The most important factor in planning treatment for stomach cancer is the stage of the disease, particularly whether the tumour has spread from its original location. Your treatment will also depend on your age, medical history and general health.
Surgery is the main treatment for stomach cancer that has not spread. If the cancer has spread, treatment will often include chemotherapy or radiotherapy, but not surgery.
Preparing for treatment
Improve diet and nutrition
People with stomach cancer often lose a lot of weight and can become malnourished. A dietitian can provide advice on ways to reduce the weight loss through changes to your diet, liquid supplements or a feeding tube. This will help improve your strength and lead to better treatment outcomes.
If you are a smoker, you will be assisted to stop smoking before surgery. If you continue to smoke, you may not respond as well to treatment and smoking may make any side effects you experience worse. See your doctor, call the Quitline on 13 7848 or visit quitnow.gov.au for support quitting.
For more information on treatments and managing side effects, see Understanding Surgery, Understanding Chemotherapy and Understanding Radiotherapy.
Surgery for stomach cancer
Surgery aims to remove all of the stomach cancer while keeping as much normal tissue as possible. However, it is essential to remove a small amount of healthy tissue around the cancer to reduce the risk of the cancer coming back. The type of surgery will depend on where the tumour is growing and how advanced the cancer is.
Endoscopic resection (ER)
Small, very early-stage tumours that have not spread from the stomach walls may be removed with an endoscope. This is usually a day or overnight stay procedure. Preparation and recovery are similar to endoscopy. This may be the only treatment needed for some people with early-stage stomach cancer.
Gastrectomy (surgical resection)
This procedure removes the cancerous tissue and part or all of the stomach, leaving as much healthy tissue as possible. The goal is to completely remove the cancer, including any affected lymph nodes.
There are two ways to perform a gastrectomy:
- in a laparotomy (open gastrectomy), the surgery is performed through a cut in the upper part of the stomach
- in a laparoscopic (keyhole) gastrectomy, the surgeon will make some small cuts in the abdomen, then perform surgery using a thin telescope to see inside the abdomen and chest.
The hospital stay and recovery time may be similar for both types of surgery. Laparoscopic surgery usually means a smaller scar, however, open surgery may be considered a better option in many situations.
The surgery will be performed under a general anaesthetic. Your surgeon will talk to you about the risks of your procedure.
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.
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 stomach's function.
Lymphadenectomy (lymph node dissection)
As the cancer might have spread to nearby lymph nodes, your doctor will usually remove a number of lymph nodes from around your stomach. This reduces the risk of leaving any cancer behind.
Risks of stomach surgery
As with any major surgery, stomach surgery has risks. Complications may include: infection, bleeding, blood clots, damage to nearby organs, or leaking from the connections between the small bowel and either the oesophagus or stomach. Some people may experience an irregular heartbeat, but this usually settles within a few days.
You will be carefully monitored for any side effects afterwards. For more information about ongoing effects after surgery, see managing side effects.
If you are unable to eat and drink enough to meet your nutritional needs, you may need a feeding tube.
You may receive all your nutrition through this tube, or it may be used to supplement the food you eat.
Some people with stomach or oesophageal cancers will have a feeding tube before treatment to help them maintain weight and build up their strength.
Other people will have a feeding tube after surgery while their wound is healing.
Your doctor and dietitian will discuss your individual nutrition care needs with you.
Many people find that having a feeding tube eases the pressure and discomfort associated with eating. Medicines can also be given through a feeding tube.
A feeding tube can be placed into your small bowel either through your nostril (nasojejunal tube) or through an opening on the outside of your abdomen (known as a jejunostomy or J-tube).
If you go home with the feeding tube in place, a dietitian will advise you on the type and amount of feeding formula you will need.
Your health care team will also tell you how to keep the tube clean, how to prevent wear, leakage and blockages, and when to replace the tube.
Your doctor will remove the feeding tube when it is no longer required.
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.
What to expect after stomach surgery
When you wake up after the operation, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be transferred to a ward where you will stay for 5–10 days until you can go home. It can take about three months to fully recover.
You will have some pain and discomfort for several days after your surgery, but you will be given pain-relieving medicines to manage this. Let your doctor or nurse know if you are in pain so they can adjust your medicines to make you as comfortable as possible. Do not wait until the pain is severe.
You will have a dressing over the wound. Your doctor or nurse will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.
Drips and drains
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 for pain relief and to replace your body's fluids until you are able to drink and eat again. You may also have a feeding tube.
You will be unable to eat or drink initially after surgery. Your doctor will advise when you are able to start eating. You will usually start with fluids such as soup, and then move onto 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. The hospital dietitian can prepare eating plans for you and work out whether you need any supplements to help meet your nutritional needs. Sometimes, a small feeding tube is placed further down the small bowel through a small cut in the abdomen. You can be given specially prepared feeding formula through this tube while the join between the oesophagus and small bowel heals. The tube is usually removed after 3–4 weeks. See more information about eating after surgery.
A physiotherapist will teach you breathing or coughing exercises to help keep your lungs clear. This will reduce the risk of you getting a chest infection.
Your health care team will probably encourage you to walk the day after the surgery. Exercise has been shown to help people manage some of the common side effects of treatment, speed up a return to usual activities and improve quality of life. Speak to your doctor if you would like to try more vigorous exercise. You will have to wear compression stockings for a couple of weeks to help the blood in your legs to circulate. You will most likely need to avoid driving for a few weeks after the surgery and avoid heavy lifting.
After surgery to the stomach, many people don't absorb vitamin D and calcium well. This can lead to thinning and weakening of the bones (osteoporosis). This may cause pain and an increased risk of fractures. For more information about how to prevent osteoporosis, talk to your doctor. It may also help to see a dietitian.
"I was diagnosed with stomach cancer eight years ago when I was 44. I was really fortunate that the cancer was found early. I was being treated for a stomach ulcer and a follow-up gastroscopy found a tumour in my stomach.
"I found it really beneficial to participate in a clinical trial looking at what combination of treatment worked best for stomach cancer. The treatment path I trialled was preoperative chemotherapy, a total gastrectomy, and postoperative chemotherapy.
"Chemotherapy was very difficult and I struggled with the side effects. My wife at the time gave birth to our little girl while I was having chemotherapy. This was very challenging – I was instructed to be really careful with the baby because of the risks associated with chemotherapy, so I couldn't even change her nappies.
"I was also trying to understand that I had cancer and deal with the emotional aspects. I found it really helpful to tap into Cancer Connect peer support. I got a lot of benefit from connecting with someone who'd had a similar type of experience and lived through it. My contact shared his experiences of waking up from surgery with lots of tubes coming out of him, so I wasn't shocked when this happened to me. It was really good to have that awareness prior to the surgery.
"Once treatment was finished, it was quite daunting and I was fearful that the cancer would come back somewhere. Eight years later, it hasn't come back, which is fantastic.
"I've changed my career path and am studying community services in order to help people though changes in their life. The way you view life is different after cancer. I really appreciate and have a lot of gratitude for what I have now."
Tell your cancer story.
Chemotherapy for stomach cancer
Chemotherapy uses drugs to kill or slow the growth of cancer cells. For stomach cancer, chemotherapy is commonly given before surgery to shrink large tumours and destroy any cancer cells that may have spread. It may also be used after surgery to reduce the chance of the disease coming back. Chemotherapy is also used on its own as a palliative treatment.
Chemotherapy is usually given into a vein in your arm through a drip (intravenously). It may also be given through a tube called a port, catheter or vascular access device. Some chemotherapy drugs for stomach cancer are given as tablets.
Most people receive a combination of drugs in repeating cycles spread over several months. There may be a rest period of 2–3 weeks between each cycle of chemotherapy. Your doctor will talk to you about how long your treatment will last.
Side effects of chemotherapy
The side effects of chemotherapy vary greatly for each person. Some people don't experience any side effects, while others have several. Most side effects are temporary. Your treatment team can help you prevent or manage any side effects.
Side effects may include feeling sick (nausea), vomiting, sore mouth or mouth ulcers, difficulty swallowing and appetite changes, skin and nail changes, numbness in the hands or feet, ringing in the ears, constipation or diarrhoea, and hair loss or thinning. You may also be more likely to catch infections.
Targeted therapy for stomach cancer
Some cancers in the stomach and gastro-oesophageal junction are linked to high levels of HER2 (human epidermal growth factor receptor 2). This protein causes cancer cells to grow uncontrollably. Tumours that have high levels of these receptors are called HER2 positive tumours.
If you have advanced HER2 positive stomach or gastrooesophageal cancer, you may be treated with a targeted therapy drug called trastuzumab. This drug destroys the HER2 positive cancer cells or reduces their ability to divide and grow. Trastuzumab is given with chemotherapy every three weeks through a drip into a vein.
Side effects of targeted therapy
Ask your doctor what side effects you may experience and how long your treatment will last. Potential side effects of trastuzumab include fever and nausea. In some people, trastuzumab can affect the way the heart works.
It is important to discuss any side effects with your doctor immediately. If left untreated, some side effects can become lifethreatening.
You may be able to access new drugs to treat stomach cancer through clinical trials. Talk with your doctor about the latest developments and whether you are a suitable candidate.
Radiotherapy for stomach cancer
Radiotherapy (also known as radiation therapy) uses x-rays to damage or kill cancer cells so they cannot multiply. The radiation is targeted at the parts of the body with cancer. Treatment is carefully planned to do as little harm as possible to healthy body tissue.
Radiotherapy for stomach cancer is usually used to control symptoms when surgery is not suitable. In this case, you will have a simple, short course (1–2 weeks) of external beam radiotherapy. This is unlikely to cause any side effects, apart from some possible nausea. Each treatment takes about 15 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 about your treatment schedule.
Palliative treatment aims to manage symptoms and improve people's quality of life without trying to cure the disease. It may be beneficial for people at any stage of advanced stomach cancer.
Palliative treatment for stomach cancer may include surgery, stenting, radiotherapy, chemotherapy or other medicines. These treatments can help manage symptoms such as pain, bleeding, swallowing difficulty and nausea. They can also slow the spread of the cancer.
For more information see Living with Advanced Cancer and Understanding Palliative Care, or call Cancer Council 13 11 20.
- The type of treatment you have for stomach cancer depends on where the cancer is located and how far it has spread.
- Early stomach cancer is usually treated with surgery to remove part or all of the stomach. This operation is called a gastrectomy. The remaining parts of the digestive system are usually stitched together so that food can still be swallowed and digested.
- Some small tumours may be removed using a long flexible tube (endoscopic resection) without removing the stomach.
- Surgery will affect your eating and digestion. Learning to adapt to these changes will take time. A dietitian can help.
- You may need a feeding tube before, during or after treatment to help you meet your nutritional needs.
- Some people also have chemotherapy before or after surgery. Chemotherapy drugs can cause side effects, such as nausea or a sore mouth. Most side effects are temporary.
- If you have advanced HER2 positive stomach or gastrooesophageal cancer, you may be given a targeted therapy drug called trastuzumab.
- Radiotherapy treatment uses x-rays to damage or kill cancer cells so they cannot multiply. It can cause nausea.
- Advanced or metastatic stomach cancer is treated palliatively with chemotherapy or radiotherapy. It is rarely treated with surgery.
- Palliative treatment seeks to improve quality of life by reducing the symptoms of advanced cancer without aiming to cure the disease.
Expert content reviewers:
Prof David Watson, Head, Flinders University Department of Surgery, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Staff Specialist, Cancer Services, Princess Alexandra Hospital, QLD; Dr Fiona Day, Medical Oncologist, Calvary Mater Hospital, Newcastle, and Conjoint Senior Lecturer, University of Newcastle, NSW; Mark Diggle, Consumer; Merran Findlay, Executive Research Lead – Cancer Nutrition and Oncology Specialist Dietitian, Royal Prince Alfred Hospital, NSW; Rosie Newth, 13 11 20 Consultant, Cancer Council NSW; Dr David Ransom, Medical Oncologist, Fiona Stanley Hospital, WA; Megan Rogers, Specialist Nurse, Upper Gastrointestinal Cancer Service, Peter MacCallum Cancer Centre, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.