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Stomach and oesophageal cancers


Treatment for stomach cancer


Your health care team will recommend treatment based on where the cancer is in the stomach, and whether it has spread (the stage). Treatment will also depend on your age, medical history, nutritional needs and general health.

Surgery is often part of the treatment for stomach cancer that has not spread. For some people with very early stomach cancer, an endoscopic resection may be the only treatment needed.

If the cancer has spread, treatment may also include chemotherapy, targeted therapy, immunotherapy or radiation therapy.

Before treatment begins

  • Stop smoking – if you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment. For support, see your doctor or call the Quitline on 13 7848.
  • Begin or continue an exercise program – exercise will help build up your strength for recovery. Talk to your doctor or physiotherapist about the right type of exercise for you.
  • Improve diet and nutrition – people with stomach cancer often lose a lot of weight and can become malnourished. Your doctor will usually refer you to a dietitian for advice on how to slow down the weight loss by changing your diet, taking liquid supplements or having a feeding tube. This will help improve your strength, reduce side effects, and may mean the treatment works better.

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Endoscopic resection

Very early-stage tumours in the inner layers of the stomach (mucosa) may be removed with an endoscope through endoscopic resection (ER). Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are two types of endoscopic resection.

For some people, an endoscopic resection may be the only treatment they need. This procedure usually means staying overnight in hospital. Preparation and recovery are similar to an endoscopy, but there is a slightly higher risk of bleeding or getting a small tear or hole in the stomach (perforation).

Surgery

Surgery aims to remove all of the stomach cancer while keeping as much of the stomach as possible. This may involve having several procedures during the operation. The surgeon will also remove some healthy tissue around the cancer to reduce the risk of the cancer returning.

The surgery will be done under a general anaesthetic. Different types of surgery can be used – you may have a laparotomy (open surgery) or laparoscopic surgery (minimally invasive or keyhole surgery). The type you have will depend on where the cancer is in the stomach.

Laparoscopic surgery usually means a smaller scar, which means the hospital stay is shorter and the recovery faster, but it’s not always possible to have this type of surgery. Open surgery may be considered a better option in many situations.

Types of stomach surgery

  • Subtotal or partial gastrectomy – only part of the stomach is removed when the cancer is in the lower part of the stomach. Nearby fatty tissue (omentum) and lymph nodes are also removed. The upper stomach and oesophagus are 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 re-joins the oesophagus to the small bowel.
  • Lymphadenectomy (lymph node dissection) – as the cancer might have spread to nearby lymph nodes, your doctor will also remove some lymph nodes from around your stomach. This reduces the risk of the cancer coming back and helps more accurately work out the stage of the cancer.

Risks of stomach surgery

As with any major operation, surgery for stomach cancer has risks. Your surgeon will talk to you about the risks and complications of stomach surgery.

These may include infection, bleeding, damage to nearby organs, or leaking from the joins between the small bowel and either the oesophagus or stomach. Some people’s heartbeat can become irregular, but this usually settles in a few days.

You will be carefully monitored for any side effects.

 

Having a feeding tube

Before or after surgery, you may need a feeding tube to help you manage issues with eating and drinking, and get the nutrition you need. You may receive all of your nutrition through this tube, or it may be used to supplement the food you eat. 

Your treatment team will show you how to care for the tube to keep it clean and prevent leaking and blockages, and when to replace the tube. Your doctor will remove the feeding tube when it is no longer required.

Having a feeding tube is a major change and it’s common to have a lot of questions. Getting used to having a feeding tube takes time. For information, talk to a dietitian or nurse. A counsellor, psychologist or our 13 11 20 cancer nurses can provide emotional support and coping strategies.

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Targeted therapy

Targeted therapy is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading.

HER2 (human epidermal growth factor receptor 2) is a protein that causes cancer cells to grow. If you have HER2 positive advanced stomach or gastro-oesophageal junction cancer, you may be given a targeted therapy drug called trastuzumab. This drug destroys the HER2 positive cancer cells or slows their growth. Trastuzumab is given with chemotherapy every three weeks through a drip into a vein. Possible side effects include fever and nausea, and in some people, the way the heart works is affected. 

Another targeted therapy drug called ramucirumab aims to reduce the blood supply to a tumour to slow or stop its growth. It has been approved to treat advanced stomach or gastro-oesophageal junction cancer that has not responded to chemotherapy. Possible side effects of ramucirumab include stomach cramps, diarrhoea and high blood pressure.

Immunotherapy

There have been some advances in treating advanced stomach cancer with immunotherapy drugs known as checkpoint inhibitors. These use the body’s own immune system to fight cancer.

Checkpoint inhibitors have been approved for use with chemotherapy as the first treatment for people with advanced stomach cancer that has high levels of the protein PD-L1. Checkpoint inhibitors may also be used when chemotherapy hasn’t worked or when the tumour has a high level of the marker MSI.

Clinical trials

You may be able to access other new drugs to treat stomach cancer through clinical trials. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods.

You may find it helpful to talk to your specialist, clinical trials nurse or GP about the latest developments and whether there are any suitable clinical trials for you.

Learn more

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. For stomach cancer, it is used:

  • before surgery (neoadjuvant chemotherapy) – to shrink large tumours and destroy any cancer cells that may have spread
  • after surgery (adjuvant chemotherapy) – to reduce the chance of the cancer coming back
  • as palliative treatment – to help control the cancer and improve quality of life and prolong overall survival.

Chemotherapy is usually given by injecting the drug into a vein in the arm. It may also be given through a tube that is implanted and stays in your vein throughout treatment (called a port-a-cath or PICC line), or as tablets you swallow.

You will usually receive treatment as an outpatient. Most people have a combination of chemotherapy drugs over several treatment sessions, with rest periods of 2–3 weeks in-between. Your doctor will talk to you about how long your treatment will last. 

Radiation therapy

Radiation therapy uses a controlled dose of radiation, such as focused x-ray beams, to kill or damage cancer cells. Radiation therapy for stomach cancer is commonly used to control symptoms of pain, difficulty swallowing or bleeding.

It is usually given as a short course (between one day and two weeks). Occasionally radiation will be given over a longer period (5–6 weeks), either before or after surgery, or if surgery is not possible. Each treatment takes about 15 minutes and is not painful. Your doctor will let you know your treatment schedule.

Possible side effects include fatigue, nausea, vomiting, diarrhoea and loss of appetite.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. Many people think that palliative treatment is for people at the end of life, but it may help at any stage of advanced stomach cancer.

The treatment you are offered will be tailored to your individual needs, and may include surgery, stenting, radiation therapy, chemotherapy or other medicines. These treatments can help manage symptoms such as pain, bleeding and nausea. They can also slow the spread of the cancer.

Palliative treatment is one aspect of palliative care, in which a team of health professionals help meet your physical, emotional, cultural, spiritual and social needs. The team also supports families and carers.

Learn more about palliative care

Learn more about advanced cancer

Understanding Stomach and Oesophageal Cancers

Download our Understanding Stomach and Oesophageal Cancers booklet to learn more.

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Expert content reviewers:

Dr Spiro Raftopoulos, Gastroenterologist, Sir Charles Gairdner Hospital, WA; Peter Blyth, Consumer; Jeff Bull, Upper Gastrointestinal Cancer Nurse Consultant, Cancer Services, Southern Adelaide Local Health Network, SA; Mick Daws, Consumer; Dr Steven Leibman, Upper Gastrointestinal Surgeon, Royal North Shore Hospital, NSW; Prof Michael Michael, Medical Oncologist, Lower and Upper Gastrointestinal Oncology Service, and Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Royal Brisbane Hospital, QLD; Rose Rocca, Senior Clinical Dietitian: Upper Gastrointestinal, Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, VIC; Letchemi Valautha, Consumer; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.

Page last updated:

The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in April 2022. 

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