Treatment
After having tests to diagnose and assess gastric cancer, your
doctor will discuss your treatment options with you. Treatment
options are determined at a weekly meeting of specialists where all
the test results are discussed. A lot of different people are
involved in making these decisions, including surgeons, oncologists
(cancer specialists), radiologists (imaging specialists),
histopathologists (experts in tissue analysis) and cancer nurse
specialists. This meeting is called the 'Multi-Disciplinary Team'
(MDT) meeting. This means that the right decisions can be made with
you based on the specific details of you and your test results.
In general, the treatment options available are explained
below.
Curative-intent vs palliative treatment
Depending upon the results of the tests and the individual
patient, treatment may be planned to try and remove all cancer and
avoid it coming back (curative-intent treatment). Alternatively, it
may not be possible to cure the cancer. For example, it may have
already spread to other organs. In this case, treatment is called
'palliative', and is designed to give the best combination of
quality and amount of time of survival possible. Even when it is
not possible to cure a person of cancer, there is much that the
team of doctors and nurses can do to help with symptoms and to
support a person and their family.
Chemotherapy
Chemotherapy involves the use of different types of drugs to
target cancer. Some medicines are given into the vein and others
can be taken as tablets. Often a combination of drugs is used.
Usually treatment is given over a period of months in a series of
cycles, with short breaks between to allow recovery. Chemotherapy
may be given as part of a curative-intent regime, with other
treatments such as surgery or radiotherapy. It may also be given as
treatment when it is not possible to cure cancer, to prolong
survival or to improve symptoms (palliative chemotherapy). As with
any treatment, there are risks and side effects which your doctor
will discuss with you.
Surgery
Surgery for gastric cancer forms part of a curative-intent
treatment plan, most often in combination with chemotherapy before
and/or after the operation itself. The surgery to remove gastric
cancer is a major operation. Only about a third of patients
diagnosed with gastric cancer undergo surgery. Many people cannot
have surgery because their cancer has already spread and it cannot
be cured. Other reasons surgery is not possible include cancer
involving other major organs that cannot be removed, or a patient
may not be fit enough to survive the operation itself.
The exact operation depends upon which part of the stomach is
affected by the cancer, and what type of cancer it is. It may
involve removing nearly all (subtotal gastrectomy) or all (total
gastrectomy) of the stomach, as well as the glands or lymph nodes
nearby. Other bits of bowel (small bowel) are then moved around and
joined together to allow food that is swallowed and enters the
gullet to go through the abdomen and mix with digestive juices to
be absorbed. After the operation, once the joins between the
different parts have healed in place, you can eat normal food, but
in smaller amounts, such that many people need to eat 5-6 smaller
meals through the day. It can take up to 9-12 months to fully
recover from the operation. Your doctor will tell you more about
the risks of the operation, the side effects, and the likely
recovery period.
Radiotherapy
Radiotherapy may be used as a palliative treatment for gastric
cancer, when the cancer cannot be cured, to help control bleeding
and anaemia from a tumour. It involves the use of targeted
radiation to affect the cancer. This is may be given as a course of
several treatments which therefore require repeated trips to
hospital. Your doctor will discuss the details as well as the risks
and benefits of treatment.
