Stomach and Oesophageal Cancers
- The oesophagus and stomach
- What are stomach and oesophageal cancers?
- What are the symptoms of stomach and oesophageal cancers?
- What are the risk factors?
- How are stomach and oesophageal cancers diagnosed?
- The staging and prognosis of stomach and oesophageal cancers
- Treatment for stomach cancer
- Treatment for oesophageal cancer
- Managing side effects of treatment for stomach and oesophageal cancers
- Life after treatment
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Stomach and Oesophageal Cancers
Treatment for stomach cancer
The most important factor in planning treatment for stomach cancer is the stage of the disease, particularly whether the tumour has spread from its original location. Treatment will also depend on your age, medical history, nutritional needs and general health.
Surgery to remove the tumour is the main treatment for stomach cancer that has not spread. If the cancer has spread, treatment may also include chemotherapy, targeted therapy or radiation therapy.
Preparing for treatment
Improve diet and nutrition – People with stomach or oesophageal cancer often lose a lot of weight and can become malnourished. Your doctor will usually refer you to a dietitian for advice on ways to reduce the weight loss through changes to your diet, liquid supplements or a feeding tube. This will help improve your strength, lessen side effects, and lead to better treatment outcomes.
Stop smoking – If you are a smoker, you will be encouraged to stop smoking before surgery. If you continue to smoke, you may not respond as well to treatment and smoking may make any side effects you experience worse. For support, see your doctor or call the Quitline on 13 7848.
Surgery aims to remove all of the stomach cancer while keeping as much normal tissue as possible. The surgeon will remove some healthy tissue around the cancer to reduce the risk of the cancer returning. You may have an endoscopic resection or a gastrectomy depending on where the tumour is growing and how advanced the cancer is.
Endoscopic resection (ER)
Very early-stage tumours that have not spread from the stomach walls may be removed with an endoscope. For some people, an endoscopic resection may be the only treatment needed. This is usually an overnight-stay procedure. Preparation and recovery are similar to endoscopy, but there is a higher risk of bleeding or getting a small tear or hole in the stomach (perforation).
This procedure removes part or all of the stomach, leaving as much healthy tissue as possible. The goal is to completely cut out the cancer, including any nearby affected lymph nodes.
Subtotal or partial gastrectomy – The cancerous part of the stomach is removed, along with nearby fatty tissue (omentum) and lymph nodes. The upper stomach and oesophagus are usually left in place.
Total gastrectomy – The whole stomach is removed, along with nearby fatty tissue (omentum), lymph nodes and parts of nearby organs, if necessary. The surgeon reconnects the oesophagus to the small bowel. The top part of this connection (which is a tube of intestine) takes over some of the stomach’s function.
Lymphadenectomy (lymph node dissection)
As the cancer might have spread to nearby lymph nodes, your doctor will usually remove some lymph nodes from around your stomach. This reduces the risk of leaving any cancer behind.
How the surgery is done
The surgery will be done under a general anaesthetic. There are two ways to perform a gastrectomy:
- in a laparotomy (open surgery), the procedure is done through a long cut in the upper part of the stomach
- in a laparoscopy (keyhole surgery), the surgeon will make some small cuts in the abdomen, then insert a thin instrument with a light and camera (laparoscope) into one of the cuts. The surgeon inserts tools into the other cuts and performs the surgery using the images from the camera for guidance.
The hospital stay and recovery time are fairly similar for both types of surgery. Laparoscopic surgery usually means a smaller scar, however, open surgery may be considered a better option in many situations.
Risks of stomach surgery
As with any major surgery, stomach surgery has risks. These may include infection, bleeding, increased strain on the heart and lungs, damage to nearby organs, or leaking from the connections between the small bowel and either the oesophagus or stomach. Some people experience an irregular heartbeat, but this usually settles in a few days. You will be carefully monitored for any side effects.
What to expect after surgery
This is a general overview of what to expect. The process varies from hospital to hospital, and everyone will respond to surgery differently.
- Your recovery time after the operation will depend on your age, the type of surgery you had and your general health.
- When you wake up after the operation, you will be in a recovery room near the operating theatre or in the intensive care unit.
- Most people will need a high level of care. You can expect to spend time in the high dependency unit or intensive care unit before moving to a standard ward.
- You will probably be in hospital for 5–10 days, but it can take 3–6 months to fully recover from a gastrectomy.
- Talk to your treatment team about any concerns you have about caring for yourself once you return home. If you think you will need home nursing care, ask hospital staff about services in your area.
Help with your recovery
- You will have some pain and discomfort for several days after your surgery. You will be given pain-relieving medicines to manage this.
- Let your doctor or nurse know if you’re in pain so they can adjust your medicines to make you as comfortable as possible. Do not wait until the pain is severe.
- You may have a dressing over the wound. Your doctor or nurse will talk to you about how to keep the wound clean when you go home, to prevent it becoming infected.
- After surgery you will have several tubes in your body, which will be removed as you recover. You may have a drip inserted into a vein in your arm to give you pain relief and to replace your body’s fluids until you are able to drink and eat again. You may have a tube from your bladder (catheter) to collect urine in a bag. You may also have a feeding tube.
- You will be unable to eat or drink straight after surgery. Your doctor will tell you when you are able to start eating.
- You will usually start with fluids such as soup, and then eat soft foods for about a week. When you are ready, you can try eating some solid foods.
- You may be advised to eat 6–8 small meals or snacks throughout the day.
- The hospital dietitian can prepare eating plans for you and work out whether you need any nutritional supplements.
- After surgery, a feeding tube is sometimes placed into the small bowel through a cut in the abdomen. Specially prepared feeding formula is given through this tube while the join between the oesophagus and small bowel heals. The tube is usually removed after 3–4 weeks.
- Your health care team will probably encourage you to walk the day after surgery. They will also provide guidance on suitable activity levels as you recover from surgery.
- Gentle exercise has been shown to help people manage some of the common side effects of treatment, speed up a return to usual activities and improve quality of life. Ask your doctor or nurse if there are any suitable exercise programs available in your area.
- You will have to wear compression stockings for a couple of weeks to help the blood in your legs circulate and reduce the risk of developing blood clots.
- You will most likely need to avoid driving for a few weeks after the surgery and avoid heavy lifting.
- A physiotherapist will teach you breathing or coughing exercises to help keep your lungs clear. This will reduce your risk of getting a chest infection.
Chemotherapy uses drugs to kill or slow the growth of cancer cells. For stomach cancer, chemotherapy is commonly given before surgery to shrink large tumours and destroy any cancer cells that may have spread. It may also be used after surgery to reduce the chance of the disease coming back. Chemotherapy is also used palliatively.
Chemotherapy is usually given as a liquid through a drip inserted into a vein in the arm. It may also be given through a tube implanted into a vein (called a port, catheter or vascular access device), or as tablets you swallow. You will usually receive treatment as an outpatient.
Most people receive a combination of drugs in repeating cycles spread over several months. There may be a rest period of 2–3 weeks between each cycle of chemotherapy. Your doctor will talk to you about how long your treatment will last.
Side effects of chemotherapy
The side effects of chemotherapy vary greatly for each person. Some people have few side effects, while others have many. Most side effects are temporary, but some may last longer or be ongoing. Your medical oncologist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medicine.
Side effects may include feeling sick (nausea), vomiting, sore mouth or mouth ulcers, appetite changes and difficulty swallowing, skin and nail changes, numbness in the hands or feet, ringing in the ears or hearing loss, constipation or diarrhoea, and hair loss or thinning. You may also be more likely to catch infections.
This is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading.
HER2 (human epidermal growth factor receptor 2) is a protein that causes cancer cells to grow uncontrollably. If you have HER2 positive advanced stomach or gastro-oesophageal junction cancer, you may be given a targeted therapy drug called trastuzumab. This drug destroys the HER2 positive cancer cells or slows their growth. Trastuzumab is given with chemotherapy every three weeks through a drip into a vein.
Another targeted therapy drug called ramucirumab aims to reduce the blood supply to a tumour to slow or stop its growth. It has been approved to treat advanced stomach or gastro-oesophageal junction cancer that has not responded to chemotherapy. Ramucirumab is not subsidised on the PBS so it is expensive (as at October 2019).
You may be able to access other new drugs to treat stomach cancer through clinical trials. Talk to your doctor about the latest developments and whether there are any suitable clinical trials for you.
Side effects of targeted therapy
Ask your doctor what side effects you may experience. Possible side effects of trastuzumab include fever and nausea. In some people, trastuzumab can affect the way the heart works. Possible side effects of ramucirumab include stomach cramps, diarrhoea and high blood pressure. Let your doctor know of any side effects immediately.
Also known as radiotherapy, this treatment uses a controlled dose of radiation to kill or damage cancer cells. Radiation therapy for stomach cancer is commonly used to control symptoms. It is usually given externally as a short course (between one day and two weeks). Occasionally radiation will be given over a longer period (5–6 weeks), particularly if surgery is not possible, or there are concerns about cancer cells being left behind after surgery.
Each treatment takes about 15 minutes and is not painful. You will lie on a table under a machine that delivers radiation to the affected parts of your body. Your doctor will advise you about your treatment schedule. Potential side effects include fatigue, nausea, vomiting, skin redness and loss of appetite (anorexia).
Palliative treatment aims to help maintain a person’s quality of life by managing the symptoms of cancer without trying to cure the disease. Many people think that palliative treatment is for people at the end of life, but it can help at any stage of advanced stomach cancer.
The treatment you are offered will be tailored to your individual needs, and may include surgery, stenting, radiation therapy, chemotherapy or other medicines. These treatments can help manage symptoms such as pain, bleeding, difficulty swallowing and nausea. They can also slow the spread of the cancer.
This information is reviewed by
This information was last reviewed October 2019 by the following expert content reviewers: Prof David Watson, Senior Consultant Surgeon, Oesophago-gastric Surgery Unit, Flinders Medical Centre, and Matthew Flinders Distinguished Professor of Surgery, Flinders University, SA; Kate Barber, 13 11 20 Consultant, Cancer Council Victoria; Katie Benton, Advanced Dietitian, Cancer Care, Sunshine Coast Hospital and Health Service, QLD; Alana Fitzgibbon, Clinical Nurse Consultant, Gastrointestinal Cancers, Royal Hobart Hospital, TAS; Christine Froude, Consumer; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Gold Coast University Hospital, QLD; Dr Spiro Raftopoulos, Interventional Endoscopist and Consultant Gastroenterologist, Sir Charles Gairdner Hospital, WA; Grant Wilson, Consumer; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.