10 minute read
Immunotherapy enhances survival in stomach cancer
6 critical signs of stomach cancer!
Professor Faysal Dane
Although stomach cancer is globally the ffth most common cancer, it is the second most common cause of cancer deaths. Almost one million people are diagnosed with stomach cancer annually around the world, while around 780 thousand people die due to stomach cancer. Approximately 12 thousand people are diagnosed with stomach cancer annually in Turkey and around 10 thousand people die due to stomach cancer.
The most important underlying cause is lack of symptom in early-stage stomach cancer and late diagnosis due to ignorance of complaints that emerge when the tumor grows, as patients consider ‘indigestion’ for the underlying cause of the complaints. The relieving news is about the results of trials conducted on immunotherapy that is regarded as the major step recently taken in anti-cancer treatment.
According to recent studies, immunotherapy delays progression of the disease and thus prolongs the survival by contributing to the shrinkage of the tumor in patients with stomach cancer. Also, it acts without deteriorating patient’s quality of life and it does not result in severe side PROFESSOR FAYSAL DANE EMPHASIZES THAT REDUCTION OF THOSE RISKS MAY PARTIALLY PREVENT THE STOMACH CANCER. STOMACH CANCER IS USUALLY DIAGNOSED IN LATE STAGE BOTH IN OUR COUNTRY AND WESTERN COUNTRIES. ONLY ONE THIRD OF PATIENTS CAN BE DIAGNOSED IN AN EARLY STAGE
efects. Professor of Medical Oncology Faysal Dane, M.D., from Acıbadem Hospital in Istanbul, Turkey says “Thanks to advancements in treatment of the stomach cancer, not only quality of life is boosted, but also the survival is prolonged. However, it is necessary to keep in mind that as is the case with all cancer types, early diagnosis is very critical for stomach cancer.”
6 critical signs of stomach cancer!
Stomach cancer has certain risk factors, including but not limited to Helicobacter pylori infection, smoking, alcohol, obesity, too salty foods, certain food preservatives, deep fried foods and genetic predisposition. Professor Faysal Dane emphasizes that reduction of those risks may partially prevent the stomach cancer. Stomach cancer is usually diagnosed in late stage both in our country and Western countries. Only one third of patients can be diagnosed in an early stage. There are certain reasons for this fact: the condition does not cause any symptom in early stage; stomach cancer does not have specific symptoms; and screening methods are seldom used. “From this perspective, one may speculate that stomach cancer progresses insidiously”, says Professor of Medical Oncology Faysal Dane and adds that the complaints emerging due to progression of the tumor should not be ignored
a doctor should be seen immediately and she lists the 6 critical signs: “Persistent nausea and vomiting, long-standing stomach ache, getting full easily, blood in vomit, difculty swallowing and weight loss”.
Treatment is planned depending on stage of the disease
“Success of treatment varies substantially in stomach cancer depending on the stage the cancer is diagnosed” says Professor Faysal Dane, who emphasizes that as is the case with all cancers, early diagnosis is also very crucial in stomach cancer. Clarifying that the treatment approach varies according to the stage of the disease, Professor Faysal Dane adds “Proper removal of the tumor with a surgical procedure may be curative in a small part of patients who are diagnosed in a very early stage. However, deep invasion of the gastric wall or presence of tumor in surrounding lymph nodes requires pre- and post-operative medication treatments depending on patient- and disease-related factors. Moreover, chemotherapy is combined with radiotherapy in certain patient groups, although it is not a viable option for all patients.” Professor Faysal Dane states that if the disease spreads to distant body parts in addition to the lymph nodes located around the stomach, the management mostly involves medication treatments, such as chemotherapy, targeted drugs and immunotherapy.
Striking outcomes from immunotherapy!
As is the case with other cancers, advancements in targeted drugs and immunotherapy that are, recently, combined with chemotherapy excite the medical community in terms of the stomach cancer. Cancer immunotherapy is defned as treatment modalities that prevent formation of cancer cells, control their growth or kill them by strengthening the immune system. On the contrary to other anti-cancer treatments, immunotherapy activates the immune system to promote their attack to the tumor rather than exerting a direct efect on the cancer cell. “SUCCESS OF TREATMENT VARIES SUBSTANTIALLY IN STOMACH CANCER DEPENDING ON THE STAGE THE CANCER IS DIAGNOSED” SAYS PROFESSOR FAYSAL DANE, WHO EMPHASIZES THAT AS IS THE CASE WITH ALL CANCERS, EARLY DIAGNOSIS IS ALSO VERY CRUCIAL IN STOMACH CANCER.
Today, efciency of immunotherapy, both alone and in combination with chemotherapy, in stomach cancer is intensively investigated. Results of those trials have been presented in meetings for several years. At last instance, it is reported in the Congress held by the European Society for Medical Oncology (ESMO) held in September 2020 that when combined with chemotherapy, immunotherapy delays progression of the disease and thus enhances the survival by contributing to the shrinkage of the tumor in patients with stomach cancer. Emphasizing that this advancement in treatment of stomach cancer is very signifcant, Professor Faysal Dane says “Although it is, today, not clearly known, based on the results of the study, which patients will respond to the treatment, certain tests help us predict which patients will be a good candidate for immunotherapy. Therefore, all patients with stomach cancer are evaluated regarding immunotherapy based on the striking results demonstrated by scientifc studies.”
Radiotherapy today: Even some metastatic cancers can be cured
Doctors and patients can beneft from various options in well-equipped hospitals
Professor Mehmet Ufuk Abacioglu
50 to 60% of all patients diagnosed with cancer need radiotherapy at some point in their lives. It is a key part of the cancer treatment process and can be used either as a primary treatment or complementing the other treatment options like surgery and chemotherapy. Radiation treatment is painless, non-invasive, and takes only minutes per session. But still many people are afraid of it and the negative connotation of the word ‘radiation’. When used the right way, radiation is an efective tool both for diagnosis and treatment, states Professor Dr. Ufuk Abacıoğlu, Radiation Oncology specialist with more than 25 years of experience. Prof. Abacıoğlu works at ACIBADEM Altunizade Hospital in Turkey, where doctors and patients can take advantage of the latest devices in this ever-evolving medical feld. For all those who might not understand how exactly the radiotherapy works or what makes it efective for cancer treatment, the expert provides some useful information and debunks misconceptions about the medical applications of radiation.
Radiation affects the DNA of the tumor cells and their vessels
Radiation is thought to be one of the causes for cancer, and that is certainly true. But we can also use radiation for treating cancer. How exactly radiation kills tumors? Prof. Dr. Ufuk Abacıoğlu explains: “The radiation afects the DNA of the tumor cells. That’s what we knew for many years, and we can cause some DNA damage. We can just focus the radiation on the tumor masses and damage the tumor cells, and fnally the tumor may diminish in size and disappear. It is a kind of chain reaction that starts with the radiation. That’s physical, chemical and biological efect of radiation that causes the tumors to disappear. But recently we have found that it’s not only the DNA damage on the tumor cells; there is also a vascular efect. We can also obliterate the vessels that are feeding the tumor cells.” Obliteration of blood vessels is possible by striking the tumor with high doses of radiation in one or a few fractions: then we treat the tumor not only through DNA damage but also with vascular efects. “We call this stereotactic radiosurgery or stereotactic radiotherapy. As you can see from the name radiosurgery, it’s like a single-shot treatment; it’s causing ablative efect, so it’s like a surgical efect or surgeon’s knife. It is very precise irradiation, we just focus dose to the tumor cells and we have a very rapid dose fall-of around the target that causes less harm to the normal tissue but very high efect
over the tumor cells,” the specialist points.
Protection of healthy tissues is achieved by detailed calculations of the applied doses, as well as distribution of irradiation through multiple beams from diferent angles. “We use multiple beams around the patient, so when we collect all of them in the center we have a very high dose for the tumor itself, but the beam passes through the normal tissue with very low doses,” explains Prof. Abacıoğlu. Nowadays, sophisticated technology devices allow precise targeting of tumor masses for efective results and less side efects.
One of the latest advancements in radiation technology is the MR Linac device which combines MR imaging and linear accelerator in one single machine. ACIBADEM was among the frst worldwide to implement the new technology in September 2018. More than 300 patients have been treated with the new device with very good results, says Professor Dr. Ufuk Abacıoğlu and adds: “It has been a revolutionary device for us because it has three main advantages. MR is very useful for seeing the soft tissues in the body. The CT or X-ray based imaging is very useful for the bones, but for seeing soft tissue MR is much more useful. The second advantage of MR Linac is the opportunity to adapt the treatment plans and treat the patients with the anatomy of the day. And the third is that you can see the tumor itself while you are treating it. That’s not possible with other technologies. That gives us the opportunity to reduce the clinical target volume which covers the potential movement. If we have a 3 cm tumor, you have to add just 3 mm around it and we irradiate this volume. Otherwise, we have to give 5 mm, 1 cm, 2 cm, depending on the motion of the tumor with breathing. That gives us the ability to irradiate tumors with proximity to very critical structures.”
Radical treatment is now possible even for some metastatic patients
Radiation therapy can be applied for two main purposes: to kill the cancer cells completely which is called curative radiotherapy, or to relieve the symptoms in advanced stage disease which is referred to as palliative radiotherapy. Recent advances in radiation oncology brought new options for cancer patients, including those with metastatic disease. Prof. Ufuk Abacıoğlu explains: “In recent years we have a new defnition. In the past we used to call stage 4 ‘metastatic’ disease, as a time period when we only do palliative treatments. We didn’t want to give radical treatments like surgery and ablative radiation treatment; we just wanted to palliate for example the pain of bone metastasis or relieve the symptoms of brain metastasis. But nowadays, we call some group of patients ‘oligometastatic’. That means that we have a primary cancer for example in the lung, but only a few metastases, one or two or three metastases in the brain, one metastasis in the adrenal gland – then we call this patient ‘oligometastatic’. And we treat this patient with still radical intent; we want to cure these patients. When you give locally ablative treatments like surgery or stereotactic radiotherapy for these patients, the studies have shown that they live much longer than the other metastatic disease patients. So, we are treating more patients with metastatic disease with radical intent nowadays.”
