Stomach cancer

About stomach cancer

In the UK, around 7,000 people get stomach cancer each year. It’s one of the less common cancers and the number of people getting it has been steadily decreasing. It’s more common in other areas of the world, such as Eastern Asia, probably because of differences in diet and lifestyle.

Early symptoms of stomach cancer may be quite vague. Many stomach cancers are diagnosed when the cancer has already spread to areas nearby or to other parts of the body, such as the liver.

More than 9 out of 10 stomach cancers are a type called adenocarcinoma.

Treatment of stomach cancer

Your choice of stomach cancer treatment will depend on the size of your stomach cancer, where it is, and whether it’s spread. Your general health and fitness will also be taken into account, along with your own wishes about your treatment.

If the cancer is still contained within your stomach, or has only spread to nearby lymph nodes, it may be possible to cure it. You’re most likely to have surgery, often alongside chemotherapy. You may also have radiotherapy.

If your cancer has spread further, stomach cancer treatment will focus on controlling it and relieving any symptoms you have. You may have (either on their own or a combination):

• chemotherapy
• radiotherapy
• targeted or immunotherapy medicines
• surgery

A multi-disciplinary team that includes surgeons, cancer specialists and other health professionals will discuss your stomach cancer treatment plan. They’ll decide on the most suitable treatments and discuss your options with you.

Surgery

This is the main treatment for stomach cancer that hasn’t spread. It may be possible to cure your cancer. There are several different options.

For a very small cancer that’s only in the stomach lining, you may have endoscopic surgery. You may hear this called endoscopic mucosal resection (EMR) or dissection (EMD). A doctor will pass a flexible tube with a camera on the end (an endoscope) down your throat. They’ll remove the affected areas of your stomach lining and then take out the tube. So you don’t have any cuts to your tummy (abdomen).

For larger cancers, you may have surgery to remove part or all of your stomach. These operations are called subtotal, partial, or total gastrectomies. You may be able to have keyhole surgery, also called laparoscopic surgery. This means your surgeon will make several smaller cuts in your tummy, instead of one large one.

If your surgeon recommends surgery, they’ll explain what will happen before, during and after your operation, including potential side-effects.

Recovering from surgery

As soon as you’re able to after surgery, you can start taking sips of water. But in the first day or so after your operation, you won’t be able to eat. You may have a drip to give you fluids and sometimes a feeding tube into your bowel to help you get enough nutrition. You usually start building up to eating small amounts within a week or so.

If you had all or part of your stomach taken out, you’ll have to change your eating habits longer term. Aim for the same amount of food over a day, but have it in smaller meals spread throughout the day. A dietitian can give you some helpful advice.

Some foods may make you feel sick or give you diarrhoea or indigestion. Try to keep track of what foods cause you problems. You can discuss this with your nurse or dietitian, who will advise you.

You may need to take supplements of some vitamins and minerals that your stomach usually absorbs. If you’ve had all of your stomach removed (a total gastrectomy), you’ll also need regular injections of vitamin B12 (usually every three months).

Some people develop a problem called dumping syndrome after stomach surgery. Food moves into your small bowel more quickly than before. This can cause symptoms such as dizziness, faintness, sickness and diarrhoea, straight after eating a meal or a few hours later. If you have these symptoms, ask your nurse or dietitian for advice.

Chemotherapy

You may have chemotherapy before and after surgery, or only after surgery. This is to reduce the risk of the cancer coming back. Whether you have chemotherapy or not depends on how far the cancer has grown.

If your cancer has spread, your cancer specialist may suggest chemotherapy to slow down the growth of your cancer and reduce symptoms. You may have chemotherapy on its own or together with immunotherapy or targeted medicines.

You have your treatment through a drip into a vein. You may also have tablets, depending on the treatment you have. You usually have your treatment every three weeks, with a rest in between.

Chemotherapy kills cancer cells but can also damage healthy cells. The body recovers, but it’s this that causes side-effects after treatment. People are affected differently, but possible side-effects include:

• an increased risk of getting an infection
• tiredness (fatigue) and breathlessness
• feeling or being sick
• diarrhoea
• hair loss

Side-effects can vary depending on the chemotherapy medicines you have. So, ask your doctor or chemotherapy nurse for more information.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells.

Radiotherapy alone isn’t used that often to treat stomach cancer. But for a more advanced cancer, you may have it to control symptoms. This is usually a short course of treatments, called fractions.

Radiotherapy has to be carefully planned. You’ll have scans and a pre-treatment planning appointment to map out the treatment area and calculate the dose you’ll need.

Radiotherapy side-effects can include tiredness, indigestion, feeling sick, and red skin in the treatment area, similar to sunburn. They usually come on gradually and last for around two weeks after treatment. With a short course of treatment, side-effects are likely to be less. Chemoradiotherapy can have more severe side-effects.

Targeted cancer drugs

These are medicines that seek out cancer cells and interfere with the way they grow. There are many different types. Some targeted therapies are also called immunotherapy because they encourage your immune system to attack the cancer.

These treatments are currently only used for stomach cancer that has spread.

Nivolumab is an immunotherapy that you may have alongside chemotherapy for stomach cancer that has spread. Or you may have trastuzumab (Herceptin®). This locks on to cancer cells and stops them growing. Again, you have it with chemotherapy.

Research has shown that immunotherapy may be able to cure stomach cancer too – ask your doctor to explain what is possible for you.

Targeted therapies’ side-effects vary a great deal, depending on the particular medicine you have. They may include skin rashes, diarrhoea and tiredness. Ask your doctor or nurse about side-effects for the treatment they suggest.