Many hospitals use multidisciplinary teams (MDTs) to treat stomach cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Members of your MDT may include:
- a surgeon
- a clinical oncologist (a specialist in the non-surgical treatment of cancer)
- a pathologist (a specialist in diseased tissue)
- a radiologist (a specialist in radiotherapy)
- a dietician
- a social worker
- a psychologist
- a specialist cancer nurse, who will usually be your first point of contact between yourself and the rest of the team
Your treatment plan
When deciding what treatment is best for you, your doctors will consider:
- the stage and grade of your cancer (how big it is and how far it has spread)
- your general health
Feel free to discuss your treatment with your care team at any time and to ask any questions.
The main treatments for stomach cancer are:
- surgery
- chemotherapy
- radiotherapy
You may have one of these treatments or a combination. The type of treatment or the combination of treatments will depend on how the cancer was diagnosed and at what stage and grade it is.
The first aim of treatment, where possible, is to completely eliminate (remove) the tumour and any other cancerous cells in your body. 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 is usually done using a combination of surgery and chemotherapy.
In some cases, it is neither possible to eliminate the cancer or slow down its progression. In this case, your treatment will aim to relieve your symptoms and to make you as comfortable as possible. This is usually done using radiotherapy. In some cases, surgery and chemotherapy may be used.
A new medication called trastuzumab can also be used to treat some types of advanced stomach cancer.
Your healthcare team will discuss with you which treatments are most suitable.
Surgery
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.
Partial gastrectomy
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
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 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
- feeling sick (nausea) and being sick (vomiting)
- loss of appetite
- sores around your mouth
- anaemia (this may cause tiredness and breathlessness brought on by a lack of red blood cells)
- increased vulnerability to infection
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
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 it’s advanced and 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. Read more about clinical trials for stomach cancer.
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
If radiotherapy is being used to relieve symptoms of advanced stomach cancer then it is usually given at a relatively low dose so you should not experience any significant side effects.
If it is being given in combination with chemotherapy then the dosage will be higher and you may experience the following side effects:
- nausea, with or without vomiting
- diarrhoea
- tiredness
- stomach pain
- irritation and darkening of your skin where the treatment takes place
Trastuzumab
Trastuzumab (sold under the brand name Herceptin) is a medication that was first used to treat breast cancer and has now been found to be 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). So trastuzumab works by blocking the effects of the HER2 protein.
This does not cure stomach cancer but it can slow its growth and increase survival time.
If you are diagnosed with advanced (stage 4) stomach cancer and testing shows you have high levels of the HER2 protein in the cancerous cells then your doctors may recommend you are treated 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 that it maybe not 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 make sure it is not causing 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
Read more about trastuzumab.
Comments are closed.