Stomach cancer treatment

How treatment is planned

Your health care team will recommend treatment based on where the cancer is in the stomach, and whether it has spread (the stage). Treatment will also depend on your age, medical history and general health.

To plan and provide care, a multidisciplinary treatment (MDT) team works together. This team may include a gastroenterologist, surgeon, radiation and medical oncologists, specialist nurses, and allied health professionals, such as a dietitian, exercise physiologist or social worker.

Surgery is often part of the treatment for stomach cancer that has not spread. For early-stage cancer, you may only need to have an endoscopic resection. If the cancer has spread, treatment may include chemotherapy, targeted therapy, immunotherapy or radiation therapy.

Surgery for stomach cancer

Surgery aims to remove all of the stomach cancer while keeping as much of the stomach as possible. The surgeon will also remove some healthy tissue around the cancer to reduce the risk of it returning. Different types of surgery can be used depending on where the cancer is in the stomach.

The surgery will be done under a general anaesthetic. There are 3 main ways to perform surgery for stomach cancer:

Open surgery (laparotomy)

The surgeon makes a long cut in the upper part of the abdomen from the breastbone to the bellybutton.

Keyhole surgery (laparoscopy)

The surgeon makes some small cuts in the abdomen, then inserts a thin instrument with a light and camera (laparoscope) into one of the cuts. The surgeon puts tools into the other cuts and performs surgery using the images from the camera for guidance. Also called laparoscopic or minimally invasive surgery.

Robotic surgery

This is a type of keyhole surgery where the surgeon uses robotic tools to remove the cancer through small cuts in the abdomen and/or chest.

I had surgery for stomach cancer, which is hard because my stomach is so much smaller. I have good days and bad days, but I’m back at work and I exercise every week. My prognosis for the future is good.

Brian

Types of stomach surgery

Subtotal or partial gastrectomy

Only part of the stomach is removed when the cancer is in the lower part of the stomach. If necessary, nearby fatty tissue (omentum) and lymph nodes are also removed. A small part of the upper stomach attached to the oesophagus is usually left in place.

Total gastrectomy

The whole stomach is removed when the cancer is in the upper or middle part of the stomach. Nearby fatty tissue (omentum), lymph nodes and parts of nearby organs, if necessary, are also removed. The surgeon rejoins the oesophagus to the small bowel.

Lymph node dissection

Also called lymphadenectomy, lymph nodes are removed from around your stomach to reduce the risk of the cancer coming back and to help in the staging of the cancer.

Endoscopic resection

If you are diagnosed with very early stomach cancer, you may have an endoscopic resection. This aims to remove the whole tumour during the endoscopy so further treatment is not needed. An endoscopic resection is often done as a day procedure but in some cases, you may stay in hospital overnight.

What to expect after surgery

This is a general overview of what to expect when having surgery for stomach cancer. The process varies from hospital to hospital, and everyone will respond to surgery differently.

Recovery

• Most people need extra care after surgery. You may spend some time in a high-dependency or intensive care unit before moving to a regular ward. Most people stay in hospital for 3–10 days.
• You will have some pain and discomfort for several days after surgery, but this will be managed with pain medicines.
• The doctor or nurse will talk to you about how to care for any wounds when you go home.

You will have several tubes in your body after surgery. These may include:

• a drip in your arm to give you pain medicine and to replace your body’s fluids
• a tube from your bladder (catheter) to collect urine in a bag
• a feeding tube.

Talk to your treatment team if you want to organise support at home. 

Activity and exercise

•  You will usually be asked to start walking the day after surgery. Research shows gentle exercise soon after surgery can reduce side effects, speed up recovery, and improve how you feel.
• Your health care team will provide advice about the right activity levels for you.
• For about 2 weeks after surgery, you’ll need to take steps to lower the risk of blood clots in your legs. This may include wearing compression stockings or having daily injections to thin your blood.
• You may need to avoid driving and heavy lifting for 1–2 months after surgery.
• You will be taught breathing or coughing exercises to help keep your lungs clear and reduce the risk of a chest infection.

Eating and drinking

• How you eat and drink will change after surgery.
• When you start eating again, you will begin with clear fluids such as water or broth. Then you’ll move to liquids such as milk, soup, ice-cream and yoghurt. After that, you will try pureed foods, then soft foods, and finally solid foods. This can take several weeks or even months.
• Start eating and drinking by mouth when your doctor says it’s safe. Eating early (called early oral feeding) can help your body heal and lower the chance of problems.
• Try eating 6–8 small meals or snacks a day. This is usually easier than having a few big meals. Ask the hospital dietitian for advice about what to eat.

For more information on what to expect when having surgery, including preparation and recovery, see Surgery.

Having a feeding tube

Some people with stomach cancer may need a feeding tube before, during or after treatment. This helps keep your weight steady and gives your body strength. A feeding tube can go into your stomach or small bowel. It may be put in through your nose (nasogastric or nasojejunal tube) or through your belly with a small operation (gastrostomy or jejunostomy tube).

The tube may stay in place until you can eat and drink normally again. A special liquid food (called formula) goes through the tube to give you the nutrients your body needs. If you go home with the feeding tube, a dietitian will tell you how much formula to take and how often.

Many people find that having a feeding tube is a more comfortable way to get enough food and drink if the cancer is making eating and drinking difficult. Your health care team will show you how to keep the tube clean and working well. The doctor will remove the tube when you no longer need it.

Other types of treatment

Follow-up appointments

You will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer has not come back or spread.

During these check-ups, you may have blood tests, imaging scans or an endoscopy if needed. You will be able to discuss how you’re feeling and any concerns you may have. How often you need to see your doctor will depend on the level of monitoring needed for the type and stage of the cancer you had. You should also see a dietitian for advice about good nutrition.

For some people, stomach cancer does come back. This is known as a recurrence. If this happens, you may have further treatment, including chemotherapy, radiation therapy or surgery.