Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
Surgery may be done to remove the cancer and part or all of the stomach and some nearby lymph nodes, depending on the type and stage of the stomach cancer. The surgeon will try to leave behind as much normal stomach as possible. The extent of the surgery should be discussed with your doctor before it is done.
Endoscopic mucosal resection and endoscopic submucosal resection can be used exclusively on very early-stage cancers, where the chance of spread to the lymph nodes is very low. These are not done routinely in the United States and if you are going to have this kind of surgery, it should be at a center that has experience with this technique.
Gastric cancer surgery in the united states is usually a subtotal (partial) gastrectomy This operation is often recommended if the cancer is only in the lower part or upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine (the duodenum). The remaining section of stomach is then reattached. Some of nearby lymph nodes, and possibly the spleen and parts of other nearby organs may be removed depending on the stage of the tumor. Eating is much easier after surgery if only part of the stomach is removed.
If the cancer has spread throughout the stomach or outside of the stomach, then the gastric cancer surgery is a total gastrectomy. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus. The surgeon removes the entire stomach, nearby lymph nodes, omentum, and may remove the spleen and parts of the esophagus, intestines, pancreas, or other nearby organs. The end of the esophagus is then attached to part of the small intestine. This allows food to move down the intestinal tract. But people who have had their stomach removed can only eat a small amount of food at a time. Because of this, they must eat more often.
For people with unresectable stomach cancer, palliative surgery can often still be used to help control the cancer or to help prevent or relieve symptoms or complications. For some people who are healthy enough for surgery, a subtotal gastrectomy can help treat problems such as bleeding, pain, or blockage in the stomach, even if it does not cure the cancer. Tumors in the lower part of the stomach may eventually grow large enough to block food from leaving the stomach. For people healthy enough for surgery, one option to help prevent or treat obstruction due to tumor is gastric bypass surgery which bypasses the lower part of the stomach. This is done by attaching part of the small intestine (called the jejunum) to the upper part of the stomach, which allows food to leave the stomach through the new connection.
Endoscope can also be used to guide a laser beam to vaporize parts of the tumor. This endoscopic tumor ablation can be done to stop bleeding or help relieve a blockage without surgery.
In some cases, such as in people who are not healthy enough for surgery, an endoscope is used to place a stent (a hollow metal tube) to keep the lumen open so food can continue to pass into the stomach-this is used in cases of obstructing tumors. This helps keep the esophagus and stomach open and allows food to pass through, allowing oral nutrition.
Some people with stomach cancer are not able to eat or drink enough to get adequate nutrition. A minor operation can be done to place a feeding tube through the skin of the abdomen and into the distal part of the stomach (known as a gastrostomy tube or G tube) or into the small intestine (known as a jejunostomy tube/J tube). Liquid nutrition can then be infused through the tube into the stomach.
Complications and side effects of surgery
Surgeries done for stomach cancer are difficult and can have complications. These can include bleeding from the surgery, blood clots, and damage to nearby organs during the operation. After the operation, the connections made during surgery between the ends of the stomach or esophagus and small intestine may leak. If patients have trouble in taking enough nutrition after surgery, liquid nutrition can be introduced via a feeding tube directly into the intestine to help prevent and treat malnutrition. Some people may develop side effects after they recover from surgery. These can include nausea, heartburn, abdominal pain and diarrhea; particularly after eating. These side effects often get better over time, but in some people they can last for a long time. Your doctor might prescribe medicines to help with this.
Eating or drinking will not be possible for at least a few days after a total or subtotal gastrectomy. Changes in your diet will be needed after a partial or total gastrectomy. You will need to eat smaller, more frequent meals. The amount of stomach removed will affect how much you need to change the way you eat. People who have had a subtotal or total gastrectomy may develop vitamin deficiencies. If certain parts of the stomach are removed, doctors routinely prescribe vitamin supplements, some of which can only be injected.
Anti-cancer drugs are used in gastric cancer chemotherapy. They are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond where it started. Chemotherapy can be given before surgery called neoadjuvant therapy to shrink the tumor, thus making surgery easier and more limited. Often, chemotherapy is then given again after surgery.
Chemotherapy may be given after surgery to remove the cancer. This is called adjuvant treatment. The goal of adjuvant chemotherapy is to kill any cancer cells that may have been left behind but are too small to see. This may prevent cancer recurrence.
Often, for stomach cancer treatment, chemotherapy is given with radiation therapy after surgery. This combination is called chemoradiation. This may be especially helpful for cancers that could not be removed completely by surgery.
Chemotherapy is also given as main treatment for stomach cancer when there is spread (metastasized) to distant organs. It may help shrink the cancer or slow its growth, which can relieve symptoms for some patients and help them live longer. Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.
Side effects of chemotherapy include:
Loss of appetite and nausea; Diarrhea; Increased chance of infection; Increased bleeding tendency; Fatigue and shortness of breath.
The side effects mentioned are mainly short-term and go away after the treatment is finished. For instance, hair will usually grow back after treatment ends. Be sure to tell your cancer care team about any side effect you experience, because there are often ways to lessen them. Some chemotherapy drugs have specific side effects. You should be given specific information about each drug you are receiving and you should review it before you start treatment.
There are some other side-effects like neuropathy, heart damage and hand-foot syndrome, related to specific drugs. Permanent heart damage can occur if some drugs are used for a long time or in high doses. For this reason, doctors carefully control the doses and use multiple investigations and do frequent evaluations to detect them early and take measures quickly.
Radiation therapy uses high-energy rays or particles to destroy cancer cells in a specific area of the body. Before surgery for some cancers, radiation can be used along with chemotherapy to shrink the tumor to make surgery easier. After surgery, radiation therapy can be used to kill very small remnants of the cancer that cannot be seen and removed during surgery. It may delay or prevent cancer recurrence after surgery and may help patients live longer. Mayo clinic has reported very good results with treatment after surgery. Radiation therapy can be used to slow the growth and ease the symptoms of advanced stomach cancer, such as pain, bleeding, and eating problems.
External beam radiation therapy is the type of radiation therapy often used to treat stomach cancer. This treatment focuses radiation on the cancer from a machine outside the body. Often, special types of external beam radiation, such three-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) are used. These use computers and special techniques to focus the radiation on the cancer and limit the damage to nearby normal tissues. For an expanded discussion of precision radiation therapy, go HERE.
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is much stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time (getting you into place for treatment) usually takes longer.
Side effects from radiation therapy for stomach cancer are as follows.
Skin redness to blistering and peeling; Diarrhea ; Nausea and vomiting; Fatigue; Low blood cell counts
These fade off within several weeks after the treatment is finished. Some people need to have fluids given into a vein (IV) or have a feeding tube placed to get nutrition during treatment. Patients have to make sure to tell their doctor about any side effects they have, because there are often many ways to relieve them. Doctors take all the necessary steps possible to prevent damage to other nearby organs by using only the needed dose of radiation, carefully controlling where the beams are aimed, and shielding certain parts of the body from the radiation during treatment.
Stomach cancer Immunotherapy is a method of treatment where drugs or other substances are used to help the body’s immune system fight the cancer. A Korean study looking at stomach cancer immunotherapy with an agent called polyadenylic-polyuridylic acid slowed stomach cancer after combining with chemotherapy when given as adjuvant therapy after surgery. It also helped some patients live longer. This field is just getting developed and there are constant new developments. Not all immune therapies have had good outcomes, some have stimulated the immune system to destroy good organs and had unacceptable toxicity. An expanded discussion of Immunotherapy is found HERE.
There is a dramatic decline of stomach cancer in the past few decades as a result of people reducing many of the known dietary risk factors. This includes greater use of refrigeration for food and avoiding a diet that is high in smoked and pickled foods and salted meat and salted fish. A diet high in fresh fruits and vegetables can also lower stomach cancer risk. Citrus fruits (like oranges, lemons, and grapefruit) may be especially helpful. The American Cancer Society recommends maintaining a healthy weight throughout life by balancing calorie intake with physical activity. Avoid stomach cancer by reducing tobacco use also reduces the risk of getting stomach cancer. For an expanded discussion about Detoxification go HERE.