| Stomach & oesophageal cancer | Diagnosing stomach or oesophageal cancer | Treatment for stomach and oesophageal cancer |
Reviewed by: Dr Stuart Roberts, Director Gastroenterology, The Alfred
Taken from 
Stomach & Oesophageal Cancer booklet (2.1MB)
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's likely to work for a particular type and stage of cancer. Your doctor will advise you of the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it's 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're 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 isn't 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.
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.
If the extra tests have shown no evidence of cancer spread, and you are well enough, your doctor will discuss surgery with you.
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 oesophagus or small bowel (depending whether you had the upper or lower part of your stomach removed). If you have a total gastrectomy, your oesophagus will be connected to your small bowel.
The operation is generally done through an incision (cut) from the bottom of the breastbone to the navel (belly button). Sometimes an incision on the side of the chest is also used.
Surgery for stomach cancer is sometimes done after 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.
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.
You'll have some pain and discomfort for several days after the operation. You will have pain-relieving drugs to deal with this.
An intravenous infusion (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 seven 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 dietitian will also discuss changes to your diet, such as needing to eat smaller meals.
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.
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.
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 surgery (called ‘neoadjuvant therapy') or after. Neoadjuvant therapy aims to shrink the cancer before an operation, and to destroy any cancer cells that may have spread away from the primary site. In the same way, 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.
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 medical oncologist will discuss these and other side effects and risks with you.
Treatment for stomach or oesophageal cancer is most effective if the cancer is found in its early stages; it can be cured if the cancer is removed before it spreads. However, because there are few symptoms in the early stages, and symptoms are similar to those of many other disorders, these cancers are often not discovered until they are more advanced.
If the cancer has advanced and the cancer cannot be removed, palliative treatment is possible. This might include chemotherapy or radiotherapy, and can provide relief from symptoms and help people to live a normal life for as long as possible.
The question, ‘How long am I likely to live?' is often raised by people who have stomach or oesophageal cancer. It is not possible for your doctor to give a precise length of time for you as an individual. However, they may be able to give an estimate based on the average length of time lived by people with a similar cancer to yours. It is important to remember that this is an average, and will not necessarily apply to you: some people survive for less than the average time and some survive much longer.
If you would like information about your own prognosis, you need to speak to a doctor who knows your full medical history.
