Treatment for stomach & oesophageal cancer

Sunday 1 November, 2015

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On this page: SurgeryAfter stomach or oesophageal surgery | Radiotherapy | Chemotherapy | Palliative treatment | Key points


Surgery is a common type of treatment for oesophageal and stomach cancer. Some people have chemotherapy or radiotherapy either on their own or in combination. These treatments may also be given in combination with surgery in one of two ways:

Neoadjuvant treatment

Chemotherapy and/or radiotherapy given before surgery. The aim is to shrink the cancer before surgery and to destroy any cancer cells that may have spread away from the primary cancer site. Neoadjuvant treatment appears to increase the chance of successful treatment for oesophageal and stomach cancers.

Adjuvant treatment

Chemotherapy and/or radiotherapy given after surgery. Adjuvant treatment is used to destroy any cancer cells that may remain in the body. This treatment will be offered if pathology results indicate that all cancer cells have not been removed by the surgery.

Your doctor will discuss the recommended treatment options with you.

Surgery

The type of surgery you have will depend on the location of the tumour and how advanced the cancer is. You will be advised how to prepare for surgery. For example, you may need to change your diet or fast beforehand. If you are a smoker, you will be assisted to stop smoking before surgery.

Oesophageal cancer surgery

During oesophageal cancer surgery, the surgeon will remove the cancerous tissue, including part of the oesophagus, the upper part of the stomach, and some nearby lymph nodes. The surgical approach and amount of oesophagus removed may differ depending on the location of the cancer in the oesophagus.

Oesophagectomy

To remove the oesophagus, the surgeon will need to gain access separately to the upper abdomen and to the chest through the ribs on the sidewall of the chest. This may be done by opening the chest and the abdomen or by using a telescope to perform keyhole surgery for some or all of the procedure.

Once the cancerous sections of the oesophagus are removed (along with part of the upper stomach, lymph nodes and other tissue) the healthy part of the oesophagus is reconnected to the remaining part of the stomach by turning the stomach into a tube. This will allow you to swallow and eat relatively normally. In rare cases, the oesophagus is connected to the small bowel or large bowel if it cannot be reconnected to the stomach.

Endoscopic resections (ER), including endoscopic mucosal resections (EMR) are becoming the preferred option for the treatment of very early-stage oesophageal and stomach cancers, and the diagnostic staging of early oesophageal cancers, as they involve less risk and a faster recovery. During this procedure, the tumour is removed through a long, flexible tube (endoscope). This is usually a day or overnight stay procedure.

Stomach cancer surgery

During stomach cancer surgery, the surgeon will remove the cancerous tissue and part or all of the stomach, leaving as much healthy tissue as possible. The goal of surgery is the complete removal of the cancer, including any affected lymph nodes. The amount of stomach tissue removed will vary accordingly. Surgery is performed through a cut in the upper part of the abdomen. In some selected cases, keyhole surgery may be recommended.

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 intact.

Total gastrectomy

Removal of the whole stomach, along with nearby fatty tissue (omentum), lymph nodes and parts of adjacent 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 function of the stomach. Often, a small feeding tube is placed further down the small bowel and out through the abdomen. You can be given food through this tube while the join between the oesophagus and small bowel heals. The tube is usually removed after 2–6 weeks.

Risks of oesophageal and stomach surgery

As with any major surgery, oesophageal and stomach surgery has risks. Complications may include: infection, bleeding, blood clots, damage to nearby organs or leaking from the connections between the oesophagus and stomach or small bowel. Some people may experience an irregular heartbeat, but this usually settles within a few days. Your surgeon will discuss these risks with you before surgery and you will be carefully monitored for any side effects afterwards.

Pneumonia is a common risk after oesophageal surgery. To reduce the risk of pneumonia you will be taught breathing or coughing exercises to do after surgery to help keep your lungs clear.

After oesophageal or stomach surgery

You will have some pain and discomfort for several days after your surgery, but you will be given pain relief medication to manage this. You will be unable to eat or drink initially after surgery and will then be gradually introduced to an oral diet.

After surgery you will have several tubes in your body, including a catheter to measure urine output. You may have an intravenous (IV) drip, which is used to replace your body’s fluids until you are able to drink and eat again, as well as a feeding tube. The number and location of tubes will depend on the type of surgery you have. Generally, surgery for oesophageal cancers is more complex and requires many temporary tubes and lines including a tube into the chest.

Most people are ready to go home around 10 days after stomach cancer surgery, and about 10–15 days after oesophageal cancer surgery. After oesophageal surgery, some people may need to go home with continued nutrition support using the feeding tube.

Feeding tubes

It is common for a feeding tube to be inserted at the time of your surgery. This tube will help you to meet your nutritional needs after surgery. A feeding tube can be placed into your stomach or small intestine through an opening on the outside of your abdomen. Alternatively, the tube may be inserted through your nostril.

Many people find that having a feeding tube eases the pressure and discomfort associated with eating while adjusting to their new eating habits after surgery. Medications can also be given through the feeding tube.

A dietitian will advise you on the type and amount of feeding formula you will need. Your health care team can also tell you how to keep the tube clean, prevent wear, leakage and blockages, and when to replace the tube.

It can take time to adjust to a feeding tube. It may help to talk to your family, a counsellor, or nurse, or you can call Cancer Council 13 11 20 for information and support.

After surgery to the stomach, many people don’t absorb vitamin Dand calcium well. This can cause a loss in bone density (osteoporosis). The bones may become weak which may cause pain and an increased risk of fractures. For more information, talk to your doctor. It may also help to see a dietitian.

Eating after surgery

Depending on your recovery, you may be able to start eating foods again before you leave hospital. The hospital dietitian can prepare eating plans for you and work out whether you need any supplements to help meet your nutritional needs. They can also answer any questions you may have relating to food and eating.

You will be advised to start off with liquids, such as soup, and then move on to 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.

Some people find it difficult to cope with dietary changes and gastrointestinal symptoms after surgery. Your health care team can help you manage these side effects and let you know whether they will be temporary or permanent. Your surgeon, speech pathologist and counsellor may also provide support.

For more information about managing some of the side effects of surgery, see managing side effects.

Radiotherapy

Radiotherapy treatment uses high-energy x-rays to damage or kill cancer cells so they cannot multiply. It is most commonly used to treat oesophageal cancers, usually in combination with chemotherapy.

Before starting treatment you will have a planning appointment where a CT (computerised tomography) scan is performed. The radiotherapy team will use the images from the scan to plan your treatments. Treatment is carefully planned to destroy as many cancer cells as possible while causing the least possible harm to your normal tissue. The technician may make some small permanent tattoos or temporary marks on your skin so that the same area is targeted during each treatment session.

You will usually have treatment as an outpatient once a day, Monday to Friday, for 2–5 weeks. Each treatment takes only a few 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 on the number of treatment sessions you need.

Side effects

Many people will develop temporary side effects, such as fatigue and skin reactions during their treatment. Skin in the treatment area may become red and sore during or immediately after treatment. Other side effects may include:

  • nausea and/or vomiting
  • diarrhoea
  • painful swallowing, if oesophageal cancer
  • decreased appetite and/or weight loss.

Ask your treatment team for advice about dealing with any side effects, call Cancer Council 13 11 20 or see our radiotherapy section.

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim of treatment is to destroy cancer cells, while causing the least possible damage to healthy cells. You may have chemotherapy combined with radiotherapy.

Chemotherapy is generally administered into a vein in your arm through a drip (intravenously) or through a tube called a port, catheter or vascular access device. Alternatively it can be given as tablets. Most people receive a combination of drugs. These may be given on one day or continuously using a small pump that is linked to the tube implanted into the vein. There may be a rest period of 2–3 weeks before receiving the next round of chemotherapy. The treatment process for chemotherapy can vary. Some people receive treatment on a weekly basis for up to six weeks.

You usually don’t have to stay overnight in hospital to have chemotherapy. Ask your doctor which drugs you are receiving, what side effects you may experience, and how long your treatment will last.

If you feel unwell or have a fever higher than 38°C, call your doctor immediately or, if after hours, go to the hospital emergency department.

Many people find they need to take time to recover following each chemotherapy session.

Side effects

Everyone reacts differently to chemotherapy. Some people don’t experience any side effects, while others have several. The side effects you experience will depend on the drugs you receive.

Side effects may include:

  • nausea
  • vomiting
  • appetite changes
  • weight loss
  • mouth ulcers
  • skin and nail changes
  • numbness or tingling in the hands or feet (peripheral neuropathy)
  • ringing in the ears (tinnitus)
  • fatigue and tiredness
  • changed bowel habits (e.g. constipation, diarrhoea)
  • hair loss or thinning
  • lowered immunity (e.g. more prone to get infections)
  • infertility

Chemotherapy side effects are usually temporary, and measures can be taken to prevent or reduce them. Talk to your oncologist or a member of your health care team about any side effects you are experiencing and how to manage them.

For more information call Cancer Council 13 11 20 or see our chemotherapy section.

Palliative treatment

Palliative treatment seeks to improve quality of life by reducing the symptoms of advanced cancer without aiming to cure the disease.

Palliative treatment may include radiotherapy, chemotherapy or other medication. These treatments can assist with managing symptoms such as pain, swallowing difficulty and nausea as well as slowing the spread of the cancer. For example, radiotherapy can help to relieve pain and make swallowing easier if an oesophageal cancer cannot be removed.

It is commonly assumed that palliative treatment is for people at the end of their life; however, it may be beneficial for people at any stage of advanced disease.

Palliative care is managed in various ways throughout Australia and is tailored to each individual. Your GP or palliative care team will talk to you about the best approach for you. Call Cancer Council 13 11 20 for more information or see our palliative care and advanced cancer sections.

Key points

  • Oesophageal and stomach cancers are usually treated with surgery. Some people also have chemotherapy and/or radiotherapy before or after surgery, or as their only treatment.
  • Your health care team will advise you how to prepare for treatment and manage any side effects.
  • The type of surgery you have depends on the site of the cancer and how extensive it is.
  • Surgery may remove part or all of the oesophagus and/or stomach. The remaining parts of the digestive system are usually stitched together so that food can still be swallowed and digested.
  • Surgery will affect your eating and digestion. Learning to adapt to these changes will take time. A dietitian can help with your recovery.
  • An endoscopic mucosal resection may be performed for very early-stage oesophageal and stomach cancers. It can usually be done as a day procedure. Eating returns to normal soon after the procedure.
  • Radiotherapy treatment uses high-energy rays to damage or kill cancer cells so they cannot multiply. It can cause side effects, such as tiredness, red skin or diarrhoea. Most side effects are temporary.
  • Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The drugs can cause side effects, such as a sore mouth or hair loss. Most side effects are temporary.
  • Palliative treatment seeks to improve quality of life by reducing the symptoms of advanced cancer without aiming to cure the disease.

Reviewed by:Prof Mark Smithers, Director, Upper GI/Soft Tissue Unit, Princess Alexandra Hospital, Professor, Discipline of Surgery, The University of Queensland; Katie Benton, Dietitian and Nutritionist, Upper Gastrointestinal Unit, Department of Nutrition and Dietetics, Princess Alexandra Hospital, QLD; Jeff Bull, Upper GI Cancer Clinical Practice Consultant, Cancer Services, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Radiation Oncologist, Princess Alexandra Hospital, Dept Chair MSAC, Cancer Council Queensland; Frank Hughes, 13 11 20 Nurse, Cancer Council Queensland; June Leijon, Consumer; Dr Julia Maclean, Clinical Specialist, Speech Pathology, Cancer Care Centre, St George Hospital, NSW; A/Prof Euan Walpole, Medical Director, Cancer Services, Princess Alexandra Hospital & Southern Area Health Service, QLD.

Updated: 01 Nov, 2015