If you are diagnosed with stomach cancer at an early stage, you may require surgery to try to remove the cancer.
However, if your cancer has spread beyond your stomach, it may not be possible to remove it completely through surgery. If this is the case, you may still have surgery to remove any cancer that is blocking your stomach, to ease your symptoms. This will depend on balancing the control of your symptoms and the risks and side effects of undertaking a major surgical procedure.
After surgery for stomach cancer
Any kind of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, you will usually have to stay in hospital for around two weeks. You will also need several weeks to recover at home.
Surgery to remove stomach cancer
If you have surgery to remove the cancer in your stomach, and depending on where in your stomach the cancer is, it is likely that you will need to have part or all of your stomach removed.
Surgery to remove part of your stomach is known as a partial gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may also remove part of your oesophagus (gullet), as well as the whole of your stomach, which is known as an oesophagogastrectomy.
During both of these operations, your surgeon will also remove the lymph nodes (tissues that remove bacteria from your body) nearest to the cancer in your stomach. It is possible that your stomach cancer may have spread to these lymph nodes, so removing them helps to prevent the cancer from recurring.
If your cancer is in the lower part of your stomach, you may have a partial gastrectomy, in which only part of your stomach is removed. This means that the lower part of your stomach will be removed and, afterwards, your stomach will be smaller than it was before surgery. However, the operation will not affect the top part of your stomach, where your oesophagus (gullet) feeds into it.
Total gastrectomy or oesophagogastrectomy
If your cancer is in the middle or at the top of your stomach, you may need to have a total gastrectomy, where the whole of your stomach is removed. If the cancer is close to the end of your oesophagus (gullet), where it meets your stomach, you may also need to have part of your gullet removed. This kind of surgery is known as an oesophagogastrectomy.
If you have a total gastrectomy, your stomach will be removed and the end of your gullet will be joined to the top of your duodenum (the top part of your small intestine). If you have an oesophagogastrectomy, your stomach and the end of your gullet will be removed, and the remaining part of your gullet will be joined to your duodenum.
Surgery to ease your symptoms
If your stomach cancer has spread beyond your stomach, it may not be possible to remove it through surgery.
However, if you have a large amount of cancer in your stomach, it can cause a blockage which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting, and feeling very full after eating.
If you have a blocked stomach, there are a few options which can be considered.
- You may have a stent inserted where the blockage is. A stent is a plastic or wire mesh tube that is inserted during an endoscopy. After insertion, the stent will expand in place and open up the stomach.
- You may be able to have a partial or total gastrectomy to reduce the blockage and improve your symptoms.
- You may have bypass surgery. In a bypass operation, the part of your stomach above the blockage is joined to your duodenum (the top part of your small intestine), leaving the blocked part of your stomach out of your digestive system. This allows food to move through the unblocked part of your stomach and into your intestines, without coming into contact with the blockage.
Chemotherapy is a specialist treatment for cancer that uses medicines that can stop the growth of cancer cells. These medicines are known as cytotoxic, which means they target rapidly growing cancer cells, stopping them from dividing and multiplying. As it circulates through your system, the medicine can target cancer cells in your stomach, as well as any that may have spread elsewhere in your body.
You may have chemotherapy for stomach cancer before surgery in order to reduce the amount of cancer that your operation has to remove. You may also have chemotherapy after surgery to destroy any remaining cancer cells, and prevent the cancer from recurring.
Chemotherapy can also be used to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery.
If you need to have chemotherapy, the medicine may be given as tablets or intravenously (by injection or a drip through a vein directly into your bloodstream) or a combination of both. Intravenous chemotherapy is usually given in hospital, while oral chemotherapy is taken at home. Chemotherapy is often given in cycles, each lasting about three weeks.
Alternatively, the medicine may be fed into your system through a small pump, which gives you a constant low dose of chemotherapy over a period of a few weeks or months. The pumps are portable and can be worn at home, which can mean fewer trips to hospital.
Side effects of chemotherapy
Chemotherapy works by preventing cells, such as those that are cancerous, from growing rapidly. However, there are other cells that occur naturally in your body that also divide and multiply rapidly, including hair follicles and red and white blood cells. Chemotherapy destroys these non-cancerous cells, which can cause different side effects including:
- hair loss
- nausea and vomiting
- diarrhoea or constipation
- rashes on the skin of your hands and feet
- loss of appetite
- sores around your mouth
- anaemia (this may cause tiredness and breathlessness brought on by a lack of red blood cells)
- leukopenia (this may increase the risk of infection brought on by a lack of white blood cells)
If you need to have chemotherapy, the side effects you experience will depend on the type of cytotoxic medicine that you take, the number of treatment sessions you need to have and your individual reaction to the treatment. You will be told who to contact if you are experiencing serious side effects from chemotherapy and it is very important that this contact information is recorded carefully.
If you experience nausea and vomiting as a result of chemotherapy, you may be able to take anti-sickness medication to counter it. This may be given intravenously (by injection directly into your bloodstream) at the same time as your chemotherapy.
The side effects of chemotherapy will only last for as long as your course of treatment lasts. Once your treatment is over, the rapidly growing cells that occur naturally in your body will repair themselves. This means that your hair will grow back, although it might look or feel different from how it did before your chemotherapy. For example, it may be a slightly different colour, or be softer or curlier than before.
Radiotherapy uses high energy X-rays and, like chemotherapy, works by targeting rapidly growing cancer cells. Radiotherapy is not often used to treat stomach cancer because there is a risk that other organs that are very close to your stomach might be damaged by the treatment.
However, you may need to have radiotherapy for stomach cancer if you have an advanced form of the condition that is causing bleeding or pain.
In some cases, following surgery, you may have chemotherapy and radiotherapy together, to help to prevent the stomach cancer from recurring. However, this type of treatment is still being researched and, if it is offered to you, it is likely to be as part of a clinical trial.
If you need to have radiotherapy, your treatment will begin several months after your surgery or chemotherapy to give your body a chance to recover. It is a painless procedure in which you lie under a radiotherapy machine while it directs radiation at your stomach. You will be positioned by your radiographer (a specialist in radiotherapy) so that the machine targets only the cancer cells and avoids as much of your healthy tissue as possible.
It is likely that you will have radiotherapy sessions five days a week, for about five weeks. Each session will only last a few minutes. The radiation does not stay in your system afterwards, and it is perfectly safe to be around others in between your treatments.
Side effects of radiotherapy
As radiotherapy works by targeting rapidly growing cancer cells, like chemotherapy, it can have several side effects. Other rapidly growing cells that occur naturally in your body are also damaged by radiotherapy, including the skin cells and the cells that line your digestive system. The side effects of radiotherapy may include:
- nausea, with or without vomiting
- stomach pain
- irritation and darkening of your skin where the treatment takes place
However, as radiotherapy is usually only used to treat advanced stomach cancer, you may not experience side effects. The aim of the treatment is to relieve your symptoms and make you feel better, so any side effects should be kept under control. You may be given medicines for this, such as anti-sickness medication.
A great deal of progress has been made in stomach cancer treatment and more people now live longer and have fewer side effects of treatment. These advances were discovered in clinical trials, where new treatments and treatment combinations are compared with standard ones.
All cancer trials in this country are carefully overseen to ensure the trial is worthwhile and safely conducted. In fact, participants in clinical trials can do better overall than in routine care.
If you are asked to take part in a trial, you will be given an information sheet and, if you want to take part, you will be asked to sign a consent form. You are always free to refuse or withdraw from a clinical trial without it affecting your care.