Gastric Cancer

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Surgical Treatment

Treatment for stomach cancer depends on the size, location, and extent of the tumor; the stage of the disease; and the patient's age and overall health. The goal of treatment for early-stage stomach cancer is to cure the disease. In advanced cases, when a cure is unlikely, the goal is to reduce pain and restore some quality of life (called palliative treatment).

Surgical removal (resection) is the only curative treatment. Chemotherapy and radiation therapy may be used in addition to surgery (adjuvant treatment) or as palliative treatment.

Surgery
The extent of surgery depends on the extent of the disease. Endoscopic mucosal resection may be used to treat early stomach cancer (i.e., tumor smaller than 3 cm that has not invaded beyond the innermost layer of the stomach lining [submucosa]). This procedure involves removing only the tumor and surrounding tissue.

Gastrectomy is the most common treatment for stomach cancer. In this surgery, the entire stomach (total gastrectomy) or part of the stomach (partial or subtotal gastrectomy) is removed. Parts of nearby tissues or organs (e.g., the spleen) may also be removed. In most cases, surrounding lymph nodes also are removed (lymph node dissection). Surgery for cancer of the upper stomach (cardia) may require removal of the stomach and part of the esophagus (called esophagogastrectomy).

Following total gastrectomy, the esophagus is attached directly to the small intestine. When a large section of the stomach is removed during partial gastrectomy, the surgeon reattaches the stomach to the esophagus or small intestine. The connection between these organs is called an anastomosis.

Gastrectomy requires a large incision. Most patients experience postsurgical pain, weakness, fatigue, and loss of appetite. Recovery from the procedure varies depending on the patient’s age and overall health, the type of surgery, and the stage of the disease.

Complications of surgery include the following:

• Anastomosis failure
• Blood clots
• Bowel obstruction (ileus)
• Inflammation of the gall bladder (cholecystitis) or pancreas (pancreatitis)
• Pneumonia

Removal of a large part or all of the stomach usually requires permanent alterations in diet. Patients often must eat more frequently, eat smaller meals, reduce their sugar intake, and increase their intake of fat and protein. In most cases, drinking with meals must be avoided. If a small section is removed, patients may be able to gradually return to previous eating habits.

Dumping syndrome, which results when foods and liquids move too quickly into the small intestine, may occur in patients who have undergone gastrectomy. Symptoms of dumping syndrome include the following:

• Dilation or constriction of blood vessels, which may cause pain and headache
• Dizziness
• Flushing
• Sweating
• Weakness

Other long-term complications include vitamin B-12 deficiency (pernicious anemia), inflammation of the esophagus (esophagitis), and reduced bone mass (osteoporosis). Patients who undergo gastrectomy also often experience suppression of the immune system.

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