Stomach cancer

Treating stomach cancer

The treatments recommended for stomach cancer will depend on your general health and how far the cancer has spread.

Most hospitals use multidisciplinary teams made up of a number of different specialists (see below) who work together to plan and carry outthe best treatment, tailored to your circumstances.

Feel free to discuss treatment with your care team at any time and ask questions.

Your treatment plan

The main treatments for stomach cancer are surgery, chemotherapy and radiotherapy . You may have one of these treatments or a combination.

If surgery is recommended, you may have chemotherapy beforehand. If the tumour is in the upper part of your stomach, including the junction between the oesophagus and stomach, you may also have radiotherapy prior to surgery.

Surgery is mainly used if stomach cancer is diagnosed at an early stage, whereas chemotherapy and radiotherapy tend to be used when the condition is diagnosed at a later stage.

Where possible, the primary aim of treatment is to completelyremove the tumour and any other cancerous cells in your body.It's estimated that a cure is possible in 20-30% of stomach cancer cases.

If it's not possible to remove the tumour, your doctors will focus on trying to prevent it from getting any bigger and causing further harm to your body. This may be done using surgery or chemotherapy.

In some cases, it's not possible to eliminate the cancer or slow it down. In this case, your treatment will aim to relieve your symptoms and make you as comfortable as possible, usually with surgery or radiotherapy.

A relatively new medication calledtrastuzumab (see below) can also be used to treat some types of advanced stomach cancer.

Your healthcare team will talk to you about which treatments are most suitable.

Surgery

If you're diagnosed with stomach cancer at an early stage,it may be possible for the cancer to be completely removed during surgery.

In some cases, it may be possible to pass a thin, flexible tube ( endoscope ) down your oesophagus (gullet),rather than making incisions in your tummy. This is known as endoscopic surgery, and can be used toremove a sample of the tumour for testing ( biopsy ). It can also be used to remove the tumour completely if stomach cancer is diagnosed at an early stage.

However, if your cancer has spread beyond your stomach, it may not be possible to remove it completely. If this is the case, you may still have surgery to remove any cancer blocking your stomach, to ease your symptoms. This will depend on whether your symptoms can be controlled and the risks and side effects of undertaking major surgery.

Any type of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, you'll usually need to stay in hospital for around two weeks. You'll also need several weeks at home to recover.

Surgery to remove your stomach

You mayneed to have part or all of your stomach removed.

Surgery to remove part of your stomach is known as a partial or sub-total gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may remove part of your oesophagus as well as all ofyour stomach, usinga procedure known as an oesophagogastrectomy.

These operations may be carried outusing either a large incision in your tummy (open surgery), or a number of smaller incisions through which surgical tools can be passed (laparoscopic or keyhole surgery). Both of these techniques are carried out under general anaesthetic , which means you'll be unconscious throughout the procedure.

During these operations, your surgeon will also remove the lymph nodes (small glands that help fight infection) nearest to the cancer. It's possible that your stomach cancer may have spread to these lymph nodes, and removing them helps prevent the cancer returning.

Partial gastrectomy

If your cancer is in the lower part of your stomach, you may have a partial gastrectomy toremove it.

After surgery, your stomach will be smaller than it was before the operation. However, the top part of your stomach, where your oesophagus feeds into it, won't be affected.

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 . If the cancer is close to the end of your oesophagus, where it meets your stomach, you mayneed to have an oesophagogastrectomy.

If you have a total gastrectomy, the end of your gullet will be joined to the top of your jejunum (the top part of your small intestine). If you have an oesophagogastrectomy, the remaining part of your gullet will be joined to your jejunum.

For more information about life after a gastrectomy, see living with stomach cancer and recovering from a gastrectomy .

Surgery to ease your symptoms

If your stomach cancer has spread beyond your stomach, it may not be possible to remove it using surgery.

However, if your stomach has been significantly affected by cancer 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 your stomach is blocked, there are a few options:

stenting a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic ; after being inserted, the stent will be expanded and open up the stomach
partial or total gastrectomy to remove the blockage and improve your symptoms
bypass surgery an operation where part of your stomach above the blockage is joined to yoursmall intestine, leaving the blocked part of your stomach out of your digestive system

Chemotherapy

Chemotherapy is a specialist treatment for cancer that uses medicines, called cytotoxic medicines,to stop cancer cells dividing and multiplying. As it circulates through your body, the medicine can target cancer cells in your stomach and any that may have spread to other parts of your body.

You may have chemotherapy for stomach cancer before surgery to reduce the amount of cancer that has to be removed during the operation. Chemotherapy can also be used after surgery to destroy any remaining cancer cells and prevent the cancer from coming back.

Chemotherapy can also help to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery.

If may be given orally (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 usually lasting about three weeks.

Alternatively, chemotherapy may be administered through a small pump, which gives you a constant low dose over a few weeks or months. The pumps are portable and can be worn at home, which means fewer trips to hospital.

Side effects of chemotherapy

Chemotherapy works by preventing cancerous cells from growing rapidly. However, it also destroys non-cancerous cells such ashair follicles and red and white blood cells. Side effects may include:

tiredness
nausea and vomiting
nerve damage ( peripheral neuropathy )
hair loss
diarrhoea
anaemia (a lack of red blood cells)
weight loss
skin changes such as redness, swelling and a tingling sensation in the palms of the hands and/or soles of the feet

The side effects you experience after having chemotherapy will depend on the type of chemotherapy and the number of treatment sessions you need. You'll be told who to contact if you're experiencing serious side effects from chemotherapy, and it's 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, thehair folliclesand blood cellswill repair themselves. This means your hair will grow back, although it might look or feel different from how it did before chemotherapy (for example, it may be a slightly different colour, or be softer or curlier than before).

Radiotherapy

Radiotherapy uses beams of high energy radiation to destroy cancer cells. It's not often used to treat stomach cancer because there's a risk that other organs close to your stomach might be damaged by the treatment.

However, if you have advanced stomach cancer that's causing pain or bleeding,you may need to have radiotherapy. In some cases, following surgery, you may have chemotherapy and/or radiotherapy to help prevent the stomach cancer from recurring.

If a cancer is bleeding slowly and causing anaemia , a single fraction of radiotherapy can be used to try to prevent further bleeding.

If you need radiotherapy, your treatment will usually begin two or three months after surgery or chemotherapy, to give your body a chance to recover. This is a painless procedure where you lie under a radiotherapy machine while it directs radiation at your stomach. You'll be positioned by a radiographer (a specialist in radiotherapy) so that the machine targets the cancer cells and avoids as much healthy tissue as possible.

Radiotherapy often involves having treatment sessions five days a week. Each session will only last a few minutes. The radiation doesn't stay in your system afterwards, and it's perfectly safe to be around others between your treatments.

How long you'll need to have radiotherapy for will depend on how it's used. Radiotherapy used after surgery to help prevent stomach cancer coming back usually lasts five weeks. If it's being used to control symptoms of advanced stomach cancer, it may only last one or two weeks.

Side effects of radiotherapy

You may experience the following side effects after having radiotherapy:

tiredness
nausea
diarrhoea
irritation and darkening of your skin where the treatment takes place

These side effects will usually improve within a few weeks of treatment finishing.

Trastuzumab

Trastuzumab(sold under the brand name Herceptin) is a medicationused to treat breast cancer and some cases of advanced stomach cancer.

Some stomach cancers are stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2). Trastuzumab works by blocking the effects of this protein. This doesn't cure stomach cancer, butit can slow its growth and increase survival time.

If you're diagnosed with advanced stomach cancer and tests show high levels of the HER2 protein in the cancerous cells, your doctors may recommend treatment with a combination of chemotherapy and trastuzumab.

Trastuzumab is given intravenously, through a drip, and you'll have the treatment in hospital. Each treatment session takes up to one hour and you'll usually need a session once every three weeks.

Trastuzumab can cause side effects, including heart problems. Therefore, it may not be suitable if you have a heart problem such as angina , uncontrolled high blood pressure ( hypertension ) or heart valve disease. If you need to take trastuzumab, you'll also need regular tests on your heart to check for any problems.

Other side effects of trastuzumab may include: