Once the doctor has made the diagnosis of stomach cancer and determined the location and extent of the cancer spread, he agrees with the patient what treatment steps are now pending. Various therapeutic options are available for this purpose. In many cases, surgery is the treatment of choice.
Stomach cancer: surgery as the most important form of therapy
The therapy of choice – depending on the stage and general state of health – is surgery, which attempts to remove the tumor completely. If only a small tumor is found, partial removal of the stomach including nearby lymph nodes is possible – rarely – (partial gastric resection); otherwise, the entire stomach is removed (gastrectomy) and a replacement stomach may be formed with a section of small intestine.
Endoscopic resection
If tumors are less than two centimeters in size, have spread only into the superficial lining of the stomach, and if the tumor was detected early enough, it can be removed during gastroscopy. This minimally invasive procedure is called endoscopic resection or endoscopic submucosal dissection (ESD).
Chemotherapy and radiation therapy
Radiation therapy and especially chemotherapy are used adjuvantly or alone in advanced stages but have limited success. If the tumor is very advanced and cannot be cured, it may be removed only during gastroscopy, and a feeding tube may be placed in the small intestine at the same time as a bypass. Chemotherapy aims to kill cancer cells using cell growth inhibiting drugs (cytostatics). Generally, gastric cancers are considered to be well susceptible to chemotherapy. However, gastric cancer cannot be cured by chemotherapy alone. Radiation therapy is occasionally used for gastric cancer when a patient cannot be operated on or does not respond to chemotherapy. Radiation therapy is used especially to treat pain.
Stomach cancer: side effects and consequences of surgery
Partial or total stomach removal through surgery may have some side effects. In addition, certain consequences occur, particularly related to digestion and food transport. The extent of individual discomfort can vary widely. The side effects of gastric surgery, as with any other surgical procedure, are direct complications such as bleeding, suture leaks, infection or blood clots. The sense of taste may also be altered or impaired. Possible consequences of cancer-related gastric surgery include :
- Intolerance of food
- Heartburn
- Vomiting
- Loss of appetite
- Weight loss
- Diarrhea, abdominal pain, flatulence
- Greasy stools
- Anemia (anemia)
- Bone loss (osteoporosis)
Another consequence can be a constant inflammation of the mucous membrane, due to the backflow of digestive juices in the esophagus. Sometimes the pancreas must also be removed, so that a diabetes results. This must be treated with insulin. Over time, however, the body often gets used to the changes in the organism, so that digestion and body weight return to normal.
Dumping syndrome as a result of gastrectomy
When the stomach is completely removed, the so-called dumping syndrome often occurs. The storage capacity of the replacement stomach is low, so food “plops” into the small intestine more quickly and therefore less predigested than usual. In early dumping (5 to 30 minutes after eating), the large amounts of food cause distension of the small intestine and the influx of fluid needed for digestion from the bloodstream – which, like sudden blood loss, leads to a drop in blood pressure with nausea, sweating and palpitations, and even circulatory collapse. This can be counteracted by eating many small, well-chewed portions in a semi-recumbent position and refraining from drinking at the same time. Late dumping (1 to 3 hours after eating) results in hypoglycemia with weakness and sweating. This results from increased insulin secretion in response to the fact that the sugar contained in the food has passed too quickly into the blood. So instead of regulating balance, the sugar level fluctuates wildly from too high to too low in a short time. Symptoms include weakness and trembling, pallor, and even unconsciousness.In the short term, a piece of glucose helps; in the longer term, medication can be used to counteract this.
Chances of cure for stomach cancer
The chances of cure depend on the stage and spread of the stomach cancer and the associated treatment options. If they are statistically still 70 to 80 percent in the first stage, they are only less than 5 percent in the worst stage. Nevertheless, even in incurable forms, the quality of life and lifespan after diagnosis are far greater than they were a few years ago.
Stomach cancer: what must the sufferer pay attention to?
In order to slowly accustom the body to the new situation and relieve the intestines, food is fed through a stomach tube in the first few days after surgery; after that, the diet is rebuilt over about three weeks. The change in diet to semi-normal gastrointestinal function takes several months; initial weight loss is normal. Depending on requirements, the hospital stay can be followed by an inpatient or outpatient rehabilitation program in which the body and psyche are cared for and the patient learns to cope with his or her illness. Depending on the type, accompanying relaxation methods, yoga or self-help groups can help; alternative healing methods can support the healing process or – for example acupuncture – alleviate pain or nausea. Nutritional counseling is very important. Stomach cancer sufferers need regular follow-up care – initially every three to six months, then every six months to annually. Regular vitamin injections may be needed.
