Page last updated: March 2024
The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in March 2024.
Expert content reviewers:
This information was developed based on international clinical practice guidelines, and with the help of a range of health professionals and people affected by these cancers:
- Prof David I Watson, Matthew Flinders Distinguished Professor of Surgery, Flinders University, and Senior Consultant Surgeon, Oesophago-Gastric Surgery Unit, Flinders Medical Centre, SA
- Prof Bryan Burmeister, Senior Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD
- Kieran Cahill, Consumer;
- Jessica Jong, Clinical Dietitian, Upper GI and Hepatobiliary Services, Peter MacCallum Cancer Centre, VIC
- John Leung, Consumer
- Prof Rajvinder Singh, Professor of Medicine, University of Adelaide, and Director, Gastroenterology Department and Head of Endoscopy, Lyell McEwin Hospital, SA
- Dr Sarah Sutherland, Medical Oncologist, Chris O’Brien Lifehouse, NSW
- Paula Swannock, Upper GI Cancer Nurse Consultant, St Vincent’s Hospital Melbourne, VIC
- Rebecca Yeoh, 13 11 20 Consultant, Cancer Council Queensland
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. If the cancer has spread, treatment may also include chemotherapy, targeted therapy, immunotherapy or radiation therapy.
Before treatment begins
- 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.
- Stop smoking – if you smoke or vape, 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 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 an exercise plan.
- Avoid alcohol – talk to your doctor about your alcohol use. Alcohol can affect how the body works and increase of risk of complications after surgery, and of the cancer returning.
- Talk to someone – you may find it useful to talk to a counsellor or psychologist about how you are feeling.
Talk to a cancer nurse
Endoscopic resection
Very early-stage tumours in the inner layers of the stomach (mucosa) may be removed with an endoscope through endoscopic resection. For some people, this 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. The surgeon will also remove some healthy tissue around the cancer to reduce the risk of the cancer returning.
Different types of surgery can be used depending on where the cancer is in the stomach. Your surgeon will talk to you about the best way to perform surgery for you.
How the surgery is done
The surgery will be done under a general anaesthetic. There are two ways to perform surgery for stomach cancer:
- Open surgery (laparotomy) – The surgeon makes a long cut in the upper part of the abdomen from the breastbone to the bellybutton.
- Keyhole surgery (laparoscopic or minimally invasive surgery) – The surgeon makes some small cuts in the abdomen, then inserts a thin instrument with a light and camera (laparoscope) into one of the cuts. The surgeon puts tools into the other cuts and performs the surgery using the images from the camera for guidance.
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) – 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.
Risks of stomach surgery
Your surgeon will talk to you about the risks of surgery. These may include infection, bleeding or leaking from the joins between the small bowel and either the oesophagus or stomach.
You will be monitored for side effects.
What to expect after surgery
You will wake up after the operation in a recovery room, and will likely spend time in an intensive care unit before moving to a standard ward. How long you stay in hospital will depend on the type of surgery you had, your age and general health.
You will probably be in hospital for 3-10 days, but it can take 3-6 months to full recover. Talk to your treatment team if you have any concerns about caring for yourself at home.
You will have some pain and discomfort for several days, which will be managed with pain medicines. Let your doctor know if you're in pain.
You may have a dressing over the wound, which your doctor or nurse will talk to you about, and will have several tubes in your body, which will be removed as you recover.
Your treatment team will talk to you about how to eat and drink after surgery. Eating 6-8 small meals throughout the day may make it easier to manage than a few large meals.
Your treatment team will probably encourage you to walk the day after surgery. Gentle exercise has been shown to help people manage some treatment side effects, speed up a return to usual activities and improve quality of life.
You will have to wear compression stockings for a couple of weeks to help the blood in your legs circulate and reduce the risk of developing blood clots. Check whether you need to avoid driving and heavy lifting for a few weeks after the surgery.
A physiotherapist will teach you breathing or coughing exercises to help keep your lungs clear and reduce the risk of a chest infection.
Having a feeding tube
Some people with stomach or oesophageal cancer will have a feeding tube before and/or during treatment to help them maintain their weight and build up their strength.
The feeding tube may also be needed after surgery until it is possible to eat and drink normally. You can be given specially prepared feeding formula through this tube, as well as medicines in some cases.
A feeding tube can be placed into your small bowel or stomach either through a nostril or with an operation that places a tube through the skin of your abdomen.
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.
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.
Get support
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 drugs are usually given as a liquid through a drip inserted into a vein (intravenous infusion). It may also be given through a tube that is implanted and stays in your vein throughout treatment (a central venous access device) or as tablets.
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.
Together, the session and rest period are called a cycle. Your doctor will talk to you about how long your treatment will last.
Side effects of chemotherapy
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
- 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, seek urgent medical attention.
“I found it really beneficial to participate in a clinical trial looking at what combination of treatments worked best for stomach cancer. The treatment path I trialled was preoperative chemotherapy, a total gastrectomy, and postoperative chemotherapy.” Pete
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 2-3 weeks through a drip into a vein.
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.
Side effects of targeted therapy
Ask your doctor what side effects to expect, and tell them about any you experience immediately.
Possible side effects of trastuzumab include fever and nausea. In some people, trastuzumab can affect the way the heart works.
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.
A checkpoint inhibitor drug called nivolumab may be used with chemotherapy for some people with advanced stomach cancer that has high levels of the protein PD-L1.
Nivolumab may also be used when chemotherapy hasn’t worked or when the tumour has a high level of the marker MSI.
Side effects of immunotherapy
Not everyone will experience the same effects, but they may include redness, swelling (inflammation) or pain in any of the organs of the body, leading to common side effects such as fatigue, skin rash, diarrhoea and cough.
The inflammation can lead to more serious side effects in some people, but this will be monitored closely and managed quickly.
Let your treatment team know immediately if you develop any side effects.
Clinical trials
You may be able to access other new drugs to treat stomach cancer through clinical trials. Talk to your doctor about the latest developments and whether there are any suitable clinical trials for you.
Learn more
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 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
Understanding Stomach and Oesophageal Cancers
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