Gastroenterology - Gastric (Stomach) Cancer

Planning your treatment

Introduction

This information leaflet is intended to explain the management plan for your condition. It is not meant to frighten or discourage you. It is hoped that it will help you by explaining how we choose the most suitable treatment for you.

Your care will be managed by the Upper GI Multidisciplinary Team. The team includes:

• Surgeons
• Radiologist
• Pathologist
• Upper GI specialist nurse
• Palliative care nurse
• Dietitian
• MDT coordinator

You will be allocated a key worker (usually the specialist nurse) who will be your point of contact to the team. You can contact your key worker if you have any questions or concerns about your diagnosis, investigations or treatment plan.

Diagnosis and treatment

You have been diagnosed as having cancer of the stomach.

The stomach is a “J” shaped bag at the end of your gullet (oesophagus) that receives food and liquids after swallowing. It helps digestion of the food you eat by grinding it into a liquidized state and adding acid. The liquidized food is then delivered slowly into the small intestine.

There are a number of different ways of treating patients with stomach cancer. Some treatments aim to cure the problem once and for all. In some patients the tumour is already incurable even at the time of diagnosis. In this situation the treatment should be palliative - this means trying to control the symptoms in as gentle a way as possible, while not being able to cure the tumour itself.

Stomach cancer staging tests

All potentially curative treatments involve surgery. These are big operations and carry significant risks to patients. We only consider major surgery for patients who are fit enough to come through it safely, and in those in whom we think that there is a good chance of cure.

To find out if a tumour might be curable the important questions to answer are:

Has the cancer grown right through the wall of the stomach?
Has the cancer spread more widely within the abdominal cavity?
Has the cancer spread to some of the glands (lymph nodes) around the stomach?
Has the tumour already spread to involve other, distant organs in the body such as the liver or lungs?

In order to answer these questions, you may need some or all of the following investigations for which you will be given specific information prior to these being performed:

CT scan (“CAT” or body scan)

This is a good test to assess spread to distant organs such as liver or lung. This test is done in the x-ray department. The test is painless, completed quickly and does not require admission to the hospital.

If the test shows distant organ spread, then the disease cannot realistically be cured with an operation. You will be advised to have palliative treatment. If the test is clear, then you will go on to have a laparoscopy.

Laparoscopy

This is a telescopic examination of the abdominal cavity, performed under a general anaesthetic with a rigid telescope introduced through the abdominal wall. The procedure requires admission to the short stay surgical ward and an overnight stay.

Laparoscopy can detect signs of tumour spread inside the abdominal cavity that CT scanning may not pick up. Some tissue samples may need to be collected which will take a few days to process. If the tumour spread is detected within the abdominal cavity, then the tumour is considered to be incurable by surgery, and a palliative treatment is therefore indicated.

MDT

Diagnosis and treatment of cancer requires a team of experts called a multi-disciplinary team (or MDT for short). The MDT meeting is held weekly. A wide variety of cancer specialists are present at the meeting and we aim to come to a collective decision about the best way to proceed with your treatment. We will notify you and your GP as soon as possible after the meeting.
 
Some of the team you may come into contact with may include the following:

Gastroenterologist

This is a doctor who carries out diagnostic endoscopic procedures such as gastroscopy.

Upper GI Surgeon

This is a specialist who can access and diagnose cancers of the oesophagus or stomach. The surgeon will discuss different treatment options with you and drugs currently available. The surgeon will carry out any operations needed to remove cancer.

Registrar

This is a senior doctor who has chosen to specialise in this area of care and is getting specialist training in that area.

Upper GI Nurse Specialist

This is a nurse who is an expert in caring and supporting people with Upper GI problems. The Upper GI Nurse specialist will provide information to help you understand your treatment and will support you during your treatment.

The Radiologist

This is a doctor who is specially trained to interpret x-rays and special scans from which a diagnosis is made, and who is an expert in carrying out diagnostic tests.

The Pathologist

This is a doctor who is an expert in looking at cancer cells under a microscope and giving advice on how these cells can behave to guide decisions on treatment.

The Oncologist

This is a doctor who is an expert on non-surgical treatments for your type of cancer. They specialise in radiotherapy and chemotherapy.

Upper GI Dietician

This is a specialist who can offer advice and support on nutrition.

Macmillan Nurse

This is a nurse who specialises in symptom management. They can offer emotional and psychological support to patients and carers.

MDT co-ordinator

Is an essential member of the team who ensures that all your investigations and results are available for the MDT meeting, ensuring that you get a timely treatment plan.

After staging

Once the staging investigations are completed and all the results available, your case will be discussed in detail at the MDT Upper GI Cancer meeting which is held weekly.

A wide variety of cancer specialists are present at the meeting, and we aim to reach a collective decision about the best way to proceed with your treatment. We will notify you and your GP by letter as soon as possible after the meeting.
 

Treatment options

1)    Potentially curative treatment

A gastrectomy (removal of most, or all of the stomach) is a very big operation. The operation involves about 2 weeks in hospital, and a lengthy convalescent period afterwards. In most patients the whole stomach needs to be removed.

In some patients with tumours very near to the outlet of the stomach, a small part of the top of the stomach can usually be preserved.

2)    Palliative treatment

Patients with incurable disease should not have a gastrectomy because the risks are great and there is no realistic chance of any benefit to the patient. Instead, palliative treatments should be considered to control troublesome symptoms. Frequently used palliative treatments include:

Palliative Surgery

Palliative partial gastrectomy

Sometimes removal of just the small part of the stomach which contains the tumour can be successfully performed. This may eliminate some of the symptoms caused by the tumour such as vomiting, or anaemia, but this type of limited surgery is not likely to produce a long-term cure.

Palliative surgical bypass

Sometimes the tumour is large enough to block the outlet of the stomach but cannot be safely removed with an operation.

In these circumstances, the outlet to the stomach can be bypassed without actually removing the tumour. Less commonly, a rigid tube (called a stent) can sometimes be placed across the blockage in the outlet to the stomach to relieve obstruction.

Chemotherapy

In patients who are relatively fit, despite having incurable disease, we may suggest a palliative course of chemotherapy. This can improve some symptoms and can also help increase lifespan. The treatment is intended however, to be as gentle as possible, and is not designed to provide a long-term cure. This treatment is carried out at the Christie Hospital.

Radiotherapy

In some patients, recurring episodes of anaemia can be problematic. Repeated blood transfusions can help, but sometimes we offer a short course of radiotherapy as an alternative. This helps to prevent continued blood loss from the tumour, and is usually just a single treatment, so repeated trips to hospital are not needed.

Best supportive care

When the disease is found to be incurable, and possible palliative treatments have been discussed, some patients may prefer not to have any interventional treatment at all. In such circumstances it is likely that their health will gradually deteriorate, and patients and their families will often need help and support at home. We will do our best to help by arranging appropriate social, physical and psychological support where it is needed.

Your treatment plan
 

 

 

 

 

Contacts and support

We hope that you have found this information booklet useful and that it has helped answer some of your questions and concerns. We are aware that this is a very difficult time for both patients and their relatives. Your GP will have been made aware of your diagnosis already, and further support and advice is available through your GP, local hospices and community palliative care team and the upper GI cancer specialists here at Salford Royal Hospital.

Contact numbers

Upper GI Specialist Nurse - 0161 206 5062
Email: uppergi.nursingteam@nca.nhs.uk

Upper GI Surgical Secretaries
0161 206 5472
0161 206 5744
0161 206 5128
0161 206 0449

Macmillan Cancer Support Centre
0161 206 1455