Stomach cancer - Treating stomach cancer

Treatments used for stomach cancer depend on how far the cancer has spread and your general health.

Most hospitals use multidisciplinary teams containing different specialists to plan and carry out the best treatment, tailored to your circumstances.

Feel free to discuss treatment with your care team at any time and ask any 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, depending on your individual circumstances.

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.

The primary aim of treatment, where possible, is to completely remove 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 this is not possible, your doctors will focus on trying to prevent your tumour from getting any bigger and causing any 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 called trastuzumab 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 are diagnosed with stomach cancer at an early stage, it may be possible for the cancer to be completely removed during surgery.

In some cases, this may involve passing a thin, flexible tube (endoscope) down your oesophagus, rather than incisions in your tummy. This is known as endoscopic surgery, and can be used to remove 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 during surgery. 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 a major surgical procedure.

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 stay in hospital for around two weeks. You will also need several weeks at home to recover.

Surgery to remove stomach cancer

If you have surgery to remove the cancer in your stomach, you will probably 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.

These operations may be carried out using either a large incision in your tummy (known as "open surgery"), or a number of smaller incisions through which surgical tools can be passed (known as "laparoscopic" or "keyhole" surgery). Both these techniques are carried out under general anaesthetic, which means you will be asleep through the procedure.

During these operations, your surgeon will also remove the lymph nodes (small, oval glands that remove unwanted bacteria and particles from the body) nearest to the cancer. It's possible that your stomach cancer may have spread to these lymph nodes, and removing them helps to prevent the cancer from coming back.

Partial gastrectomy

If your cancer is in the lower part of your stomach, you may have a partial gastrectomy to remove this.

After the operation, 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 to remove the whole of your stomach. If the cancer is close to the end of your oesophagus (gullet), where it meets your stomach, you may need to have an oesophagogastrectomy to remove part of your gullet.

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.

For more information about life after a gastrectomy, see living with stomach cancer or 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 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:

stenting – a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic; after insertion, it will expand 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 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

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, as this will reduce the amount of cancer that has to be removed in your operation. You may also have chemotherapy after surgery to destroy any remaining cancer cells and prevent the cancer from coming back.

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.

You may need chemotherapy. If you do, it 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 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 cells, including cancerous ones, 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:

tiredness
feeling sick (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

Your side effects to chemotherapy will depend on the type you are given, 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 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 is not often used to treat stomach cancer because there is a risk that other organs close to your stomach might be damaged by the treatment.

However, if it’s advanced and causing bleeding or pain, 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 you need radiotherapy, your treatment will usually begin two or three months after your surgery or chemotherapy, to give your body a chance to recover. This 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 the cancer cells and avoids as much of your healthy tissue as possible.

Radiotherapy often involves treatment sessions five days a week. 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 between your treatments.

How long you will 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 is being used to control symptoms of advanced stomach cancer, it may only last one or two weeks.

Side effects of radiotherapy

If you have radiotherapy, you may experience the following side effects:

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 medication first used to treat breast cancer and is also useful in treating some cases of advanced stomach cancers.

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 does not cure stomach cancer, but can slow its growth and increase survival time.

If you are diagnosed with advanced stomach cancer and testing shows you have 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 will have the treatment in hospital.

Each treatment session takes up to one hour, and you will usually need a session once every three weeks.

Trastuzumab can cause side effects, including heart problems. This means 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 will need regular tests on your heart to check for any problems.

Other side effects of trastuzumab may include:

an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever
diarrhoea
tiredness
aches and pains