Malignancy of a stomach ulcer develops as a result of a prolonged course and insufficient treatment of pathology. This process can provoke stresses or malfunctions of the immune defense. In this case, the patient has a constant pain in the epigastrium, he loses weight and becomes weak. If a disease is detected in the initial stages of development, the probability of a person's recovery is high.
The main signs of an ulcer are general exhaustion and loss of appetite in the patient.
Etiology and pathogenesis
Malignancy refers to the degeneration of a stomach ulcer into a malignant tumor. With a prolonged course of the inflammatory process, such a complication develops quite often. The process of formation of cancer cells consists in the loss of their functions and the acquisition of the ability to uncontrolled reproduction and growth. The development of a neoplasm depletes the energy reserves of the body and eventually leads to the development of a fatal outcome.
It is that aggressive and provocative factor.
The following factors can provoke the growth of malignant cells on the stomach:
- chronic severe stress,
- the presence in the digestive tract of a benign tumor formation,
- violation of the immune defense,
- genetic abnormalities of the structure of the organ,
- hormonal disruptions,
- exposure to poisons and toxins,
- excessive release of hydrochloric acid,
- irritation of the mucosa due to the use of greasy, fried or poorly chewed food.
A stomach ulcer is quite often malignant. This is due to the constant irritating effect of food entering the digestive tract, as well as the presence of hydrochloric acid. All this provokes traumatization of the mucous membrane and degeneration of its cells into malignant. An important role in the development of gastric cancer is also played by heredity.
Signs of illness
With malignancy of peptic ulcer of the stomach or duodenum, the patient has the following characteristic signs:
- feeling unwell,
- significant and sharp weight loss,
- constant aching pains in the epigastric region,
- intolerance to the use of meat dishes,
- poor appetite
- bloody feces
- decrease in the level of release of hydrochloric acid,
- bad breath
With the development of a cancerous tumor in the stomach, the patient's general state of health sharply worsens, his appetite disappears and signs of exhaustion become pronounced. In this case, the pain becomes very strong and constant, without intervals of improvement. In the stomach, the production of hydrochloric acid is reduced, which is associated with the degeneration of the cells responsible for this process. A patient with gastric ulcer is concerned about constant nausea and stool disturbance. Pancreatitis often develops due to disruptions in the digestion process.
A malignant tumor of the stomach develops very quickly and therefore it is important to detect it at the initial stages of growth, when treatment is more effective. To identify malignant cells within the ulcer, a biopsy or excision of a small amount of tissue in the area of the defect is performed. After this, a histological examination of the obtained material is done. And you can also detect a tumor using ultrasound, computed or magnetic resonance imaging. When confirming the presence of a cancer, it is important to diagnose nearby organs into which metastases can enter.
Therapy of malignant gastric ulcer should include comprehensive measures that are aimed at removing cancer cells from the body, eliminating pain and normalizing the general state of human health. Most often, such patients undergo surgery with complete removal of the affected organ. Such a radical intervention is justified by the fact that tissue excision is performed within healthy cells to prevent the spread of atypical DNA with blood flow throughout the body.
If metastases are present, surgery is palliative.
In parallel with this, radiation and chemotherapy are indicated. They are designed to slow down the rate of reproduction and spread of cancer cells, as well as reduce the likelihood of development and growth of metastases. Among the drugs used to kill atypical cells, the most common are cytostatics. They will slow the growth of cancer cells. Often used "Chlorethylamine" and steroid hormones, such as "Metipred". In addition, a malignant ulcer causes severe irritation of pain receptors and constant sharp pains that interfere with the patient's normal life. Therefore, it is important for cancer patients to prescribe potent painkillers. Severe nausea will help eliminate "Cerucal" or "Metipred" causing a blockage of the gag reflex in the brain.
What is malignancy
It is known that pathological cells, including malignant ones, constantly appear in the body. But the immune system always reflects such attacks. Therefore, the effectiveness of protection largely depends on the state of immunity and the general state of human health.
Thanks to protective mechanisms, abnormal cells are recognized and destroyed. But with weakening of immunity due to bad habits, unhealthy diet, external factors, age, the risk of a disease increases.
Cell malignancy is the initial process of the appearance of a malignant tumor in the body, its nucleation. Both healthy and pathological (damaged) cells of the body undergo such a change. Malignancy is also called the transition of a benign tumor to a malignant one.
With this phenomenon, a genetic mutation of the cells and their uncontrolled proliferation occurs. The patient himself at the initial stage does not feel any discomfort, unaware of the disease. Also, diagnosis is difficult during this period.
More often malignant tissues with various types of erosion:
- ulcerative defects
- tissue inflammation
- benign tumors.
The phenomenon is not excluded in healthy tissues. Pathological changes are uncontrolled, irreversible. They can capture more and more spaces with the formation of new foci - metastases.
Many factors contribute to malignancy: genetic predisposition, external and internal influences. Early detection of the disease significantly increases the chance of recovery, belatedly - leads to the formation of a malignant tumor with metastases with all the ensuing consequences.
Causes of malignancy of stomach ulcers
The impact of digestive juice on an ulcer, periods of exacerbation and relapse of the disease lead to proliferation of connective tissue, vascular sclerosis and atrophy of the stomach wall at the location of the ulcer defect. All this leads to a change in the properties of cells and can cause a cancer in the area of the ulcer lesion.
More often malignant ulcers of the pyloric department, anterior and posterior walls, large curvature of the stomach. The presence of the Helicobacter pylori bacteria contributes to the process. Malignancy of a stomach ulcer can begin regardless of the nature and prescription of the ulcer, but more often happens in older people with chronic ulcers.
Malignancy of a duodenal ulcer, due to more sparing conditions for the mucosa compared to the stomach, is extremely rare.
The full picture of the mechanism of cell malignancy is still not clear. There is no cure for cancer either. The onset of the disease is preceded by adverse factors that trigger the pathological process. They are divided into internal and external.
- weakening of immunity,
- hormonal disorders
- improper metabolism
- genetic predisposition
- the presence of a benign tumor,
- viral, fungal diseases,
- chronic tissue inflammation, scars, ulcers,
- prolonged stressful conditions.
- bad ecology,
- solar and other types of radiation,
- X-ray dose excess
- harmful chemical influences.
Studies indicate that the risk of malignancy is closely related to the nature of the diet:
- Lack of or inadequate consumption of natural human natural food - fresh fruits, vegetables, herbs.
- The predominance of fried, salted, smoked, containing chemicals and other junk food.
Thus, certain aggressive factors become the causes of the onset of cancer, as a dangerous complication of gastric ulcer, less commonly, the duodenum.
Signs and symptoms of malignancy
The signs and symptoms of a suspected malignancy of an ulcer are as follows:
- Pain in the stomach loses its frequency and locality, acquire a diffuse, permanent, aching character. May be given in the back and amplified at night.
- Decreased appetite, weight loss.
- Aversion to meat dishes.
- Digestive disorders (belching, heaviness, nausea, vomiting).
- Feeling unwell (emotional exhaustion, fatigue, discomfort).
These signs may indicate an already developing cancer of the stomach, which means that it is an occasion to immediately seek help from doctors. Also, such signs, when confirming a malignant tumor, indicate that the phase of malignancy was skipped.
At an early stage, the patient is unaware of the malignancy of a stomach ulcer. It is possible to identify the disease at the initial stage only in one case, if a patient with peptic ulcer undergoes a periodic medical examination.
If the ulcer has undergone malignancy, then a medical examination will reveal the following symptoms:
- Decreased acidity of the stomach.
- The presence of lactic acid in the stomach.
- Progressive Anemia
- Perhaps hidden blood in the stool due to bleeding in the area of the ulcer.
- Cell differentiation failed.
- An increase in ulcers (more than 25-30 mm) with the acquisition of an irregular shape with high, uneven, saped edges.
- The boundaries of the ulcer become blurred, the mucous membrane around can have a grainy appearance.
- Stiffness of the wall of the stomach, lack of peristalsis around the affected area.
Also, malignancy may be indicated by the lack of effect of antiulcer therapy.
Signs of malignancy of a stomach ulcer are determined by diagnostic methods.
Diagnosis of malignancy of gastric ulcers
To identify malignancy, the same diagnostic methods are used as in the study of any pathology of the stomach:
- history study (medical history),
- analysis of blood, urine, feces,
- contrast x-ray examination,
- CT scan,
- gastroscopy with targeted biopsy,
A blood test is an indirect indicator of cancer. This is reflected in a change in such quantities as:
- lower hemoglobin levels,
- Red blood cell count
- increased white blood cell count,
- an increase in the erythrocyte sedimentation rate (ESR) and other important indicators.
Blood detection in the analysis of feces is an occasion to find out the exact causes of its occurrence, among which there may be blood loss during malignancy of a stomach ulcer.
Fluoroscopy can reflect the following signs of malignancy:
- an increase in ulcers in size (more than 20 mm),
- the ulcer becomes atypical (irregular form)
- uncharacteristic state of the gastric mucosa around the defect, the disappearance of folds,
- lack of perilstatics of the affected area,
- a symptom of a submerged niche and other signs are detected.
But it is important to note here that it is almost impossible to detect early signs of the disease by X-ray examination. The listed symptoms occur later.
Therefore, the most reliable way to diagnose malignancy of a gastric ulcer is an endoscopic examination (EFGDS) with the taking and subsequent histological analysis of tissue samples from a peptic ulcer. Fragments are taken from 5-7 different places of the ulcer (bottom, edges, area around). The accuracy of this method of diagnosis reaches 100%.
EFGDS, in addition to the valuable possibility of taking tissue samples, also reveals the described signs of atypical ulcer and the area around:
- uneven, sour edges of the ulcer, a gray coating on the bottom of the defect is possible,
- widespread ulcer infiltration, deformation of the wall of the stomach in the area of the defect is possible,
- mucosal erosion around the defect,
- bleeding, etc.
Ultrasound and CT also help to identify the atypical development of ulcerative defects.
If necessary, a laparoscopic diagnostic method is used to examine the stomach from the abdominal cavity.
Treatment for malignancy of an ulcer
The fact of detection of a gastrointestinal ulcer in itself requires the active adoption of all necessary treatment measures. The patient is examined, intensive therapy is carried out. If drug treatment gives an effect (the ulcer decreases, characteristic symptoms disappear), then the treatment is continued with periodic monitoring, including cytological monitoring (to check the ulcer for malignancy). If treatment does not give an effect, then surgical intervention is used.
This statement is often quoted by a prominent Soviet surgeon and scientist S.S. Yudina (1891-1954), who most succinctly expressed the circumstances in which surgical intervention is indicated:
“The larger the ulcer, the deeper the niche, the older the patient, the lower the acidity, the greater the risk of cancer from the ulcer” (S. S. Yudin, 1965).
And therefore, the sooner the operation is indicated.
Thus, treatment for detecting malignancy of gastric ulcer is carried out by surgery. The choice of surgical intervention depends on the location of the ulcer, its nature, size, degree and extent of tissue damage around the defect:
- Distal gastrectomy is a significant removal of the lower part of the organ. An example is the removal of the antrum, while the stomach is reduced in volume by 1/3. Subtotal resection - an almost complete removal of the stomach (only a small part of it remains on top).
- Proximal resection - removal of the upper part, including the cardiac section, while maintaining the lower part of the organ.
- Ring-shaped segmental resection - removal of the middle part of the stomach while maintaining the upper and lower parts. Such an operation is rarely used.
- Total gastrectomy - complete removal of the stomach.
As noted above, if the occurrence of a cancerous tumor is detected at an early stage of malignancy followed by surgery, the likelihood of cure is significantly increased. However, the only way to detect malignancy in time is a periodic endoscopic examination of a peptic ulcer with a biopsy.
At the same time, if malignancy is not detected, but there is no effect of anti-ulcer therapy and the diameter of the ulcer exceeds 20 mm, then in this case the operation is still indicated. You should not wait for direct signs of malignancy, since earlier surgical intervention can prevent a more serious, life-threatening patient, the development of the disease in the future.