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Stomach Cancer

  • Posted: 10/15/2009

Treatment

Surgery
Chemotherapy
Radiation Therapy

The choice of treatment depends mainly on the size and location of the tumor, the stage of disease, and your general health.

Treatment for stomach cancer may involve surgery, chemotherapy, or radiation therapy. You'll probably receive more than one type of treatment. For example, chemotherapy may be given before or after surgery. It's often given at the same time as radiation therapy.

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for people at any stage of stomach cancer. See Taking Part in Cancer Research.

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat stomach cancer include gastroenterologists, surgeons, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Your health care team can describe your treatment choices, the expected results, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects, how to prevent or reduce these effects, and how treatment may change your normal activities. You and your health care team can work together to make a treatment plan that meets your needs.

You may want to ask your doctor these questions before you begin treatment:

  • What is the stage of the disease? Has the cancer spread? Do any lymph nodes show signs of cancer?
  • What is the goal of treatment? What are my treatment choices? Which do you suggest for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities? Am I likely to have eating or other problems?
  • Would a research study (clinical trial) be a good choice for me?
  • Can you recommend other doctors who could give me a second opinion about my treatment options?
  • How often should I have checkups?

Surgery

The type of surgery for stomach cancer depends mainly on where the cancer is located. The surgeon may remove the whole stomach or only the part that has the cancer.

You and your surgeon can talk about the types of surgery and which may be right for you:

  • Partial (subtotal) gastrectomy for tumors at the lower part of the stomach: The surgeon removes the lower part of the stomach with the cancer. The surgeon attaches the remaining part of the stomach to the intestine. Nearby lymph nodes and other tissues may also be removed.
  • Total gastrectomy for tumors at the upper part of the stomach: The surgeon removes the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, and other tissues near the tumor. Rarely, the spleen also may be removed. The surgeon then connects the esophagus directly to the small intestine.

The time it takes to heal after surgery is different for each person, and you may be in the hospital for a week or longer. You may have pain for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Many people who have stomach surgery feel tired or weak for a while. Your health care team will watch for signs of bleeding, infection, or other problems that may require treatment.

The surgery can also cause constipation or diarrhea. These symptoms usually can be controlled with diet changes and medicine. See the Nutrition section for information about eating after surgery.

You may want to ask your doctor these questions before having surgery:

  • What kind of surgery do you recommend for me? Why?
  • Will you remove lymph nodes? Will you remove other tissue? Why?
  • How will I feel after surgery?
  • Will I need a special diet?
  • If I have pain, how will you control it?
  • How long will I be in the hospital?
  • Am I likely to have eating problems?
  • Will I have any long-term side effects?

Chemotherapy

Most people with stomach cancer get chemotherapy. Chemotherapy uses drugs to kill cancer cells.

It may be given before or after surgery. After surgery, radiation therapy may be given along with chemotherapy.

The drugs that treat stomach cancer are usually given through a vein (intravenous). You'll probably receive a combination of drugs.

You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Some drugs used for stomach cancer also may cause a skin rash, hearing loss, and tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects.

You may want to read the NCI booklet Chemotherapy and You.

You may want to ask your doctor these questions before having chemotherapy:

  • Why do I need this treatment?
  • Which drug or drugs will I have?
  • How do the drugs work?
  • When will treatment start? When will it end?
  • Will I have any long-term side effects?

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy is usually given with chemotherapy to treat stomach cancer.

The radiation comes from a large machine outside the body. You'll go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.

Side effects depend mainly on the dose and type of radiation. External radiation therapy to the chest and abdomen may cause a sore throat, pain similar to heartburn, or pain in the stomach or the intestine. You may have nausea and diarrhea. Your health care team can give you medicines to prevent or control these problems.

It's common for the skin in the treated area to become red, dry, tender, and itchy.

You're likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay active, unless it leads to pain or other problems.

Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them. Also, side effects usually go away after treatment ends.

You may find it helpful to read the NCI booklet Radiation Therapy and You.

You may want to ask your doctor these questions before having radiation therapy:

  • Why do I need this treatment?
  • When will the treatments begin? When will they end?
  • How will I feel during treatment?
  • How will we know if the radiation treatment is working?
  • Will I have any long-term side effects?