Stomach Cancer

Different types of stomach cancer include adenocarcinoma, which includes 90% to 95% of cancers of the stomach. These cancers develop from the cells that form the innermost lining of the stomach (known as the mucosa). Lymphomas are cancers of the immune system tissue that are sometimes found in the wall of the stomach Gastrointestinal stromal tumors (GIST) are rare tumors that start in very early forms of specialized cells in the wall of the stomach called interstitial cells of Cajal. Although GISTs can be found anywhere in the digestive tract, most are found in the stomach. Carcinoid tumors are tumors that start in hormone-making cells of the stomach. Most of these tumors do not spread to other organs and can be observed if small.

Treatment

We treat cancers of the stomach at all stages. Our multidisciplinary approach helps ensure that every patient receives a personalized treatment plan. We collaborate with advanced gastroenterology experts who perform an endoscopic ultrasound and needle biopsy, if indicated, to help determine accurate staging.

Staging for gastric cancer determines the role for chemotherapy, either before or after surgery. Once this thorough evaluation is complete, our surgeons collaborate with medical oncologists to construct a treatment plan that will help ensure the best possible outcome.

• Subtotal or total gastrectomy: In patients with tumors that are located in a higher position, the majority of the stomach or the entire stomach may need to be resected to ensure that the cancer is completely removed with surrounding lymph nodes. The downstream intestine is then reattached to the stomach remnant, allowing normal food intake and digestion. Each of our patients receives a thorough consultation with a certified nutritionist prior to returning home to ensure they learn how to maintain a healthy diet following subtotal or total gastrectomy.
• Laparoscopic gastrectomy: In certain cases where the cancer is early stage, or is a less aggressive type of stomach tumor, our surgeons can perform a gastrectomy using minimally invasive techniques. Laparoscopic surgery results in smaller scars and generally allows patients a shorter hospital stay with quicker recovery times.
• Regional lymphadenectomy: In a study of all patients undergoing gastrectomy in the United States, only 10 percent of patients received the D2 lymph node dissection that is recommended by the National Comprehensive Cancer Network's guidelines for gastric cancer. Dr. Bhagwandin is specially trained as a surgical oncologist in techniques to remove the lymph nodes surrounding the stomach in order to maximize accuracy.

Peritoneal Malignancies Treatment and Surgery

Cancer can spread through the body via different routes. In some patients with cancer, the tumor spreads throughout the abdominal cavity, also called the peritoneal cavity, and this condition is known as carcinomatosis. Cancers which are often associated with carcinomatosis include colorectal cancer, ovarian cancer, gastric cancer, appendiceal tumors, and peritoneal mesothelioma.

In patients with carcinomatosis, intravenous chemotherapy alone may not be the most effective treatment. In carefully selected individuals, a combination of chemotherapy as well as surgery (cytoreductive surgery) with heated intraperitoneal chemotherapy, also known as HIPEC, may offer a better outcome. Our Surgical Oncologist has expertise in evaluating and treating patients with peritoneal malignancies, and we are among the few centers in Florida to offer this treatment.

Surgical treatments for the peritoneal malignancies are carefully tailored to meet each patient's individual case.

• Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC): Our surgical oncologist performs the surgical procedures necessary for removing all the tumor from the abdomen. This may include a bowel resection, splenectomy, and/or removal of the peritoneal lining. Once the tumor sites have been excised, heated chemotherapy is infused in order to target any remaining cancer nodules during the same surgery.
• Laparoscopic HIPEC: In certain cases, we are able to offer laparoscopic HIPEC, which allows patients all the benefits of minimally invasive surgery.