Treatment overview for stomach cancer
The main treatments for stomach cancer are surgery and chemotherapy. Sometimes, radiotherapy or targeted therapy treatments are used.
The treatments can be used alone or in combination with each other. The treatment you have will depend on the stage of the cancer, your general health and personal preferences.
You may have surgery to try to cure the cancer or to control it for as long as possible. This is a major operation, so you need to be physically well enough to have it. The operation involves removing part or all of the stomach and nearby lymph nodes. If the cancer has spread to other tissue or organs nearby, the surgeon may remove part of these.
Sometimes, surgery is used to relieve the symptoms of the cancer, for example, if it is causing a blockage (obstruction).
Chemotherapy is an important treatment for stomach cancer. Doctors often give it before and after surgery to reduce the risk of the cancer coming back. It can also be given on its own when an operation isn’t possible.
Occasionally, radiotherapy is given with chemotherapy (chemoradiation) after surgery. Doctors can also give radiotherapy to relieve symptoms if the cancer is advanced.
Sometimes, a targeted therapy drug called trastuzumab (Herceptin®) is given with chemotherapy to treat stomach cancer that has spread. This isn’t suitable for everyone.
If the cancer has spread and you decide not to have chemotherapy, your doctors will give you treatment to control your symptoms. You’ll usually see doctors or nurses who specialise in symptom control (palliative or supportive care).
You can also see a symptom control specialist during treatment if there is any problem controlling symptoms.
How treatment is planned
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In most hospitals, a team of specialists called a multidisciplinary team (MDT) will talk to you about the treatment they feel is best for your situation. The MDT will include:
a surgeon who specialises in stomach and other gastrointestinal cancers
a medical oncologist (chemotherapy and targeted therapies specialist)
a clinical oncologist (chemotherapy, radiotherapy and targeted therapies specialist)
a specialist nurse who gives information and support
a dietitian who gives you advice about your diet
a radiologist who analyses x-rays and scans
a pathologist who advises on the type and extent of the cancer.
It may also include other healthcare professionals, such as a palliative care doctor or a nurse who specialises in symptom control, a physiotherapist, an occupational therapist (OT), a social worker, a psychologist or a counsellor.
After the MDT meeting, your specialist doctor or nurse will talk to you about your treatment options. You and your doctor can then decide together on the best treatment for you.
The benefits and disadvantages of treatment
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Many people are frightened by the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will depend on your individual situation.
Surgery is used to try to cure stomach cancer. Most people also need chemotherapy. This can be quite intensive treatment. Your surgeon will explain the benefits and disadvantages of the treatments and how successful they are likely to be for you.
If the cancer is very advanced and has spread to other parts of the body such as the lungs or bones, treatment can only control it for some time. It may also help to reduce symptoms and prolong or improve the quality of your life. However, for some people in this situation, the treatment will have no effect on the cancer and they will get the side effects without any of the benefit.
If you’ve been offered treatment that aims to cure the cancer, deciding whether to accept it may not be difficult. However, if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss it in detail with your doctor or nurse. If you choose not to have treatment, you can still be given supportive (palliative) care, with medicines to control any symptoms.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you. Having a list of questions ready will also help make sure your concerns are covered during the discussion.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The choice of treatment will depend on the position and size of the tumour and whether it has spread beyond the stomach, as well as your age and general health. Different treatments can be used alone or together.