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Treatment Options

Treatment options may include surgery, chemotherapy and sometimes radiotherapy.

The treatment recommended in each case depends on both the stage of the cancer and your general health.

Some of the treatments are potentially quite difficult to tolerate and for patients with poor health, may not be safe.

These options are discussed in great detail with a specialist who will have discussed your case with other specialist colleagues through our Multi-Disciplinary Team. They will be able to discuss with you the pros and cons of each treatment, the likely success rate, possible side effects and other details about possible treatments.

Where possible, the aim of treatment will be to try and cure the cancer. In cases where the cancer is treated at an early stage, then this is possible.

However, in some cases, curative treatment is not realistic. This may be because the cancer has spread too far to be cured by any treatment or it may be that someone’s general health is so poor that any attempt at curative treatment would not be possible. In such circumstances, treatment would be aimed at limiting the growth or spread of the cancer and trying to keep patients free of symptoms for as long as possible.

 

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 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. 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 one to two weeks. You'll also need several weeks at home to recover.

 

Surgery to remove your stomach

You may need 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 of your stomach, using a procedure known as an oesophagogastrectomy.

These operations may be carried out using 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 to remove 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 may need 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.

 

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 your small 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 as hair 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, the hair follicles and blood cells 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'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.

 

Other treatments

Other operations or procedures can be used to improve symptoms rather than try and cure stomach cancer.

If the cancer is causing a blockage of the stomach and it is not possible to perform a curative operation, then smaller procedures can be used to either bypass the stomach (using an operation), or to endoscopically place a stent through the cancer to allow the stomach to empty.

These treatments will not cure the underlying stomach cancer but can delay or reduce symptoms

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