelial tumors of the stomach (NEC) are a relatively rare disease of the digestive tract. Among tumor lesions of the stomach, they are observed in 0.5-5% (Gashelin S.A., 1995, Lebedev V.A., 1991, Ponomarev A.A., 1996, Dougherty M. J., 1991, Fischbach W., 1992). The disease can be asymptomatic with a significant size of the neoplasm and be accompanied by severe clinical symptoms at a small size, if it occurs in the sphincter zones of the stomach. Therefore, the rarity of this disease, on the one hand, and the multiplicity of its manifestations, on the other, determine the complexity of diagnosis and, often, late detection of the tumor.

A lot of works by both domestic and foreign authors have been devoted to the issues of diagnosis and surgical treatment of patients with VAW. However, the analysis of modern literature data showed that a number of issues are insufficiently illuminated: the most informative complex of modern diagnostic methods has not been determined, which allows to substantiate the treatment tactics, the judgments in the choice of the method and volume of surgical treatment are contradictory.

The complexity of diagnosis can be reduced due to the introduction into clinical practice of such highly informative non-invasive instrumental methods as ultrasound, computed tomography, angiography (Roslov A.L., 1992, Ferrozzi F., 1993, Lerner M., 1992, Palazzo L., 1993) ... However, in the modern literature, the role of these techniques in VAW is practically not reflected, as a result of which the latter are often not used in patients with VAW.

The need for surgical treatment of these patients is currently beyond doubt. However, the dispute

the questions of choosing the nature and volume of surgical treatment, both benign and malignant, remain unanswered. (Petrov V.P., 1993, Rath M. 1994, Shutze W. R., 1991). So, there is no consensus about the volume of surgical intervention for gastric lymphosarcoma, the need for palliative gastrectomy in this disease (Bandoh T., 1993, Walker K., 1992). There are also alternative opinions regarding other types of stomach sarcomas. Some authors recommend performing this gastrectomy or subtotal resection of the stomach (Laletin V.G., 1991, Sobrino-Cossio S., 1995). Other experts believe that the effectiveness of gastrectomy and wedge resection of the stomach in these types of VAW is the same (Carson W., 1994, Conlon K. S., 1995, Farrugia G., 1992). The issue of the legality of organ-saving operations for benign non-epithelial neoplasms also requires its resolution.

It should be noted that the analysis of the results of various methods of surgical treatment of VAW in most authors is based on a small number of observations, which does not allow making well-reasoned conclusions. Therefore, it is of great scientific and practical interest to study the long-term results of treatment of patients with VAW, the effect of tumor characteristics (morphology of the neoplasm, its size, the prevalence of the tumor process, invasion into other organs, the presence of metastases) on the survival of patients. But, undoubtedly, one of the most important tasks is to establish the influence on the prognosis of the disease of the nature and volume of the operation performed and to determine the value of combination therapy in the treatment of VAW. This work is aimed at solving these issues.

PURPOSE OF THE STUDY

To develop an optimal diagnostic system and a pathogenetically justified choice of surgical tactics for non-epithelial tumors of the stomach.

TASKS OF THE RESEARCH

1. To substantiate the optimal complex of diagnostic studies in patients with non-epithelial tumors of the stomach, to establish the factors and conditions that determine their early diagnosis.

2. To substantiate the criteria for the choice of therapeutic tactics and methods of surgical treatment for morphologically different non-epithelial tumors of the stomach.

3. To evaluate the effectiveness of the results of surgical treatment of non-epithelial tumors of the stomach based on the analysis of its immediate and long-term results.

4. Determine the place of combination therapy in the treatment of non-epithelial tumors of the stomach.

SCIENTIFIC NOVELTY

1. A set of clinical symptoms and diagnostic criteria has been determined, which makes it possible to establish the nature of a non-epithelial stomach tumor with a greater degree of probability before surgery.

2. The role and practical value of modern instrumental (ultrasound, CT) research methods in the diagnosis of non-epithelial tumors of the stomach and the rational sequence of their use have been specified.

3. The assessment of various treatment tactics in the light of predicting the course and outcomes of the disease is presented.

4. The principles of choosing the optimal therapeutic tactics for various morphological types of non-epithelial tumors of the stomach have been substantiated.

5. Using the methods of mathematical statistics, the factors that determine the prognosis and course of the disease are identified.

PRACTICAL VALUE

1. The general patterns of clinical manifestations of non-epithelial tumors of the stomach are described in detail.

2. An optimal system of instrumental diagnostics for non-epithelial tumors of the stomach has been developed.

3. Criteria for the choice of treatment tactics, methods of surgical and combined treatment have been developed.

APPROBATION OF WORK

The main provisions of the work were reported at the conference of the Department of Abdominal Surgery of the Institute of Surgery named after A.V. Vishnevsky June 26, 1997.

SCOPE AND STRUCTURE OF WORK

The dissertation is structured according to the traditional type, consists of an introduction, a review of the literature, 4 chapters of his own research based on the analysis and observation of 82 patients with non-epithelial gastric tumors. Contains 14 tables, 10 photographs and 4 graphs. The bibliography is represented by 81 works by domestic and 86 foreign authors. The volume of the thesis is 158 typed sheets.

BASIC DATA ABOUT THE PERFORMED STUDY AND ITS RESULTS

The experience of the Institute of Surgery named after V.I. A.V. Vishnevsky RAMS and the Moscow City Oncological Dispensary, where from 1977 to 1997 inclusive 82 patients were treated for non-epithelial gastric tumors (NEC), including 38 patients with benign non-epithelial tumors of the stomach (NEP) (women - 28, men - 10), with malignant non-epithelial tumors of the stomach (NNOZH) - 44 patients (women - 18, men - 26).

The frequency of individual types of VAW in our study differed significantly. Leiomyomas predominated among benign neoplasms, which were detected in almost half of the patients (45%). They were followed by glomic tumors (13.5%), lipomas (10.5%) and angioleiomyomas (10.5%). The rest of the types of DNVD were represented by single observations.

The first place among malignant neoplasms of the stomach was occupied by lymphosarcomas (66%). The rest of the morphological types of OVOL were revealed much less frequently: angioleiomyosarcoma - 20.5%, leiomyosarcoma - 9%, malignant glomic tumor - 4.5%.

In terms of the incidence of DNES, women suffered from them almost three times more often than men. We have not seen hamartomas, fibroids, angioleiomas and neurogenic tumors in males. Lipomas, fibromas, and glomic tumors were detected with approximately the same frequency in both men and women.

Malignant neoplasms were deliberately divided by us into two groups: lymphosarcomas of the stomach and other types of malignant non-epithelial neoplasms. This gradation, in our deep conviction, is absolutely necessary in view of the identified

different clinical manifestations, course of the disease and tactics of surgical treatment of these tumors.

Sarcomatous lesions of the stomach in men were almost one and a half times higher than in women. The same ratio was found both in gastric lymphosarcoma and in other types of malnutrition.

A study of the age characteristics of patients with DNBI showed that the peak incidence occurred at the age of 50-70 years, which was found in two-thirds of our patients (66%). It should be noted that while the maximum morbidity among women was noted in the life period of 50-69 years (78.7%), in men it fell on the age over 70 (40%).

Malignant non-epithelial neoplasms prevailed in persons of both sexes at the age of 40-49 years, which was revealed in 36% of cases. Somewhat less often, OVLDs were found in the life period of 60-69 years (20%) and 50-59 years (18%). When analyzing the age characteristics of patients with lymphosarcoma, two peaks of morbidity were revealed

40-49 and 60-69 years old.

The localization of non-epithelial neoplasms was very different, however, the body of the stomach is significantly more often affected by both benign and malignant tumors.

With DNBI, this was observed in almost two thirds of patients (63%), more often a tumor was detected in the upper and middle third of the stomach. In the exit section, DNBL were noted in every fifth patient, in the proximal section

Every seventh patient. Localization of the tumor along the anterior and posterior walls of the stomach was noted in the same number of observations - 29%, somewhat less often along the greater curvature - 23.5% and along the lesser curvature - 18.5%. One of the peculiarities of localization of different morphological structures of DNOL was the fact that in 75% of cases stomach lipomas were detected in the outlet section on the posterior wall.

Sarcomatous lesions of the body of the stomach were found in more than half of our patients (54%). Weekend from-

Table 1.

MORPHOLOGICAL VARIETIES OF NEPITELIAL GASTRIC TUMORS

Benign Malignant

Histological col- Histological col-

structure honest-% structure honest-%

tumors in tumors in

leiomyoma 17 45 lymphosarcoma 29 66

glomic 5 13.5 angioleiomyo- 9 20.5

sarcoma tumor

lipoma 4 10.5 leiomyosarcoma 4 9

angioleiomyoma 4 10.5 malignant 2 4.5

fibroma 3 8 glomic

hamartoma 2 5 tumor

fibroids 1 2.5

neurineoma 1 2.5

neurofibroma 1 2.5

TOTAL 38 100 TOTAL 44 100

cases was involved in the tumor process in every fourth patient, the proximal section and corner of the stomach - in every tenth patient.

It would be unfair not to notice important features in the localization of malignant neoplasms for the selected groups of DOLS (lymphosarcomas and other types of DOLs), where heterogeneity of gastric lesions in these diseases was revealed.

Suffice it to note that in every third patient with ERV, the tumor spread to two or more anatomical parts of the stomach, and in the overwhelming majority of cases they were represented by lymphosarcoma. There is no doubt that lymphosarcoma of the stomach has the greatest tendency to local spread of the tumor process. So the total defeat of the stomach by a tumor and its spread to the esophagus or duodenum was noted exclusively in lymphosarcoma. One of the main features of mesenchymal, vascular, and neurogenic OVOL was their localization in one,

sometimes, with a significant size of the neoplasm, in two anatomical parts of the stomach.

In half of the cases, benign neoplasms had an exogastric type of growth, tumors with an intramural type of growth were somewhat less common in a third of our patients, and most rarely with an endogastric type in only every seventh patient. Tumors with an intramural location in all cases did not exceed 3 cm. In general, the size of the DNVD varied within wide limits. Most often, we detected small neoplasms (1-3 cm) - in one third of our patients. Giant tumors (more than 10 cm in size) were detected in every seventh patient.

In most cases, malignant neoplasms had an intramural growth type (61.5%). The exogastric type of growth was noted by us in one third of patients, endogastric - in single observations. At the same time, it should be noted that intramural growth was detected in 89% of patients with gastric lymphosarcoma. As a rule, other types of DOL had an exogastric type of growth in our study. For example, all the angioleiomyosarcomas observed by us were located exogastric.

The size of the RNOZH varied widely. In this case, lymphosarcomas often occupied two or more anatomical sections of the stomach, passing from one curvature to the wall or circularly covering the organ. Other types of gastric sarcomas, as a rule, grew as solitary nodules, reaching considerable sizes. The largest number of DOLs were 10 cm and more, which was found in one third of patients. The size of angioleiomyosarcomas only in every fourth patient was less than 10 cm. It is noteworthy that the leiomyosarcomas were characterized by a small size, in all cases their size did not exceed 5 cm, which was a considerable difficulty in diagnosis and differential diagnosis. Thus, according to our data, the tumor size cannot be taken in

attention, as a criterion for the benign or malignant neoplasm.

The presented data show that the localization of the tumor, its size and type of growth are random in all types of NDT. Lymphosarcoma is characterized by intramural growth, local spread of the tumor. In most cases, other types of DOL are solitary neoplasms of significant size and have exogastric growth. The external similarity with the last benign NWD does not allow to visually determine the nature of the neoplasm.

NONEPITELIAL GASTRIC TUMORS

The difficulty of early detection of both benign and malignant VAWs is based on their often asymptomatic development, as well as polymorphism of symptoms depending on the size, location and nature of growth. In turn, none of these factors by itself reflects the morphological affiliation of the tumor.

Therefore, in our opinion, it is almost impossible to rely on clinical manifestations in the formation of a presumptive diagnosis.

Clinical manifestations of VAW were determined not only by the nature of growth, localization of the tumor, its size, as well as concomitant diseases of the stomach. To confirm this, let us consider the role of individual symptoms in the diagnosis of VA.

Analyzing the clinical manifestations, we found that an absolutely asymptomatic course of the disease was observed in every seventh of our patients with DSP and the tenth patient with DSP.

In half of the observations, the most frequent symptoms of DNBE patients were pain in the epigastric region,

dyspeptic symptoms, general weakness. A third of our patients complained of a feeling of heaviness in the epigastric region. Objective examination sometimes made it possible to determine the presence of a palpable tumor-like neoplasm, which was detected in 16.5% of patients. Weight loss and vomiting were noted by every tenth patient with DNBI. An atypical manifestation of the disease (gastric bleeding) was observed in 5% of patients.

The most frequent clinical symptoms in patients with OVD were general weakness (77%), pain in the epigastric region (73%), weight loss (54.5%), dyspeptic symptoms (50%), a feeling of heaviness in the epigastric region (32%). Symptoms such as vomiting (16%), decreased appetite (11.5%), increased body temperature (4.5%) were somewhat less common. The first manifestation of the disease in 18% of patients was the presence of a palpable tumor in the abdominal cavity, and in all patients the tumors had an exogastric type of growth. Complication (gastric bleeding) as the first manifestation of the disease was noted in 13.5% of our patients.

The above data indisputably prove that the clinical symptoms of both DNBI and YVDB are identical and clearly coincide with the symptoms of any other stomach disease.

Therefore, in the case of IVD, the disease often proceeds under the "clinical masks" of other stomach diseases, which was noted in 10.5% of our patients with DNVD. In 3 cases a combination of cancer and gastric leiomyoma was revealed, and in one more leiomyoma and hepatocellular cancer. In all cases, DNVD was detected intraoperatively and their size did not exceed 2.5-3 cm.In addition, it should be noted that in 8% of cases, patients with DNVD had a history of gastric ulcer, in 16% - duodenal ulcer, 32% - chronic gastritis, 5% - stomach polyps.

In a third of the observations, patients with GVOZ had a history of gastric ulcer, and all patients were subsequently diagnosed with lymphosarcoma. Each de-

the fifth patient suffered from duodenal ulcer. In 27% of cases, patients were previously diagnosed with chronic gastritis. Three patients had previously been operated on for gastric ulcer; all underwent gastric resection.

We have identified some patterns of clinical manifestations of the disease depending on the type of tumor growth.

In endogastric and intramural forms of growth, the clinical manifestation of VAW included: pain in the epigastric region, nausea, vomiting, heartburn, belching with air, feeling of heaviness in the epigastric region. The complaints described above were also characteristic of the small size of the neoplasm. With the exogastric arrangement of the VA, the characteristic complaints were general disorders and the presence of a palpable mass in the abdominal cavity. These complaints were also noted by patients in whom the tumor reached a significant size. At the same time, attention was drawn to the discrepancy between the size of the tumor and clinical manifestations (oligosymptomatic course) in some cases of DNOL.

Exogastric and intramurally located VAW were asymptomatic in approximately the same number of cases, while endogastric sarcomas did not have such a course of the disease in any case.

One of the main features of the clinic of mesenchymal, vascular and neurogenic sarcomas is that they appear much later than lymphosarcoma and often manifest themselves with various kinds of complications. So gastric lymphosarcomas in 7% were manifested by gastric bleeding, in 7% - were asymptomatic. For other types of sarcomas, asymptomatic course was typical in 20%, and the development of complications - in 27%.

The clinical picture of the disease in patients with malignant tumors also depended on the location of the tumor. So, with the location of the LNOZH in the outlet of the stomach in 30% of cases

patients complained of vomiting and 70% of nausea. As for the considered peculiarity in relation to DNVD, no such regularities have been identified.

Summarizing our data, we can conclude that all non-epithelial tumors of the stomach do not have a pathognomonic symptom complex, often asymptomatic, which often does not allow us to assume the true nature of the disease based on the patient's complaints alone, and even more accurately differentiate the benign or malignant process. Therefore, absolutely all patients need to be examined with the involvement of all methods of instrumental diagnostics. Only this approach makes it possible to choose an adequate treatment.

DIAGNOSTICS

NONEPITELIAL GASTRIC TUMORS

The complex of diagnostic methods of research included X-ray examination of the upper gastrointestinal tract, esophagogast-rhoduodenoscopy with gastrobiopsy, ultrasound examination of the abdominal organs, computed tomography of the abdominal organs with stomach contrast, which were performed in the vast majority of patients. In some cases, diagnostic laparoscopy and duplex scanning of the vessels of the abdominal cavity were used.

ROLE OF ESOPHAGOGASTRODUODENOSCOPY

IN DIAGNOSTICS

NONEPITELIAL GASTRIC TUMORS

The characteristic signs of EGDS in patients with DNOL were the identification of a submucosal formation of a round or oval shape, with a smooth surface.

tyu, with a stretched, atrophic and thinned mucous membrane above it, in some cases with ulceration. With small neoplasms (up to 3 cm), peristalsis above the latter was not changed. In a third of the observations, atrophic gastritis was detected.

An important part of the endoscopic study was targeted biopsy followed by histological and cytological examination, which was performed in half of our patients. As a result of this study, DNEC was detected in a quarter of patients (26.5%). In three cases, gastric cancer was detected, which corresponded to reality, since later intraoperatively a combination of cancer and gastric leiomyoma was revealed.

Endoscopic examination of patients with DNBI revealed the true diagnosis in almost two-thirds of our patients (62.5%). A false positive diagnosis (stomach cancer, callous ulcer, compression and deformation of the stomach, bulb ulcer 12 sc) was established in one third of patients. There were no pathological changes in one observation with exogastric gastric leiomyoma of 1x2 cm in size.With endoscopic examination of patients with gastric lymphosarcoma, we consider the infiltration of the mucous membrane, which we detected in two-thirds of patients (65.5%), as characteristic features, while in one third of observations it passed from one wall of the organ to the curvature and another wall, and in every fifth patient it was circular. The spread of the tumor to the esophagus was revealed in two patients, and in one of them it was found that the tumor also spreads to the duodenum. In 69% of cases, the presence of deformed, thickened, convoluted, edematous folds of the gastric mucosa was revealed. Peristalsis in the infiltration zone was changed in almost half of the patients (41.5%), and in one case the latter was absent. Ulceration of the gastric mucosa was detected in 38% of patients, while in the overwhelming majority of cases they were multiple. Gastro-

biopsy in these patients revealed gastric lymphosarcoma in only 20.5% of cases.

For other types of gastric sarcomas, the following pathological changes were characteristic: visually, they were represented by a round, oval or polycyclic shape, submucosally located neoplasms protruding into the lumen of the stomach in 82% of cases. Compression of the stomach from the outside was found in 18%. In most cases, the surface of the lesions was uneven, bumpy, covered with a thinned, atrophic mucous membrane, and in almost half of the observations (45%) in the apical part of the tumor, ulceration of an irregular shape was revealed, with uneven, raised edges. Gastrobiopsy was diagnosed in 40% of patients.

At the same time, as evidenced by our experience, it is often impossible to differentiate these types of DOL with EGDS with gastrobiopsy from DOL. Therefore, the final answer can be obtained only after histological examination of the removed neoplasm.

When analyzing our results, it was revealed that EGDS and biopsy are less effective in patients with lymphosarcoma (20.5%) than in other types of malignant neoplasm (63.5%). This, apparently, can be explained by the visual similarity of gastric lymphosarcoma and the infiltrative form of gastric cancer. Therefore, in the majority of patients with lymphosarcoma, the revealed changes were interpreted as "stomach cancer".

Thus, EGDS is a valuable, informative and indispensable method for diagnosing VAW.

ROLE OF THE X-RAY METHOD OF STUDY IN DIAGNOSTICS OF NONEPITELIAL TUMORS OF THE GASTRIC

The X-ray picture of the VA was primarily associated with the nature of the growth of the neoplasm.

In endogastric VSPs, intra-luminal filling defects were revealed, oval or round in shape, with clear even contours in 80% of cases, in half of which ulceration in the apical part was determined. Displacement of the tumor was noted in all patients. In addition, a change in the contours of the folds of the gastric mucosa was detected in 60% of patients, an arcuate bending of the folds of the mucous membrane in 40%, and the breakage of the latter with a significant size of DNVD in 20%.

In the case of intramural placement of the VSP, the characteristic signs were the presence of a persistent marginal filling defect of a small size, ulceration over the formation was detected only in every fifth patient. The tumors were mobile; the motor-evacuation function was not changed in any patient. In 3 patients with intramural leiomyoma, the X-ray picture was due to the presence of gastric cancer in them, while DNOL was not detected.

With the exogastric position of the DNBE, the image was quite varied. In cases when the neoplasm was connected to the wall of the stomach with a "leg" (21%), in some projections no pathological changes were detected. In case of significant DNBE, which was revealed in one third of our patients, the stomach was displaced and compressed. In 84% of cases, a marginal filling defect of 2 to 10 cm in size was detected, ulceration on the apical part of the neoplasm was found in 16% of patients. In half of the observations, the folds of the gastric mucosa were smoothed and fanned out over the tumor. During X-ray examination, such patients often had the idea of \u200b\u200bthe presence of an exogastric neoplasm or pressure on the stomach of a tumor emanating from any organ of the abdominal cavity.

The true diagnosis after performing an X-ray examination in patients with DNOZH was established when

endogastric, intramural and exogastric forms of growth, respectively, in 60%, 50% and 68%, and for all forms of growth - in 60.5%.

X-ray examination of the upper parts of the gastrointestinal tract in patients with lymphosarcoma was characterized by the following pathological changes: filling defects of 1-10 cm in size with indistinct uneven contours and ulceration in the form of a "niche" with indistinct uneven contours - in half of the patients, local absence peristalsis - in 45% of cases, its complete absence - in two patients. Persistent deformity of the stomach was detected in a quarter of observations, the infiltration of the gastric mucosa - in 79.5%, the rigidity of the mucosa in the infiltration zone - in 62%. In one third of our patients, there was an alternation of tuberous growths of the mucous membrane with areas of atrophy and thinning of the latter.

After this study, the true diagnosis was established only in% of cases. In most cases, these changes were interpreted as stomach cancer (83%).

X-ray examination with other forms of OVOL with exogastric growth revealed deformation of the stomach in 78% of cases, filling defects of 4-8 cm in size, with irregular fuzzy contours, 89% observed a change in folding in the zone of the filling defect, in 78% - bending of folds the mucous membrane of the tumor. The motor-evacuator function was not changed in any patient.

In the endogastric position, filling defects with indistinct uneven contours, convergence of mucosal folds to the formation and a wide tumor shaft were determined, while local absence of peristalsis was noted.

With intramural growth, a filling defect with uneven clear contours and a local absence of peristalsis were revealed in two thirds of patients.

With X-ray examination of mesenchymal, vascular and neurogenic sarcomas, the true diagnosis was established in 65% of cases.

So, it should be noted that esophagogastroduodenoscopy and X-ray examination of the stomach make it possible to identify and correctly interpret the revealed changes in a fairly large percentage of observations of DNVD and mesenchymal, vascular and neurogenic VVD. At the same time, in case of gastric lymphosarcoma, these research methods are often not enough to verify the true nature of the disease.

ROLE OF ULTRASONIC STUDIES IN NONEPITELIAL GASTRIC TUMORS

Diagnostic difficulties can sometimes be resolved by the method of ultrasound diagnostics.

The study revealed pathological formations, in 20% having a connection with the stomach, their contours varied from clear even to clear uneven, echogenicity - from hypo to hyperechoic, structure - from heterogeneous to homogeneous. No dependence of the contours, structure, and echogenicity on the morphological type of DNBV was revealed.

In patients with DNBD, the true diagnosis was established in every fifth case. In 17%, a false-positive diagnosis of a tumor of another abdominal organ was obtained.

In lymphosarcoma, a thickening of the stomach walls up to 2-2.5 cm was visualized, in other types of malignant tumors, solid neoplasms with a connection with the stomach, heterogeneous structure, hypoechoic, in some cases heterogeneous, with decay cavities.

The true diagnosis in patients with OVD was established in 10% of patients. In a third of the observations, a false-positive diagnosis of stomach cancer was obtained (mainly with lim-

phosarcoma) or a tumor of some other abdominal organ.

The low percentage of detection of both OVD and OVD in our study can be explained by a number of reasons. Firstly, our study was of a screening nature, and was not carried out for a targeted search for pathological gastric neoplasms. Secondly, we did not use any special contrasting techniques or tight filling of the stomach. Therefore, this result can be considered satisfactory.

Thus, in our opinion, traditional endoscopic, X-ray and ultrasound research methods do not provide enough information for VAW. To clarify the diagnosis of these diseases, it is imperative to use more modern examination methods, namely, computed tomography of the abdominal and stomach organs.

COMPUTER TOMOGRAPHY

IN THE DIAGNOSIS OF NONEPITELIAL TUMORS OF THE STOMACH

The most effective method in diagnosing DNVD is computed tomography of the abdominal and stomach organs, which made it possible to establish the correct diagnosis in DNVD patients in most cases (83.5%).

The study revealed pathological neoplasms ranging in size from 2 to 12 cm, density from -112 to 40-44 units, their contours varied from clear uneven to clear even. The structure was homogeneous in some cases (lipoma, hamartoma), in others it was inhomogeneous (leiomyoma, angioleiomyoma, glomic tumor).

Our experience has shown that CT allows not only to accurately determine the organ affiliation of the tumor, but also in some cases to characterize it morphologically.

In case of VNOZH, computed tomography made it possible to correctly establish the diagnosis in half of the observations.

At the same time, pathological formations of 6-14 cm in size were revealed, in all cases with an even clear contour, in most (68%) inhomogeneous, in a third of observations with decay cavities.

In other cases, a false-positive diagnosis of stomach cancer (with lymphosarcoma) and a tumor of any organ of the abdominal cavity (with other types of gastric cancer) was established. In addition, the role of CT in the detection of metastases in malignant tumors is undoubted.

It should be noted that CT was more effective in diagnosing mesenchymal, neurogenic and vascular tumors, when the correct diagnosis was established in the vast majority of cases. The sensitivity of this method for all types of DOL was significantly higher than with other instrumental examination methods.

We are deeply convinced that the CT method should be widely used in the diagnosis of VA. To ensure greater efficiency, the research method itself must necessarily include the maximum expansion of the stomach walls with the introduction of a gas or water-soluble contrast.

The sequence of application of various methods of instrumental diagnostics in patients with VAW, in our opinion, should be as follows: X-ray examination of the stomach, esophagogastroduodenoscopy with gastrobiopsy, ultrasound, computed tomography. We believe that only the use of the entire set of instrumental research methods in the diagnosis of VAW allows one to get as close as possible to solving the diagnostic problem in these patients.

So, when using the whole complex of diagnostic measures, the diagnosis of DNBE was established and then

the study coincided with the clinical diagnosis in 69% of cases. In case of OVOZH, the diagnostic accuracy was 30% (lymphosarcoma - 20.5%, other types of OOZH - 48%).

Table 2.

INFORMATIVITY OF THE METHODS

INSTRUMENTAL DIAGNOSTICS

FOR NONEPITELIAL GASTRIC TUMORS

Research method of the bottom number of observations by the diagnostician, accuracy of ZNOZh number of observations by the diagnostician, accuracy

egds 37 62.5% 40 32.5% lymphosarcoma - 20.5% other malignant neoplasms - 63.5%

X-ray examination 38 60.5% 43 25.5% lymphosarcoma -7% other GIOL - 65%

Ultrasound 30 20% 30 10%

CT 12 83.5% 11 54.5%

TREATMENT OF PATIENTS WITH NONEPITELIAL GASTRIC TUMORS

Formation of the principles of substantiation of therapeutic tactics for VAW is based on their morphological variety, localization, and size of the neoplasm.

But the fact that many patients with VAW in the preoperative period do not have morphological

confirmation of the diagnosis or morphological diagnosis is of a presumptive nature, the need for surgical treatment in this category of patients is beyond doubt.

TREATMENT OF PATIENTS WITH BENEFICIAL NONEPITELIAL GASTRIC TUMORS

Most of our patients (78.3%) underwent organ-sparing surgery - tumor enucleation or wedge resection of the stomach. An urgent histological examination performed revealed the benign nature of the disease, the absence of tumor cells in the section of the removed part of the stomach. Analysis of the immediate and long-term results of treatment showed that in none of the observations there were no tumor recurrences. All this allows us to consider an organ-saving operation as the operation of choice in DNOSE.

At the same time, the surgeon should not be fooled by either the appearance or the size of the neoplasm. In those cases (21.7%), when it was impossible to reliably exclude malignancy, as well as when a large tumor is localized in the antrum or when DNOC is combined with an epithelial tumor, gastric resection should be performed in an oncologically justified volume.

In one case, an operation was performed for endoscopic removal of the endogastrically located DNOZH. Taking into account the absence of a large number of such observations, it is not possible to unequivocally speak for or against such operations.

In the immediate postoperative period, no complications were found in patients with DNBI in the vast majority of patients. One patient had gastric bleeding and another had an

stomositis and violation of evacuation. Conservative treatment in both cases led to recovery. In one more observation, an eventration was detected in the area of \u200b\u200bthe postoperative wound, and the postoperative wound was sutured. Finally, the fourth patient was found to have an esophageal-gastric anastomosis failure after proximal subtotal gastrectomy for leiomyoma and gastric cancer; the patient died.

TREATMENT OF PATIENTS WITH MALIGNANT NEPITELIAL GASTRIC TUMORS

In case of gastric lymphosarcoma, depending on its location and size, we performed subtotal gastrectomy or gastrectomy, which were performed in our patients, respectively in 67% and 22.2% of cases. At the same time, the lesion of the regional lymph nodes was revealed in this disease in 52% of our patients and the spread of the tumor to two or more anatomical parts of the stomach in 37% of cases. In every seventh patient, with involvement of adjacent abdominal organs in the tumor, the operation was extended to complete removal of the neoplasm.

Analysis of the immediate and long-term results of surgical treatment of these patients showed that subtotal gastrectomy and gastrectomy are an adequate intervention for gastric lymphosarcoma.

We believe that in these patients, if radical surgery is impossible due to the presence of regional and distant metastases, it is advisable to perform palliative gastrectomy followed by chemotherapy. This tactic, according to our data, provided a median survival rate of 80.7 months and an actual survival rate.

54.5%. The reason for rejecting the latter can only be a high degree of operational risk. In this case, we recommend polychemotherapy as the only treatment.

Complications in the immediate postoperative period were observed in 29% of patients (postoperative pneumonia, suppuration of the postoperative wound, puncture pneumothorax). In all cases, conservative treatment led to the recovery of patients. Failure of esophagojejunostomy, bilateral pneumonia with abscess formation and pulmonary edema, necrosis of the stomach stump wall were the cause of death in 3 patients. Thus, the mortality rate in the immediate postoperative period of patients with lymphosarcoma was 11%.

Chemotherapy in a number of patients in the postoperative period made it possible to achieve long-term remission in a number of patients. Polychemotherapy in the immediate postoperative period in the amount of 4 to 8 courses was carried out in every fourth patient, which was prescribed at the slightest doubt about the radical nature of the operation.

Based on our experience, the treatment of patients with gastric lymphosarcoma should be complex and include surgical intervention with obligatory postoperative polychemotherapy.

In other types of gastric sarcomas, a rare local-regional and metastatic spread, as shown by the analysis of long-term results of surgical treatment, makes it possible to perform a wedge-shaped resection of the stomach, which was performed in 53% of patients. Due to the spread of the tumor to neighboring organs (40%), it was often necessary to supplement the operation with resection of the abdominal organ involved in the tumor process. Subtotal gastrectomy was performed in 37% of cases.

Postoperative complications in patients with mesenchymal, vascular and neurogenic malignant neoplasms were noted in every seventh observation (postoperative

pneumonia, pancreatic necrosis). Conservative treatment in all patients led to recovery.

Mortality in the immediate postoperative period with all types of DOL was 7.1%. ZNOZH were resectable in 78.5% of cases, palliative operations were performed in 16.5%.

LONG-TERM RESULTS OF SURGICAL AND COMBINED TREATMENT OF PATIENTS WITH NONEPITELIAL

TUMORS OF THE STOMACH

When analyzing the long-term results of surgical treatment of patients with VAW, we used the methods of statistical processing of the SZB: 81ise (81a1Bo11, 1991). A study of the long-term results of treatment of 73 patients with NID was carried out, information about which was available to us by 1997 (DNOZH - 36, EOZH - 37). 5 patients were lost for remote observation.

39% of patients with gastric lymphosarcoma in the long-term period died from the underlying disease. The actual 3-year survival rate of patients with lymphosarcoma in our patients was 81%, 5-year - 50%, 10-year - 12%.

Among our patients with other types of HPAI, 28.5% of patients died from the underlying disease in the long-term period. The actual 3-year survival rate in these patients was 50%, 5-year - 30%, 10-year - 10%.

It was statistically reliably revealed that the survival rate of patients with lymphosarcoma is higher than with other types of malignant tumors (p< 0,05).

When analyzing the long-term results of surgical treatment of patients with DNBI, it was revealed that in none of the observations the cause of death was associated with the underlying disease.

We have information on the high statistical significance of the adverse effect on the prognosis of the disease in patients with gastric cancer, infiltration of the entire thickness of the stomach wall, invasion into adjacent organs of the abdominal cavity, the spread of the tumor to two or more anatomical parts of the abdominal cavity, tumor size more than 7 cm, and regional and distant metastases. Undoubtedly, the prevalence of the tumor process and the presence of metastases are of greater importance for the prognosis of the disease than other factors (p< 0,05).

The best results in gastric lymphosarcoma are subtotal gastrectomy or, if necessary, gastrectomy. In other types of gastric cancer, the survival rate of patients was identical with both wedge-shaped and subtotal gastrectomy. Significantly increases the survival rate of patients with lymphosarcoma chemotherapy in the postoperative period, which made it possible to increase the 5-year survival rate of patients from 28% to 66% (р< 0,05). Итоги изучения отдаленных результатов хирургического лечения больных ДНОЖ указали на высокую эффективность малотравматичных экономных, органосберегающих операций.

1. Non-epithelial tumors of the stomach (NEC) do not have a pathognomonic symptom complex, are often asymptomatic or are characterized by a variety of clinical manifestations depending on the location, size of the neoplasm, the nature of growth and morphology. For the diagnosis of the knife, it is necessary to use the whole complex of modern methods of studying the stomach, among which computed tomography is the most diagnostically informative.

2. From the standpoint of assessing the immediate and long-term results of the operation of choice for benign non-epithelial tumors, organ-saving operations are advisable - enucleation of the tumor or wedge-shaped resection of the stomach with urgent histological examination. If it is impossible to exclude malignancy, gastric resections in an oncologically justified volume should be performed.

3. The volume of surgical intervention for malignant non-epithelial tumors of the stomach largely depends on the nature of the tumor. In lymphosarcoma of the stomach, depending on its size and location, subtotal resection or gastrectomy is adequate. In the presence of unrecoverable regional and distant metastases and the impossibility of radical surgery, palliative gastrectomy is advisable. Rare local-regional and metastatic spread in other types of sarcomas allows wedge-shaped resection of the stomach.

4. After removal of gastric lymphosarcoma, polychemotherapy is indicated in all cases, which significantly increases the 5-year survival rate of patients.

5. The prognosis for benign neoplasms is favorable. For all types of gastric sarcomas, unfavorable factors. Worsening prognosis of disease-28

these are the infiltration of all layers of the stomach wall, the tumor size is more than 7 cm and, to the greatest extent, the presence of metastases and the spread of the tumor to more than one anatomical part of the stomach.

1. Symptoms of non-epithelial tumors of the stomach are always nonspecific, do not have clear manifestations. If a patient is suspected of having a non-epithelial tumor of the stomach, early involvement of a comprehensive diagnostic program, including all modern methods of instrumental diagnostics, is necessary.

2. In the diagnosis of VA should be taken into account that the highest diagnostic sensitivity is possessed only by a set of methods, including X-ray examination of the stomach, esophagogastroduodenoscopy with gastrobiopsy, ultrasound, computed tomography of the abdominal cavity and stomach.

3. In operations for benign non-epithelial tumors of the stomach, organ-saving interventions are indicated - enucleation of a neoplasm or wedge resection of the stomach. The benign nature of the tumor must be confirmed by an urgent histological examination of the operating material.

4. In operations for gastric lymphosarcoma, it is necessary to perform subtotal resection or gastrectomy; in other types of gastric cancer, it is permissible to perform a wedge-shaped resection of the stomach.

5. In the postoperative period, polychemotherapy is indicated for all patients with gastric lymphosarcoma.

1. "Treatment of non-epithelial tumors of the stomach" / collection of abstracts of the international conference of the 8th congress of surgeons of the Republic of Moldova "Topical issues of thoracoabdominal surgery", Chisinau, 1997 / et al. V. A. Kubyshkin, V. D. Chkhikvadze, I. P. Kolganova.

2. "Clinic, diagnosis and treatment of benign non-epithelial tumors of the stomach" 1997. Co-authors. V. A. Kubyshkin, G. G. Karmazanovsky, K. D. Budaev, I. P. Kolganova (accepted for publication).

A benign stomach tumor is a neoplasm that has no signs of a malignant process. In some cases, there is a small risk of rebirth if not properly treated. Benign neoplasms of the stomach account for up to 5% of all tumoral diseases of the stomach; they can develop from epithelium, nervous tissue, adipose structures or vascular. Growth can be fast or slow. In the direction of growth, tumors are isolated that move towards the lumen of the stomach, towards the organs of the abdominal cavity and neoplasms that grow inside the wall. By localization, they occur with the same frequency in the body of the stomach, antrum or elsewhere.

Varieties and features of gastric tumors

By origin, all neoplasms localized in the stomach area are divided into two large groups: epithelial and non-epithelial.

Among the first group, there are adenomas and polyps (single or in groups). The difference is that polyps are outgrowths into the lumen of an organ, they are usually round in shape and have a wide base, and can be located on a pedicle. The development of polyps is associated with age-related changes - they are more common after the age of 40, the disease affects men more often than women. Histologically, a polyp is an overgrown glandular and epithelial tissue with connective tissue elements and a developed network of blood vessels.

Adenomas are true benign neoplasms, consisting mainly of glandular tissue. Unlike polyps, an adenoma can regenerate more often. But they are less common than polyps.

Non-epithelial tumors are rare. They form in the wall of the stomach and can be made up of a wide variety of tissues.

Non-epithelial neoplasms include:

• Myoma is formed from muscle tissue.
• Neurinoma - is formed from the cells that make up the myelin sheath of nerve fibers.
• Fibroma - develops from connective tissue.
• Lipoma - consists of adipose tissue.
• Lymphangiomas - Tumor cells originate from the walls of the lymphatic vessels.
• Hemangiomas are made from cells lining blood or lymph vessels.
• and other options, including mixed tumors.

Unlike polyps, which are more common in men, non-epithelial tumors are more commonly diagnosed in women. All such neoplasms have distinctive features: as a rule, they have a clear outline, a smooth surface, and a rounded shape. They can grow to a considerable size.

The non-epithelial tumor of leiomyoma is especially distinguished - it occurs with a higher frequency than other neoplasms from this group. This tumor can cause gastric bleeding or potentiate the formation of ulcers by invading the gastric mucosa. All non-epithelial neoplasms are characterized by a rather high risk of oncological degeneration - malignancy.

Symptoms

Symptoms of a stomach tumor are usually mild. If the neoplasm does not grow, then it practically does not appear and is not observed in any way. Very often, benign tumors are determined by indirect signs or are detected by chance during endoscopic examination.

The clinical picture includes:

• Manifestations characteristic of gastritis, but without sufficient diagnostic signs to make a diagnosis of gastritis.
• Hemorrhage in the stomach.
• Loss of appetite, fatigue, weight fluctuations are common disorders that can be associated with diseases of the digestive system.
• Dyspepsia.
• With frequent hemorrhages - anemia.

With an absolutely calm course, pains of a dull and aching nature can be observed, localized, as a rule, in the epigastrium. Pain often occurs after eating. Quite often, patients associate these symptoms with gastritis.

With tumors of a sufficiently large size, more pronounced manifestations may be observed. There is severity, there are bouts of nausea, frequent belching appears. Patients find blood impurities in the vomit and stool. In laboratory tests, low hemoglobin is determined. Patients experience weakness and dizziness. Regardless of the preservation of normal appetite, weight loss begins. In total, more than a hundred types of benign neoplasms are distinguished - with a different course and clinical picture. The severity of symptoms depends on the location, size and growth rate of the tumor. The classic clinical picture that allows one to suspect a tumor is bleeding, accompanied by general disorders of the gastrointestinal tract.

The reasons

To date, all the causes of the formation of benign stomach tumors are unknown. Therefore, it is correct to talk about risk factors - factors that provoke pathological processes leading to the appearance of neoplasms. These include the presence of other gastrointestinal diseases.

The most current theory is that polyps appear as a result of disturbances in the natural regeneration of the gastric mucosa. Therefore, polyps often develop against the background of gastritis. Adenomas are more often accompanied by atrophic gastritis. At the same time, it was noted that more than 70% of all neoplasms develop in the lower third of the stomach - that is, in the area with a low concentration of hydrochloric acid.

The reason for the development of non-epithelial tumors can be embryonic disorders or the presence of chronic diseases. Since it is not possible to identify specific reasons, there is no specific prevention of benign tumors. We must not forget about the hereditary predisposition - patients whose relatives had stomach neoplasms, it is necessary to perform endoscopic examination even in the absence of any symptoms of stomach disease. In any case, if you suspect the presence of a polyp or polypoid formation of the stomach, you should consult a surgeon.

Our doctors

Chief Surgeon of CELT, Honored Doctor of the Russian Federation, Chief Specialist of the Moscow Healthcare Department for Endosurgery and Endoscopy, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Surgery No. 1 of SBEE BPO MGMSU, Doctor of Medical Sciences, Doctor of the Highest Category, Professor

Diagnostics

Diagnostics of stomach tumors consists of three main stages: history taking, examination, X-ray and endoscopic examination. A blood test is also prescribed to detect a decrease in hemoglobin levels, that is, anemia, characteristic of tumors that cause bleeding. The benign quality of a neoplasm is determined by the following characteristics: size, presence of peristalsis (with instrumental examination), shape. Fuzzy contours, rapid growth, and lack of peristalsis indicate that the polyp is malignant.

To clarify the diagnosis, EGDS is used - esophagogastroduodenoscopy, which allows you to visually assess the condition of the mucous membrane and in real time see the shape and size of tumors localized on the mucous membrane. This method allows you to assess the risk of malignancy - it is visually impossible to distinguish a malignant tumor of an early stage from a benign one; a biopsy is required. If there is a suspicion of oncology during FGDS, a sample is taken for histological examination in the laboratory - a biopsy allows you to accurately determine the nature of the neoplasm.

Since non-epithelial tumors are very diverse, it is often possible to make a final diagnosis only after surgery.

The study of tumors located outside the mucosa is possible by the same means: the contours are visible on X-ray, and endoscopic examination in combination with an ultrasound method (endo-ultrasound) allows you to determine the compression zones that appear when tumors grow inside the walls of the stomach or towards internal organs.

Treatment

Treatment of a benign stomach tumor is only surgical. Conservative methods are ineffective. The operation can be postponed if the tumor is small and there is no danger of malignancy. But in most cases, surgical removal is indicated - with the help of modern technologies, the operation is safe. Early removal is especially important when it is not possible to reliably determine the nature of the tumor - malignant neoplasms must be removed at an early stage.

There are several methods of removing a benign tumor that are currently used:

• Endoscopic electroexcision is the so-called minimally invasive operation, which involves electrocoagulation through an endoscopic access. In this way, polyps are removed.

• Enucleation - allows to reduce blood loss, is performed through endoscopic or laparoscopic access (depending on the location of the formation).
• Laparoscopic gastrectomy is an operation with access through punctures of the anterior abdominal wall and an incision in the stomach wall, in which part of the stomach is removed, and then the continuous digestive tract is restored using a hardware suture.
• Gastrectomy is the complete removal of the stomach. Practically not used for benign tumors.

Endoscopic surgery is indicated when polyps are found that are visible during diagnosis and are located alone. If the polyp is small, coagulation is sufficient. For neoplasms larger than 5 mm, electro excision is used - the polyp is tightened by the leg, and then removed with an electrocoagulator. For larger polyps, submucosal resection of the formation is performed (through an endoscope).

Today it is very difficult to find a person who does not suffer from stomach diseases, and gastritis is considered a normal part of the life of almost everyone living in a metropolis. We are so accustomed that in the modern world it is very difficult to maintain the balance of a healthy diet that we let stomach problems go by themselves, which can subsequently lead to very sad consequences, because in almost 95% of the stomach tumor is malignant, and the disease itself is in second place after lung cancer.

In the modern world, men are more susceptible to the effects of this disease than women, especially the risk increases after reaching 45 years. Recently, there has been a small wave of decline in the statistics of the disease, but it is too early to speak about the complete absence of danger.

Classification of stomach tumors

Depending on the type of tissue from which the tumor emerged, they are divided into benign and malignant - such a classification not only tells us about the danger of neoplasm, but also indicates the main place of inflammation.

A benign stomach tumor is a polyp, a glandular formation that has a round shape. There is also a quantitative classification:

• Solitary polyps;
• Multiple polyps;
• Polyposis.

Classification of the structure of polyps:

• Adematous - with a size of more than fifteen millimeters, they are converted into a tumor.
• Hyperplastic - develop in connection with atrophic gastritis.
• Inflammatory connective tissue tumors are not.

There is also a classification of tissues from which a benign neoplasm can occur:

1. muscle (leiomyoma);
2. submucosal layer (lipoma);
3. vessels (angioma);
4. nerve fibers (neurinoma);
5. connective tissue (fibroma).

The classification of gastric tumors also includes malignant tumors. Most of these neoplasms are of epithelial origin. Gastrointestinal stromal tumor of the stomach is also a malignant tumor, although it accounts for only one percent of the total number of cases. Other tumors include:

• carcinoid - a tumor is capable of producing hormones;
• leiomyoblastic tumor - contains epithelial and smooth muscle cells;
• leiomyosarcoma - matted smooth muscle cells.

The main causes of occurrence

Epithelial cells located on the inner wall of the gastric tract are a common site for tumors. Cancer can develop in any of the stomach regions:

1. main or middle departments;
2. on the border with the esophagus - the upper section;
3. on the border with the intestines - the lower section.

As in other areas of oncological abnormalities, scientists have not been able to identify the exact time and cause of cell mutation, which as a result leads to the appearance of a tumor. However, scientists managed to find out what events precede the onset of tumor formation. In a healthy stomach, a neoplasm cannot develop, which means there must be reasons that lead to a change in the gastric composition.

From all known reasons, the following classification can be made:

• heredity: stomach ulcer, polyps, gastritis (with low acidity);
• the use of foods that provoke the appearance of gastric diseases: smoked, spicy, fried. This can also include drinking alcohol, smoking;
• the presence of helicobacter pylori bacteria in the stomach;
• a low content of vitamins B12 and C can also cause gastric cancer.

Signs of a stomach tumor

The main problem in identifying this terrible disease is that at the initial stages of appearance, the symptoms are very similar to ordinary gastritis, which pushes doctors to determine this particular diagnosis and prescribe the wrong treatment.

There are no sharp changes or pains at the initial stage of the stomach tumor, but after a while the patient begins to experience all the signs of a tumor inherent in patients:

1. fatigue;
2. apathy;
3. lack of appetite;
4. depression;
5. pallor of the skin;
6. drastic weight loss;
7. development of pernicious anemia is possible.

A stomach tumor, the symptoms of which are listed above, are also accompanied by unpleasant sensations in the esophagus itself: there is a feeling of overeating and heaviness even after a small portion of food, the patient experiences nausea, which is often accompanied by vomiting. At later stages, the human skin becomes grayish, back pain appears (if metastases also appear in the pancreas), bleeding is possible. Only non-epithelial tumors of the stomach are asymptomatic in the first stages and are mostly benign.

The internal development of a stomach tumor occurs as follows:

• the cancer cell grows to about 2 cm;
• then it begins to penetrate both deep into the tissues and spread over the surface, preventing food from entering the stomach or entering the intestines, depending on its location;
• then it spreads to the colon and pancreas, and metastases spread to the peritoneum, ovaries and liver.
• cancer cells are separated and spread throughout the body using blood flow and lymph.

Diagnostics and treatment

To correctly establish the diagnosis and determine the stage of the disease, the patient needs to undergo appropriate tests:

1. x-ray of the pancreas;
2. Ultrasound of the abdominal cavity;
3. gastroscopy;
4. biopsy;
5. cT scan.

This stage is the most important - the fate of the patient will depend on the results of this spectrum of studies. If a malignant tumor of the stomach was nevertheless found, then it is at this stage that its size, boundaries and stage of the disease itself are determined.

Most often, after the examination, a decision is made to remove part of the stomach or the entire stomach as a whole. If the tumor of the stomach, the treatment of which is no longer possible, has spread to other organs: the spleen, liver or intestines, then they must be removed as well.

After the operation, in order to reduce the possibility of metastases and prolong remission, courses of chemotherapy and radiation therapy are carried out, and a course of drugs with a high content of vitamins and minerals is prescribed to maintain and restore the body itself.

The point of chemotherapy is to destroy cancer cells. Sometimes it is prescribed even before the operation and is an intravenous infusion of special drugs. Radiation therapy is carried out remotely and occurs due to irradiation of the necessary organs, which slows down the process of tumor development.

Treatment with folk remedies

It is difficult to imagine that such a serious disease can be cured only by self-hypnosis or folk remedies. Modern medicine does not accept the possibility that this is possible and generally has difficulty in recognizing alternative therapies. Nevertheless, there are adherents of similar methods, and there are several reasons for this:

• More than once we have heard versions that a cure for any type of cancer has long been invented, but since treatment in most cases costs the patients a tidy sum, any attempts to leave chemotherapy and other methods of treatment in the past are chopped off. Pharmacology is a huge business that dictates to doctors how and with what it is worth treating patients. Nobody claims that the known methods of cancer treatment are ineffective, however, there are already a lot of questions about them.
• Sometimes doctors refuse to treat a patient, promising only to "reduce the suffering" - this also pushes people to self-medicate.
• There are many methods of treatment additional to classical medicine - they do not contradict the prescribed procedures and may well help the patient in maintaining immunity. We will talk about these methods below.

Treatment with oils and juices

This method of treatment is rather a panacea, a week officially recognized method of fighting cancer, however, it is also widely used. The thing is that oils are saturated with useful substances and have enveloping properties, which protects cells from damage. However, despite the general belief, applied oils directly inside the body significantly reduces its beneficial properties - many substances are destroyed during digestion. The surest way to absorb all the beneficial substances is to rub it into previously cleansed skin.

For the treatment of cancerous tumors, the most saturated oils are used: oil of avocado, sea buckthorn, cedar, chestnut, lilac, flax, eucalyptus, chicory, etc.

Juice treatment is a worthy alternative to oil treatment. The fact is that natural juices are saturated with vitamins and minerals that are so necessary for the body, invigorated with oncology. However, a weakened gastric compartment does not always cope with the digestion of food, and the consumption of juices significantly facilitates its work.

The juices most useful for gastric tumors are the juice of nettle and dandelion. They will be especially useful in the spring season - at the beginning of ripening. The juice of these plants increases the body's immune properties, saturates it with energy and increases efficiency, so you should not neglect at least a few spoons a day. It is better to drink juice before meals in order to increase acidity and facilitate digestion of food, however, this advice is relevant only in the case of low stomach acidity.

Do not forget about antioxidants, which are found in large quantities in juices, and have an antitumor effect. In the presence of tumors, doctors advise replacing an early breakfast with juices when the body is still full from dinner.

Prevention of tumor development

Today, all the reasons for the appearance of a gastrointestinal stromal tumor of the stomach have not yet been fully understood, but we can already say that basic patterns and risk zones have been identified, which allows us not only to fight against its development, but also to carry out targeted prevention. Scientists have proven that the use of certain foods in food can significantly reduce the risk of a disease, while you should not look for a special diet, but it is enough to include only a few foods in the diet.

Timely studies should not be neglected, with the help of which it is possible to identify and remove the tumor at the early stages of its development. It is worthwhile to be more attentive to your body - do not postpone the examination with the following symptoms:

1. high fever that does not subside without other symptoms of the flu or cold;
2. rapid weight loss;
3. prostration;
4. changing taste habits;
5. dysfunction of the intestines.

It cannot be denied that the main thing on the path to recovery is the very desire of the patient to recover - in this case, any methods of treatment will acquire a completely different meaning. At the moment, there is no sure way to prevent the development of a tumor, and each of us is more or less at risk. However, you can well minimize the possibility of illness - follow the diet, give up bad habits and do not start stomach diseases. After 45 years, it is worth taking it as a norm to come to an appointment with a gastroenterologist, so that, in the event of an inflammatory process, it can be immediately identified.

The second circumstance limiting the widespread use of radiation therapy is its futility in cancer with metastases to distant organs. Radiation methods are applicable for locally advanced inoperable cardia cancer. Therefore, the most promising method of treating inoperable forms of cardia cancer is medication.

The use of 5-fluorouracil in a number of cases leads to an oo-objectively recorded decrease in the tumor and in other cases - to a symptomatic effect (N. G. Blokhina, 1977). The drug was administered intravenously at 0.75-1 g every other day (at 15 mg / kg). The course dose was 4.5 g. The treatment was repeated after 1-1 "/ 2 months as long as the patient's condition allowed (Fig. 106).

Combination chemotherapy for gastric cancer is in research stages. The combination of different drugs provides for the effect on various links in the metabolic chain of a tumor cell by combining drugs with different mechanisms of action. The toxicity of a combination of several drugs (polychemotherapy) should not exceed the toxicity of one drug.

Unfortunately, half of the patients treated with 5-fluorouracil and a combination of drugs did not have a noticeable effect. Therefore, attempts to use intra-arterial regional methods of treatment, in which the drug was administered fractionally for several days through a catheter inserted into the celiac artery, seemed quite justified. This made it possible to introduce a highly concentrated drug into the zone of an unremovable tumor and nearby metastases with a lower risk of general toxic complications. The use of this method in the ONC of the USSR Academy of Medical Sciences in 12 patients with cardiac cancer (U.Sh. Shaikhiev, 1968) gave an objective positive result in only 4 patients. V. A. Cherny (1969) did not receive any convincing success in the treatment of 44 patients with the method of regional chemotherapy for stomach cancer. Regional chemotherapy for gastric cancer has not proven itself.

Methods of conservative (radiation and drug) cancer treatment are just developing, and it is too early to assess their effectiveness in cardia cancer.

Thus, the main in the treatment of cancer of the proximal stomach is the improvement of surgical methods of treatment. Due to the limited possibilities of performing radical surgery and the high percentage of relapses and tumor dissection in the first 2 years after it, the main attention should be paid to the search for therapeutic methods of treatment.

NONEPITELIAL MALIGNANT GASTRIC TUMORS

Primary sarcomastomach is quite rare and accounts for about 4-5% of all malignant tumors of the stomach. The ratio among sick women and men is 1.4: 1.0, that is, there is a slight predominance of women. In terms of age, these patients are much younger than those with stomach cancer (V.N. Gerasimenko, E.O. Kovalevsky, A.A. Klnmen-

Localization of sarcomas does not obey the laws that are characteristic of cancerous tumors. Sarcomas are most often located along the greater curvature of the stomach, then on the anterior and posterior walls, along the lesser curvature. Much less often sarcomas are localized in the antrum of the stomach.

Almost all histological types of sarcomas are found in the stomach, but reticulosa rcomas (lymphosarcomas) prevail, then myosarcomas, fibrosarcomas, malignant neurinomas, polymorphic cell sarcomas, etc.

By the nature of growth and spread in the stomach, these tumors are divided into:

1) exogastric;

2) endogastric;

3) intramural (infiltrating);

4) endoexogastric.

Exogastric sarcomas affect a limited area of \u200b\u200bthe stomach. Growing out from under the serous cover, exogastric forms of sarcomas grow into the abdominal cavity, pushing apart, squeezing and germinating adjacent organs. Usually these tumors have a rounded tuberous or lobular shape and reach enormous size, descending in some cases into the pelvic cavity. The mucous membrane of the stomach in this form suffers, as a rule, little.

Depending on the location, direction of growth and distribution, an appropriate clinical picture is observed.

Endogastric sarcomas grow in the lumen of the stomach in the form of small polyps, often on a broad base, emanating from the submucosal layer. They do not reach large sizes. The mucous membrane around the tumor changes little. Necrobiotic changes in the tumor are possible during the growth of the sarcoma. The clinical picture is dominated by symptoms of impaired permeability of food and evacuation of stomach contents.

Intramural (infiltrating) sarcoma accounts for about 60% of all forms. It differs in more rapid infiltrating growth along the gastric wall, the stomach grows over a long distance from the pyloric region to the cardia. By the nature of growth, it resembles an infiltrating stomach cancer. If the tumor occupies a smaller area, it may appear as lumpy nodes that disintegrate with the formation of extensive ulcers.

Mixed (exo-endogastric) sarcomas grow into the lumen of the stomach like an endogastric tumor, but they spread more into the abdominal cavity like exo-gastric ones, reaching large sizes. In their inner part, these tumors are connected by a leg of various shapes and lengths, sometimes relatively narrow. Almost 30% of sarcomas give early metastases to regional lymph nodes. The first two forms have a more favorable course.

Clinic. The clinical course of gastric sarcomas is very diverse. With exogastric growth, when the bulk of the tumor is located outside the stomach, the symptoms associated with the germination of neighboring organs (liver, pancreas, intestines) come first. Exogastric sarcomas can reach very large sizes, descend into the small pelvis and simulate a tumor of the female genital area. The pain syndrome is especially pronounced. In most cases, the tumor is palpable. Attention is drawn to the discrepancy between the general satisfactory condition of the patient and the size of the palpable tumor. Bleeding into the lumen of the gastrointestinal tract is rare. Usually, with these forms of tumor, dyspeptic symptoms are absent and appear only in the advanced stage of the disease.

Endogastric, intramural and mixed forms of sarcomas pose significant difficulties for diagnosis. The clinical, radiological and endoscopic picture resembles stomach cancer. Unlike cancer, achlorhydria is observed much less frequently, and anemia occurs in only 25% of patients. Rapidly progressive weight loss, increasing weakness, fatigue, apparently associated with the rapid absorption of decay products

a growing tumor, severe pain of a constant nature, vomiting, a short (1-6 months) history of the disease may indicate a sarcoma of the stomach. In addition to these symptoms, the clinical picture may be dominated by phenomena associated with various complications of gastric sarcoma.

Due to the disintegration and bleeding from the tumor into the lumen of the stomach or abdominal cavity, the corresponding symptomatology occurs, sometimes requiring urgent surgical intervention. A febrile condition is most often associated with an infected disintegrating tumor, up to the development of peritonitis. With large exogastric sarcomas on the pedicle, torsion is possible with the subsequent development of peritonitis. Often, such patients undergo urgent surgery with a diagnosis of torsion of the ovarian cyst.

Diagnostics. Diagnosis of gastric sarcomas should be comprehensive, the main role belongs to X-ray examination. The nature of the growth of the sarcoma of the stomach determines the X-ray picture of the changes.

Endoscopic (gastroscopic) diagnosis in exo-gastric and infiltrating forms of sarcomas is based only on indirect data. Due to the submucosal growth of the tumor, it is extremely difficult to obtain morphological confirmation of the diagnosis. With endogastric and mixed growth, in some cases it is possible to produce a biopsy. With endo-g astral tumors originating from the anterior wall of the stomach, laparoscopy can help correct the diagnosis.

Pre-treatment diagnosis of gastric sarcomas is extremely difficult. The diagnosis in most cases can be tentative before surgery. The final diagnosis is made only after laparotomy and histological examination of the drug. In these cases, the role of urgent histological examination during the operation is extremely increasing.

Treatment and prognosis.The main treatment is subtotal gastric resection or gastrectomy. With exogastric and endogastric forms of sarcomas, due to the long absence of metastases, the percentage of radically operated patients reaches 70-80. Good long-term results were obtained in 15-20% of patients.

Radiation therapy and drug treatment are possible only if the tumor is sensitive. This applies mainly to reticulosarcomas (lymphosarcomas) of the stomach.

Radiation therapy is indicated for inoperable reticulo-sarcomas or as a prophylactic radiation after radical surgery. Irradiation of an inoperable tumor pursues two main tasks: direct action aimed at obtaining a therapeutic effect; transfer of the tumor to an operable state with subsequent surgical treatment. After

surgical removal of gastric reti-culosarcoma postoperative radiation therapy aims to increase the radicalism of the operation.

In connection with the development of medicinal methods for the treatment of malignant tumors, attention is drawn to the possibility of combining surgical and chemotherapeutic (sarcolysine, cyclophosphamide, endoxan, etc.) methods of treating reticulosarcomas (lymphosarcomas) of the stomach. In this regard, it is advisable to carry out preventive courses of treatment after radical operations. Given the sensitivity of reticulosarcomas (lymphosarcomas) to ionizing radiation and chemotherapy, this method should be considered promising.

TUMORS OF THE LIVER, CHILD TRACT,

PANCREAS