Surgery is the main treatment for stomach cancer. Depending on the type and stage of your cancer, surgery might be used to remove the cancer and part or all of your stomach. The surgeon will try to leave behind as much normal stomach as possible.
At this time, surgery is the only way to cure stomach cancer. If you have stage 0, I, II, or III cancer, and if you are healthy enough, your doctor will likely try to treat your cancer with surgery. Patients with stage IV cancer might also have surgery if the cancer has not spread to distant sites.
Even if the cancer is too widespread to be completely removed, an operation could help prevent bleeding from the tumor or keep the stomach from being blocked. This type of surgery is known as palliative, meaning that it relieves or prevents symptoms but is not done to cure the cancer.
The 3 main types of surgery for stomach cancer
- Endoscopic mucosal resection: Resection refers to cutting out a tumor or part of an organ. In this operation, the cancer is removed through an endoscope (a long, flexible tube passed down the throat and into the stomach). This can be done only for some very early cancers where the chance of spread is very low.
- Subtotal (partial) gastrectomy: This approach is often used if the cancer is in the lower part of the stomach close to the intestines. It is also sometimes used for cancers that are only in the upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine. Nearby lymph nodes are also removed. Eating is much easier when only part of the stomach removed.
- Total gastrectomy: This method is used if the cancer has spread throughout the stomach. It is also often used if the cancer is in the upper part of the stomach. The surgeon removes all of the stomach. The nearby lymph nodes are removed, and sometimes also the spleen and parts of the esophagus, intestines, pancreas, and other nearby organs. If you have a total gastrectomy, the surgeon will make a new "stomach" out of intestinal tissue. But people who have had a total gastrectomy can only eat a small amount of food at a time. Because of this, they must eat more often.
Placement of a feeding tube
Some patients have trouble taking in enough food after surgery for stomach cancer. Further treatment, like chemotherapy with radiation can make this problem worse. To help with this, a tube can be placed into the intestine at the time of gastrectomy. This allows liquid nutrition to go straight into the intestine and can help prevent and treat malnutrition.
Taking out lymph nodes
In either a subtotal or total gastrectomy, the lymph nodes and some of the fatty tissue (omentum) around the stomach are removed. If the cancer has spread beyond the stomach to the spleen, it will also be removed.
Many doctors feel that the success of the surgery is linked to how many lymph nodes the surgeon removes. But it takes a skilled surgeon with experience in operating on stomach cancer to do this safely. Studies have shown that the results are better when both the surgeon and the hospital have had a lot of experience in treating patients with stomach cancer. It is important to ask your surgeon about his or her experience in operating on stomach cancer.
Possible problems and side effects of surgery
Surgery for stomach cancer is very hard to do and can lead to problems. These could include bleeding from the surgery, blood clots, and damage to the nearby organs like the gallbladder and the pancreas. Rarely, the new connections between the ends of the stomach and esophagus or small intestine may not hold together and can leak. These problems, which could be fatal, were more common in the past. Today, only about 1% to 2% of people die after this surgery. This number can be higher when all the lymph nodes are removed.
Other side effects may start after you have recovered from surgery. These could include heartburn, abdominal pain (especially after eating), and shortages of some vitamins. The stomach is important in helping the body take in certain vitamins. If some parts of the stomach are removed, the doctor will prescribe vitamin supplements. Some of these can only be taken only as shots (injections). After stomach surgery, most people will need to change their diets, eating smaller meals more often.
It is very important that you talk to your doctor about the surgery you are going to have. Some surgeons try to leave behind as much of the stomach as they can so that patients will have fewer problems later. But the tradeoff is that the cancer might be more likely to come back. Again, it's important that your surgeon be very skilled, have a lot of experience, and be able to do the most up-to-date operations.
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