Gastric cancer is a growth of abnormal and malignant (cancerous) cells in the stomach. Gastric cancer is difficult to detect in its early stages and sometimes, there are no symptoms. In general, when the symptoms occur, the tumour can be well advanced.
Even though early-stage gastric cancer often doesn’t present symptoms, as it progresses, certain symptoms may include:
If the symptoms persist or aggravate, then it is important to go through medical evaluation. Early detection of gastric cancer leads to better outcomes.
The most common treatment is the removal of part or all of the stomach, and when necessary, other organs or lymph nodes that have been affected.
Gastric surgery is not always the definitive solution to cure the disease, but it can also be used to reduce the symptoms and damage it causes in the body.
Other treatment options include radiotherapy and chemotherapy. A multidisciplinary team is required and this can involve oncologists, radiation oncologists, pathologists, radiologists, surgeons and gastroenterologists.
This surgery consists of removing the cancer, the nearby lymph nodes and part of the stomach – the amount of tissue removed depends on the severity of the disease. The stage of the condition at the time of diagnosis and the position of the cancer is key to determining the most effective surgery.
When undergoing a subtotal (partial) gastrectomy, or a total gastrectomy, your surgeon might recommend open surgery or keyhole surgery.
If the cancer has advanced to an incurable state, a patient can be offered palliative surgery which consists of alleviating cancer symptoms. This surgery prevents bleeding from the tumour and the tumour blocking the stomach.
Endoscopic mucosal resection and endoscopic submucosal resection can only be performed to treat some very early-stage cancers. This type of surgery consists of inserting an endoscope through the mouth, down the throat and into the stomach and then removing the tumour and some healthy tissue surrounding it.
When the cancer is present in in the lower section of the stomach, subtotal gastrectomy is the solution. The procedure can be used in some cases where the upper section of the stomach needs removing.
Subtotal gastrectomy may involve:
– Removal of part of the stomach and nearby lymph nodes;
– Removal of cancerous tissues with specific instruments;
If the cancer has spread throughout the entire stomach, a total gastrectomy will be performed and this involves removing the entire stomach, nearby lymph nodes and the surgeon may also need to remove parts of other nearby organs such as the oesophagus, intestines or pancreas. After the removal of the stomach, the oesophagus is connected with the small intestine to allow the patient to eat.
For people with incurable stomach cancer, surgery is used to help control the cancer or relieve symptoms. This aims to prevent bleeding, pain, or blockage of the stomach from the tumour. If the situation demands, doctors could remove parts of the pancreas, spleen or intestines.
You will enter the hospital several hours before surgery and have your medical history and blood checked. You will need to fast for at least 8 hours before surgery. The medical evaluation consists of blood work, imaging (CT scans, endoscopy) and certain nutritional assessment are needed.
In some situations, patients could resort to laxatives or enemas to prepare the bowel. No smoking. Most studies show that smokers have higher risks of developing complications during and after gastric surgery.
After the operation, you are taken to intensive care or a high dependency recovery unit and you will be given anaesthetic and painkillers to manage pain. Surgical incision wounds are dressed and you will be advised on how to manage the healing wounds and avoid infection once you leave.
It is not possible to eat or drink after surgery, and you will be given fluids through a drip for 24-48 hours. IV fluids and feeding tubes are necessary in this phase. In around a week or two after surgery, you can expect to be able to eat small amounts. Doctors will manage pain through epidurals and in some cases, intravenous painkillers.
A dietician will advise you on what to eat once you are discharged from the hospital. Dietary adjustments are necessary after the gastric cancer surgery. Patients can experience side effects such as nausea, heartburn, diarrhoea, and abdominal pain and this is due to food moving too quickly through the intestines.
It is very important that patients avoid swallowing anything six to eight hours before the procedure.
Stage 1: 70 – 90% five-year survival rate;
Stage 2: 30 – 50% five-year survival rate;
Stage 3: 10 – 30% five-year survival rate;
Stage 4: Less than 10% five-year survival rate.
A profound understanding of gastric cancer surgery is necessary. Gastric cancer surgery is a crucial intervention that can offer a chance of cure for early-stage patients and symptom relief for advanced ones.
As it is for most cancers, early detection remains the key to successful treatment, underlining the importance of frequent screenings, especially for high-risk individuals. Ongoing advancements in minimally invasive techniques and personalized treatment plans continue to improve patient outcomes.
Medical technology keeps on improving; offering doctors the chance to perform better and with positive results. Regular follow-ups are necessary to detect potential recurrences. In some cases, vitamin B12 injections may be of help due to impaired absorption. Early detection is very important to increase survival chances.
References for further study:
World Health Organization (WHO) Global Cancer Statistics 2020
National Cancer Institute (NCI) – Stomach Cancer Treatment Guidelines
The Lancet Oncology, “Advancements in Gastric Cancer Treatment” (2021)
Stomach cancer, Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/syc-20352438
