THE ROLE OF THE INSTUMENTAL EXAMINATIONS IN DIAGNOSTICS AND STAGING OF LOCALY DISTRIBUTED STOMACH CANCER

Abstract

The diagnostics and treatment of stomach cancer is still one of most complex and actual issue, despite of morbidity decreasing tendency.
 Objective. Improvement of algorithm of diagnostics of patients with complicated stomach cancer.
 Materials and methods. It was shown the analysis of results of surgical treatment of 418 patients with complicated stomach cancer, which got the hospital treatment at GI «V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine « from 2010 till 2019, aged 29 till 76. Course of the disease was complicated with bleeding in 252 (60,3 %) case, with stenosis in 89 (21,3 %), with perforation in15 (3,5 %), and with its combination — in 62 (14,8 %). Radical operations were performed in 168 (40,2 %) cases, palliative and symptomatic in 250 (59,8 %) — cases. 107 patients aging 36 till 73 were examinated with SCT to revealing and staging of tumor.
 Results. Patiens were examinated with using of combination of instrumental methods. SCT provides to detect the primary tumor, the process spreading, differetion of tumor from the healthy tissues of stomach, local lymphatic nodal metastasis and other organs, that definite staging of pathology, volum of operation and further prognosis. SCT has precission of 95-97 % at detecting of cancer, definition of stage — 77–80 %. Endoscopy allows to define the location, spreading of process, sizes of tumor and presence of complications. Panoramic x-ray provide to detect the free air in abdomen, that is main symptom of perforation, but doesn`t indicate the localization and root of perforation. Angiography allows to identify the sources of tumor`s blood supply, and also continuing bleeding direct and indirect markers, that leads to conversion of diagnostics into curative. Bleeding vessel`s embolization were performed in 7 cases as first treatment stage (the second one is operative), and in 11 cases as finishing curative method. There no any ideal oncomarker. Diagnostic precission of CA 72-4 is 28–80 % (40–46 % on the average). According to international guides [7], all patients were performed the diagnostic laparoscopy with researching of washout liquids of abdomen in uncertain cases.
 Conclusion. Only complex examination of patients with stomach cancer with using combination of SCT of abdomen, FEGDS with biopsy, laparoscopy can provide total volum of examination, staging and surgical aid.