Stomach cancer treatment

• 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.

These may include:

• feeling sick (nausea)
• vomiting
• appetite changes and difficulty swallowing
• sore mouth or mouth ulcers
• 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. If you feel unwell or have a temperature of 38°C or higher, get urgent medical attention.

Before chemotherapy begins, your doctor, pharmacist or nurse will talk to you about the side effects to watch out for or report, how to help prevent or manage them, and who to contact after hours if you need help.

Ask your doctor what side effects to expect. Possible side effects include

• fever
• nausea
• diarrhoea, and
• high blood pressure.

Sometimes, targeted therapy can affect the way the heart works. Tell your doctor immediately if you have any side effects.

These may include:

• fatigue
• skin rash
• diarrhoea, and
• cough.

Sometimes organs such as the lungs and bowel can become inflamed, which may lead to more serious side effects. Let your treatment team know immediately if you develop any side effects.

As surgery has changed the structure of your stomach, partially digested food can move into the small bowel too quickly. This is called dumping syndrome.

This can especially be a problem with sugary fluids, such as soft drinks, juices and cordial. You may have cramps, nausea, a racing heart, sweating, bloating, diarrhoea or dizziness.

This combination of symptoms most commonly occurs 15-30 minutes after a meal. If they happen 1-2 hours after a meal, they are called late symptoms and can include weakness, light-headedness and sweating.

Symptoms are often worse after eating foods high in sugar. To help manage dumping syndrome, try to:

• eat smaller meals
• chew your food well
• choose high-protein foods (e.g. lean meats, fish, eggs, dairy, beans) and starchy foods (e.g. pasta, rice, potatoes)
• avoid food and drinks high in sugar, and
• not drink with meals.

After surgery to remove part or all of your stomach, your body may not absorb certain vitamins and minerals as well as before. When these levels are low, you may develop additional symptoms.

• Calcium – Over time, low calcium can cause your bones to become weak and brittle and break more easily (osteoporosis). Your doctor will talk to you about exercise, your diet and drug treatments.
• Vitamin B12 – The most common symptom of low B12 is tiredness. Other symptoms include pale skin, breathlessness, headaches, a racing heart and appetite loss. Your doctor may recommend regular B12 injections. If you had a total gastrectomy (see above), you will need regular injections as your body will no longer be able to absorb B12.
• Iron – Low iron can lead to iron deficiency anaemia, which can cause fatigue, dizziness and shortness of breath. You may need an iron infusion, when iron is given as a liquid through a drip inserted into a vein.

You will probably have regular blood tests to check your vitamin and mineral levels.

You need to eat and drink enough to get the nutrition your body needs and to avoid dehydration. It is also important to maintain your weight to prevent malnutrition.

You may need a feeding tube during or after treatment if you are unable to eat and drink enough to meet your nutritional needs (see above).

After treatment, you may find that some foods are uncomfortable to eat and cause digestive problems. You will need to try different foods and change your eating habits, such as eating smaller meals more often throughout the day.

Ask your doctor for a referral to a dietitian with experience in cancer care – they can give you more information.

If you are eating less than usual, it is often recommended that you have high-energy and high-protein foods and follow healthy eating guidelines.

• Have a snack or small meal every 2–3 hours if you have lost your appetite and don’t feel hungry enough for a big meal.
• Keep a variety of snacks on hand (e.g. in your bag or car).
• Eat when you feel hungry or crave certain foods.
• Try eating different foods to see if your taste and tolerance for some foods have changed. 
• Eat slowly and stop and rest when you are full.
• Try to drink fluids that add energy (kilojoules), such as milk, milkshakes, smoothies or nutritional supplement drinks recommended by your dietitian. 
• Prevent dehydration by drinking fluids between meals (30–60 minutes before or after meals).
• Ask your dietitian how you can increase your energy and protein intake. • Use a food diary to keep a record of how you react to certain foods.