Stomach cancer is one of the most common cancers worldwide but it is decreasing in the Western world, with an estimated 21,130 diagnosed in 2009.1
Stomach cancer typically affects older adults. Two-thirds of stomach cancer patients are over age 65. It affects men more than woman. Your risk of getting this disease is also higher if you have/had the following conditions or habits:2
Stomach cancer is hard to diagnose in its early stages. Indigestion and stomach discomfort can be symptoms of early stomach cancer, but other conditions can cause the same symptoms. In advanced cases of this disease, there may be:
Regardless of what stage of stomach cancer you have, treatment is available. The choice of treatment you receive depends on many factors. The location and the stage (extent) of the tumor are very important. In choosing your treatment plan, you and your cancer care team will also take your age, general state of health, and personal preferences into account.
The main treatments for stomach cancer are surgery, chemotherapy, and radiation therapy. More than one treatment method is often used to treat this disease. Stomach cancer can be difficult to treat because it is often found in later stages.
Before starting treatment, it is important to understand the goal of your treatment - whether it is to cure your cancer or to relieve symptoms. If the goal of your treatment is to cure the cancer, you will also receive treatment to relieve common side effects that may be caused by your treatment. If a cure is not possible, treatment is aimed at relieving symptoms, such as trouble eating, pain, or bleeding.
It is also important to have a team of doctors with different specialties involved in your care before making plans to treat your stomach cancer. Most likely, a surgeon, medical oncologist, and possibly a radiation oncologist will consult about a treatment plan before the start of your treatment.
Chemotherapy - Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond the stomach.
Often for stomach cancer, chemotherapy is given along with radiation therapy after surgery. This combination is called chemoradiation. It may delay the cancer from coming back and extend the life span of people with less advanced stomach cancer. This may be especially helpful for cancers that could not be removed completely by surgery.
Chemotherapy drugs kill cancer cells but also damage some normal cells, which can lead to side effects. The type of side effects depends on the type of drugs, the amount taken, and the length of treatment. Short-term side effects common to most chemotherapy drugs can include:
Newer chemotherapy drugs that target specific parts of cancer cells are now being tested to treat stomach cancer. This is referred to as targeted chemotherapy. You may want to talk to your doctor about these types of drugs.
Radiation - External beam radiation therapy is the type of radiation therapy often used to treat stomach cancer. This treatment focuses the radiation on the cancer from a machine outside the body. Having this type of radiation therapy is like having an x-ray, except each treatment lasts longer, and the patient usually receives five treatments per week over a period of weeks or months.
After surgery, radiation therapy can be used to kill very small remnants of the cancer that cannot be seen and removed during surgery. Radiation therapy -- especially when combined with certain chemotherapy drugs may delay or prevent cancer from coming back after surgery and may help patients live longer. Radiation therapy can also be used to ease the symptoms of advanced stomach cancer, such as pain, bleeding, and eating problems.
Side effects from radiation therapy for stomach cancer can include:
Side effects usually go away within several weeks after treatment is finished. When radiation is given with chemotherapy, side effects are often worse. Please be sure to talk with your doctor about any side effects you have, because there are often ways to relieve them. It is also very important that you get treated at a center that has extensive experience in treating stomach cancer.
Surgery - Surgery may be used to remove the cancer and part or all of the stomach, depending on the type and stage of the cancer. The surgeon will try to leave behind as much normal stomach as possible. This operation is called a gastrectomy and is viewed as the most realistic chance to cure stomach cancer. If a patient’s cancer is in the early to moderate stage and is healthy enough, an attempt should be made to treat the cancer with surgery. Some patients with stage IV cancer that has not spread to distant sites may also benefit from surgery.
Even when the cancer is too widespread to be removed completely by surgery, patients may be helped from surgery because it may help prevent bleeding from the tumor or prevent the stomach from being blocked by tumor growth.
There are three kinds of surgery that may be used to treat stomach cancer:
Endoscopic mucosal resection - In this procedure, the cancer is removed through an endoscope - a long, flexible tube passed down the throat and into the stomach. This procedure is only done for certain very early stage cancers, where the chance of it spreading to the lymph nodes is very low.
Subtotal gastrectomy - A subtotal gastrectomy is often recommended if the cancer is only in the lower or the upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the beginning of the small intestine (the duodenum). Nearby lymph nodes are also removed. The remaining section of stomach is then reattached. Eating is much easier if only part of the stomach is removed instead of the entire stomach.
Total gastrectomy - Your doctor will probably recommend a total gastrectomy if the cancer has spread throughout the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus. A total gastrectomy involves removing the entire stomach, nearby lymph nodes, and possibly removal of 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. Usually the end of the esophagus is attached to part of the small intestine, and some extra intestine is also attached. This can make room for food to be stored before moving down the intestinal tract, and will allow you to eat some food before getting full. But, people who have a total gastrectomy can only eat a small amount of food at a time. Because of this, they must eat more often.
In either a subtotal or total gastrectomy, the nearby lymph nodes and some of the omentum are usually removed. The omentum is an apron-like layer of fatty tissue that covers the stomach and intestines. Lymph node removal is a very important part of the operation. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes.
In the United States, it is recommended that a gastrectomy be accompanied by removal of nearby lymph nodes with the goal of removing at least 15 nodes. Surgeons in Japan have had very high success rates by doing a more extensive removal of lymph nodes near the cancer. Stomach cancer is much more common in Japan, but the disease is often caught in early stages since patients are screened for stomach cancer.
It takes a skilled surgeon who is experienced in stomach cancer surgery to remove all the lymph nodes successfully. It is important that you ask your surgeon about his or her experience in operating on stomach cancer. Studies have shown that the results are better when both the surgeon and the hospital have had extensive experience in treating patients with stomach cancer.4
Surgery for stomach cancer is difficult, and complications can occur. These can include bleeding from the surgery, blood clots, and damage to nearby organs during the operation. It is rare but possible that the new connections made between the ends of the stomach or esophagus and small intestine may leak.
Surgical techniques have improved in recent years, so only about 1% to 2% of patients die from surgery for stomach cancer.4 This number is higher (as high as 5% to 15%) when the operation is more extensive, such as when all the lymph nodes are removed, but is lower in the hands of highly skilled surgeons.
You may develop other side effects after you have recovered from surgery. These can include frequent heartburn, abdominal pain (particularly after eating), and vitamin deficiencies. Changes in your diet will often be needed after a partial or total gastrectomy. The biggest change is that you will need to eat smaller, more frequent meals.
It cannot be stressed enough that your surgeon must be highly skilled. He or she should be experienced in treating stomach cancer and able to perform the most up-to-date operations to reduce your risk of complications.
da Vinci® Surgery for Stomach Cancer - If your doctor recommends surgery to treat stomach cancer, you may be a candidate for a safe, effective and minimally invasive procedure –da Vinci Surgery. Using the most advanced technology available, the da Vinci System enables your doctor to perform this delicate operation with breakthrough vision, precision and control.
da Vinci Surgery offers stomach cancer patients many potential benefits, including:
da Vinci Surgery offers patients other key benefits when compared to traditional laparoscopic surgery, including:
When compared to both traditional open and laparoscopic surgery,da Vincioffers patients additional benefits, including:
This procedure is performed using the da Vinci Surgical System, a state-of-the-art surgical platform. By overcoming the limits of both traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.
1American Society of Clinical Oncology, Cancer Education Slides, "Stomach Cancer 2009"; http://www.cancer.net/patient/ASCO%20Resources/Stomach_Cancer_Slide_Deck.ppt#256,1,Cancer Education Slides
2"Stomach Cancer", National Institutes of Health, www.nlm.nih.gov, URL: http://www.nlm.nih.gov/medlineplus/stomachcancer.html
3"How is Stomach Cancer Treated", American Cancer Society, www.cancer.org, URL: http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_How_is_stomach_cancer_treated_40.asp?rnav=cri
4"Stomach Cancer Surgery", American Cancer Society, www.cancer.org, URL: http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Surgery_40.asp?rnav=cri
5Song J, Oh S, Kang WH, et al., Robot-Assisted Gastrectomy With Lymph Node Dissection for Gastric Cancer - Lessons Learned From an Initial Consecutive Procedures; Ann Surg 2009 249; 927-932
6Song J, Kang WH, Oh SJ, et al.; Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy; initial experience of 20 consecutive cases. Surg Endosc (2009) 23:1204-1211 DOI 10.1007s/0046-009-0351-4
7Kim MC, Heo GU, Jung GJ; Robotic gastrectomy for gastric cancer; surgical techniques and clinical merits; Surg Endoscopy, 2009 DOI 10.1007/s00464-009-0618-9
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whetherda Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors aboutda Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.
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