Treatment for stomach & oesophageal cancer

Thursday 30 June, 2011

Reviewed by: Dr Stuart Roberts, Director Gastroenterology, The Alfred

On this page: Surgery for stomach cancer | Surgery for oesophageal cancer | After the operation | Radiotherapy | Chemotherapy | Prognosis

Many years of treating cancer patients and testing different treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your general health, and what you want.

The main treatment for stomach and oesophageal cancer is surgery; however chemotherapy and radiotherapy may also be used. You may have just one of these treatments, or a combination.

If the tests showed no evidence of the cancer having spread, and you are fit for major surgery, your doctor will discuss the benefit of surgery with you. You may also be offered chemotherapy, radiotherapy or the combination of chemotherapy and radiotherapy before or after the surgery.

If the cancer has spread and surgery to remove all the cancer is not possible, your doctor will arrange treatment for symptoms (palliative treatment) and discuss options such as surgery, chemotherapy and/or radiotherapy.

Before any treatment begins, make sure that you've discussed it with your doctor so that you know what to expect. You may find it useful to have your partner or a friend with you when you talk with the doctor. You may also find it helpful to make a list of questions before your visit: nurses on the Cancer Council Helpline (13 11 20) can help you prepare any questions to take to your doctor.

People having treatment for oesophageal cancer may be advised to visit a dentist for an examination before treatment, because cancer treatment can increase the risk of mouth infection.

Surgery

If the extra tests have shown no evidence of cancer spread, and you are well enough, your doctor will discuss surgery with you.

Stomach cancer

The operation for stomach cancer is called gastrectomy. In a partial gastrectomy, the doctor removes part of the stomach. In a total gastrectomy, the doctor removes all of the stomach. Lymph nodes near the stomach and other tissue are likely to be removed also.

If you have a partial gastrectomy, the doctor will connect the part of your stomach that remains to your small bowel.  If you have a total gastrectomy, your oesophagus will be connected to your small bowel.

The operation is generally done through a cut (incision) from the bottom of the breastbone to the belly button (navel). Sometimes a cut on the side of the chest is also used.

Sometimes before surgery for stomach cancer, chemotherapy or chemotherapy and radiotherapy have been used to shrink the cancer.

Gastrectomy for stomach cancer is major surgery. If you are able to have surgery, it is possible that gastrectomy could cure your cancer. You also need to be aware of its risks. Your surgeon should explain the risks before you have the operation.

Oesophageal cancer

This operation (oesophagectomy) removes the cancer and nearby lymph nodes and tissue. The remaining, healthy part of the oesophagus is connected to the stomach so that you are able to continue swallowing and eating relatively normally.

Depending on where the cancer is, cuts will be made to your abdomen and chest, to your abdomen and neck, or to your abdomen, chest and neck, to take out the affected part of the oesophagus. In this operation, your stomach will probably be raised into your chest. Your oesophagus may be joined to the bowel if it cannot be joined to the stomach.

It sometimes happens that the surgeon finds, during the operation, that the cancer cannot safely be removed. Various procedures can be tried, including stretching the oesophagus and shrinking the tumour, to help your swallowing return to normal.

Surgery for oesophageal cancer is sometimes done after radiotherapy or chemotherapy have been used to shrink the cancer.

This is major surgery and it will take time to recover.

People with smaller cancers that have not spread outside the oesophagus, and who have good general health, have a greater chance of cure.

After the operation

You will have some pain and discomfort for several days after the operation. You will have pain-relieving drugs to deal with this.

An intravenous drip will be used to replace your body's fluids until you are able to drink and eat again a few days after the operation. You may have a feeding tube put through your abdomen and into your upper bowel during the surgery, so you can have adequate nutrition. When you start eating, you will have liquids, then soft foods, then solid foods. You will probably be ready to go home 7 to 12 days after the operation.

When they first start eating, people who have had a partial or total gastrectomy find they feel full with a small amount of food. This improves with time as the ‘new' stomach gradually enlarges. You will need to eat frequent small meals after leaving hospital. A dietitian can help you with changes to your diet, if needed.

In some people, the operation can cause bile from the small bowel to reflux back up into the remaining part of your stomach or oesophagus. This causes the feeling of having an upset stomach. There are drugs that can help.

People who have a total gastrectomy cannot absorb vitamin B12. You will need to have regular injections of vitamin B12, and may need to take iron supplements as well.

People who are treated for oesophageal cancer will be taught breathing and coughing methods to help keep their airway clear. A dietician will also discuss changes to your diet, such as needing to eat smaller meals.

Radiotherapy

Radiotherapy treats cancer by using radiation to destroy cancer cells. Radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.

For treatment aimed at curing the stomach or oesophageal cancer, radiotherapy is often combined with chemotherapy. It can be given before surgery to make the cancer smaller and to increase the chances of cure. Alternatively, it can be given after surgery to reduce the chances of the cancer coming back. The radiotherapy is given daily for about five weeks, and this only takes a few minutes a day.

For palliative treatment, radiotherapy can be used to relieve symptoms, particularly pain. Radiotherapy can help to relieve pain and make swallowing easier where an oesophageal cancer cannot be removed.

This treatment usually only takes one to two weeks for a few minutes a day.

Side effects of radiotherapy

Side effects of radiotherapy may include tiredness, reddening of the skin, feeling sick (nausea), vomiting, diarrhoea, and sometimes painful swallowing. Talk with your doctor or the radiotherapy staff about any possible side effects and how to manage them.

You will not be radioactive after your treatment.

Chemotherapy

This is the treatment of cancer by anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.

If your cancer is found at an early stage, you may have chemotherapy, radiotherapy, or both as additional treatments to surgery. This is called adjuvant therapy. It can also be used before an operation, to try to shrink the tumour and to destroy any cancer cells that may have spread away from where the cancer began.  Adjuvant chemotherapy after an operation aims to destroy cancer cells that might remain in the body but cannot be detected. This treatment can reduce the chance of the cancer coming back (recurring).

You will probably have the chemotherapy by injection into a vein in your arm. This is called intravenous treatment. You will probably have a combination of drugs over a few days, followed by a rest period of two to three weeks. Or you may have continuous treatment, where you have the chemotherapy through a pump.

You can usually have chemotherapy as an outpatient. You should discuss with your doctor which drugs you are having and how long your treatment will last.

Side effects of chemotherapy

Some drugs used in chemotherapy can cause side effects. They may include feeling sick (nausea), vomiting, feeling unwell and tired, and some thinning or loss of hair from your body and head. Generally, these side effects are temporary, and steps can be taken to prevent or reduce them.

The doctor who prescribes the chemotherapy (medical oncologist) will discuss these and other side effects and risks with you.

Complementary and alternative medicines

It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.

Complementary therapies include massage, meditation and other relaxation methods, which are used along with medical treatments. Alternative therapies are unproven remedies, including some herbal and dietary remedies, that are used instead of medical treatment. Some of these have been tested scientifically and found to be not effective or even harmful.

Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treatment. However, some alternative therapies are harmful, especially if:

  • you use them instead of medical treatment
  • you use herbs or other remedies that make your medical treatment less effective
  • you spend a lot of time and money on alternative remedies that simply don't work.

Be aware that a lot of unproven remedies are advertised on the internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline .

For more information we recommend reading::

You can find out about what scientific research has been done into specific herbs, supplements and other products on the Memorial Sloan-Kettering website. The US National Center for Complementary and Alternative Medicines (NCCAM) and Quackwatch are also a reliable sites.

 

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