During treatment for a stomach ulcer, Deborah Knifton was devastated to find out that she had stomach cancer. This was followed by surgery to remove her stomach.

“I’d been having treatment for a stomach ulcer, when a routine biopsy showed up a tiny cancerous area. I was reassured that, because it was so small, the cancer was probably in the very early stages. But even so, it was horrendous news and such a shock. Because I was being treated for a stomach ulcer, it hadn’t occurred to me there could be anything else wrong. 

“After more biopsies, a CT scan and blood tests, it was recommended that I have surgery to remove my stomach. It sounded very drastic to me. At the time I didn’t even realise that you could live without a stomach. 

“A gastrectomy is major surgery. They take your stomach away and attach the end of your lower bowel to the bottom of your oesophagus. In my case, the operation took about six hours. When I came round I had a feeding tube which went in to my lower bowel just above my left hip, and on the other side I had a drain. At first I was in a lot of pain, the drain was quite sore, but I saw a pain management nurse and the pain eased once they found a good combination of drugs.

“The operation had gone well, but unfortunately they discovered that the cancer had spread to my lymph nodes and I was referred for chemotherapy. That was a very low point. I felt devastated. It knocked me for six. I’d thought that the worst was over and that I’d done okay. Discovering it had spread and I had to have more treatment was very hard.

“My chemotherapy started two months after my surgery. All in all, I had 70 days of it. A line was put into my arm (which looked like a long tube bound to my forearm) and the chemo passed through it on a continuous basis. In addition, every month, I had to go into hospital for a day and have a different chemo through a drip.  

“I didn’t have too many side effects from the chemo. My taste changed, which made me lose my appetite, and the tube on my arm was a bit uncomfortable at first. The main side effect was feeling absolutely exhausted. But I didn’t have any nausea or sickness. They even told me that I’d lose all my hair, so I had my hair cut short and then didn’t lose any of it. 

“Eating after surgery took a lot of getting used to. The feeding tube was left in for 18 weeks, just in case my weight dropped and I needed to be fed on a drip, but when I came out of hospital I had to learn how to eat again. Swallowing food was a bit nerve-wracking at first. My throat felt quite sore and I kept forgetting that the swallowing hole was smaller because of the scar tissue, so I used to choke quite a bit.

“I was sick a lot at first. Because the stomach isn’t there, you don’t get the sense of being full and you don’t realise you’ve over-eaten. Now, however, I eat more than I did before and I’m exactly the same weight that I was before the op, although I was told I might not get back to my original weight. I can eat a full-sized dinner again. I have to chew more, but looking at me, you would never know I don’t have a stomach. 

“The other thing that changes is your bowel movements. You don’t absorb fat so everything looks different. It’s worrying at first. When things look or feel different, you wonder what’s going on, whether it’s the cancer coming back. My husband was often on the phone to the nurse at the hospital as we both needed reassurance. 

“I now see the nurse and dietitian every six months and I have a yearly ultrasound scan. I also see an oncology psychiatric nurse which is incredibly helpful. It’s really useful being able to chat to someone about your worries, which are still there even two years down the line. Having cancer really changes your life and it has a knock-on effect with family and friends. I still worry and I don’t feel I can take my health for granted, but it is very reassuring being able to talk about how you’re feeling.”

Stomach cancer is caused by changes in the cells of the stomach, although it’s unclear exactly why these changes occur.

Cancer begins with a change in the structure of DNA, which gives our cells a basic set of instructions, such as when to grow and reproduce.

A change in DNA structure is known as a mutation, and it can alter the instructions that control cell growth. This means that cells continue to grow instead of stopping when they should. Cells multiply in an uncontrollable manner, producing tissue called a tumour.

Exactly what triggers the changes in DNA that lead to stomach cancer and why only a small number of people develop stomach cancer is still uncertain.

Increased risk

However, evidence suggests that a number of things can affect your chances of developing stomach cancer. These are discussed below.

Age

Your risk of getting stomach cancer increases with age. Most cases occur in people aged over 55, with the average age at diagnosis being around 70.

Gender

Men are twice as likely as women to develop stomach cancer. It is unclear why.

Smoking

People who smoke may be twice as likely to develop stomach cancer compared with people who don’t. This is because some tobacco smoke will always be swallowed when you inhale and end up in your stomach. The many harmful substances in tobacco may then damage the cells in your stomach.

The more you smoke and the longer you have been smoking, the bigger the risk. On average, people who smoke are twice as likely to get stomach cancer as people who don’t. Around one in every five stomach cancer cases in the UK is thought to be related to smoking.

H. pylori infection

Helicobacter pylori (H. pylori) is a common type of bacteria. In most people, these bacteria are harmless; however, in some people, a H. pylori infection can cause conditions such as stomach ulcers, recurring bouts of indigestion or long-term inflammation of the stomach lining (chronic atrophic gastritis).

Research has found people with severe chronic atrophic gastritis have an increased risk of developing stomach cancer, although this risk is still small.

Diet

A diet rich in pickled vegetables (such as pickled onions or piccalilli), salted fish, salt in general and smoked meats (such as pastrami or smoked beef) increases your risk of stomach cancer.

Countries where this type of diet is popular, such as Japan, tend to have much higher rates of stomach cancer than the UK.

Family history

You’re more likely to develop stomach cancer if you have a close relative with the condition, such as one of your parents or a sibling. In such cases, it may be appropriate for your doctor to arrange genetic counselling.

It’s not fully understood why this is. It may be due to shared risk factors (such as having similar diets or having a H. pylori infection), or because of certain genes you inherit from your parents.

In around one in 50 cases of stomach cancer, testing has found that people share a mutation in a gene known as E-cadherin.

Research into stomach cancer has also shown that you may be more at risk of getting the condition if you have the blood type A. Your blood type is passed on from your parents, so this could be another way in which family history may increase your risk of developing stomach cancer.

There is also a condition that runs in families called familial adenomatous polyposis (FAP), which may increase your risk of stomach cancer. FAP causes small growths, called polyps, to form in your digestive system, and is known to increase your risk of developing bowel cancer.

Having another type of cancer

If you have had another type of cancer, such as cancer of the oesophagus (gullet) or non-Hodgkin lymphoma (cancer that develops in your immune system’s white blood cells), you have an increased risk of developing stomach cancer.

There are more cancers that can make developing stomach cancer more likely for both men and women. If you’re a man, the risk of stomach cancer is increased if you’ve had prostate cancer, bladder cancer, bowel cancer or testicular cancer. If you’re a woman, the risk of developing stomach cancer increases if you’ve had ovarian cancer, breast cancer or cervical cancer.

Certain medical conditions

Having certain medical conditions can also increase your risk of developing stomach cancer, such as pernicious anaemia (a vitamin B12 deficiency, which occurs when your body cannot absorb it properly) and peptic stomach ulcers (an ulcer in your stomach lining, often caused by H. pylori infection).

Surgery affecting the stomach

If you’ve had surgery on your stomach, or to a part of your body that affects your stomach, you may be more likely to develop stomach cancer.

This can include surgery to remove part of your stomach (known as a partial gastrectomy), surgery to remove part of your vagus nerve (the nerve that carries information from your brain to organs such as your heart, lungs and digestive system), or surgery to repair a stomach ulcer.

How stomach cancer spreads

There are three ways stomach cancer can spread:

• directly – the cancer can spread from the stomach into nearby tissues and organs, such as the pancreas, colon, small intestine and peritoneum (the lining of the inside of the abdominal cavity)
• through the lymphatic system – the lymphatic system is a series of glands (nodes) located throughout your body, similar to the blood circulatory system; glands produce many specialised cells needed by your immune system to fight infection
• through the blood – which can cause the cancer to spread from the stomach to other parts of the body, most commonly the liver

Stomach cancer that spreads to another part of the body is known as metastatic stomach cancer.

If you have symptoms that could be a sign of stomach cancer, see your GP as soon as possible.

Your GP will ask about your symptoms and examine your stomach for any lumpiness or tenderness.

Tests at hospital

If your GP thinks you may have stomach cancer, they will refer you to a specialist for tests.

These may include a blood test and chest X-ray, which will assess your overall health. A sample of your stools may also be tested for blood.

Due to the potentially serious nature of stomach cancer you should be referred to the specialist within two weeks. Read more about waiting times.

The main tests used to diagnose stomach cancer are outlined below.

Endoscopy and endoscopic ultrasound

An endoscopy is a procedure where a healthcare professional examines the inside of your stomach using a device known as an endoscope, which is a long, thin flexible tube with a light and a video camera at the end.

If you need to have an endoscopy, you will not be able to eat or drink for between four to eight hours before the procedure. This is to ensure your stomach and duodenum (top of the small intestine) are empty.

You will be awake for the endoscopy, but may be given a sedative by injection to make you feel drowsy and relaxed. You may also have a local anaesthetic sprayed onto the back of your throat, so the area is numbed.

The endoscope will then be passed down your throat and into your stomach so the specialist can look for any stomach ulcers or signs of cancer. If tissue is found that may be cancerous, your specialist will take a sample of it for testing. This procedure is known as a biopsy. The sample will be examined beneath a microscope in a laboratory. The results will show whether the cells are cancerous (malignant) or non-cancerous (benign) and normally take seven to 10 days to come back.

The endoscopy itself usually takes about 15 minutes, although you should allow about two hours for your visit.

If your specialist thinks you may have cancer in the top part of your stomach, you may have an ultrasound scan at the same time as an endoscopy, known as an endoscopic ultrasound. This uses high frequency sound waves to produce an image of your stomach (this method is commonly used to view an unborn baby in the womb).

If you have an endoscopic ultrasound, an ultrasound probe will be attached to the end of the endoscope before it is passed down your throat. The scan will help to show the stage of any cancer in the top part of your stomach.

After an endoscopy, or an endoscopic ultrasound, you will not be able to drive for several hours, due to the sedative. You may also have a sore throat, although this should pass within a few days.

Barium meal X-ray

A barium meal X-ray or barium swallow uses a liquid containing a substance called barium, which makes your stomach show up on an X-ray. Nowadays, however, it’s less commonly used to diagnose stomach cancers.

Normally, organs such as your stomach do not show up on an X-ray because they are made of soft tissue that is not dense enough to stop the X-rays passing through. However, when these organs are filled with barium, it blocks the X-rays and shows up white on an X-ray screen.

If you need to have a barium meal X-ray, you will not be able to eat or drink for at least six hours before the procedure, as your stomach and duodenum need to be empty. You may be given an injection to relax the muscles in your digestive system.

You will then lie down on a couch, and your specialist will give you a white, chalky liquid to drink that contains barium. As the barium fills your stomach, your specialist will be able to see your stomach on an X-ray monitor, as well as any ulcers, or abnormal growths. Your couch may be tipped slightly during the test so the barium fills all the areas of your stomach.

A barium swallow usually takes about 15 minutes to perform. Afterwards, you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick after a barium meal X-ray, and the barium may cause constipation. Your stools may also be white for a few days afterwards as the barium passes through your system.

Further testing

If you are diagnosed with stomach cancer, further tests may be needed to help determine how far it has spread and how quickly it is likely to spread (known as the stage and grade). Your cancer specialist (oncologist) will discuss this with you.

However, it may not always be possible to identify the exact stage of your condition until your treatment starts.

Laparoscopy

Your specialist may need to examine your stomach in more detail to see if the cancer has spread, especially to the lining of the abdominal cavity (peritoneum). If it has, you may need to have a small operation called a laparoscopy.

This procedure is carried out under a general anaesthetic, so you will be asleep.

Your specialist will insert a thin viewing tube with a camera on the end (a laparoscope) into your stomach through a small cut (incision) in the lower part of your tummy. In some cases, your specialist may need to examine more than one area of your stomach and may need to make more than one incision.

Computerised tomography (CT) or positron emission tomography (PET) scan

CT scans or PET scans take a series of X-ray images of your body. A computer then puts them together, creating a detailed picture of the inside of your body.

These scans will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours anywhere else in the body. The scan helps your doctors work out which type of treatment will be most effective and appropriate for you.

Liver ultrasound scan

If your specialist thinks your stomach cancer may have spread to your liver, you may need to have a liver ultrasound. This type of scan uses high frequency sound waves to produce an image of your liver.

Staging and grading

One method of assessing stomach cancer uses a number system to measure the spread of the cancer:

Stage 1A:

• the cancer is contained within the inner lining of the stomach, and no lymph nodes are affected

Stage 1B:

• the cancer is still contained within the stomach lining, but has spread to one or two lymph nodes, or
• the lymph nodes are unaffected, but the cancer has spread into muscles that surround the inner lining

Stage 2A:

• the cancer is still contained within the stomach lining but has now spread to between three and six lymph nodes, or
• it has spread into the surrounding muscles and to one or two lymph nodes, or
• the lymph nodes are unaffected, but the cancer has now spread into the outer layer of the stomach

Stage 2B:

• the cancer is still contained inside the lining, but has now spread into seven or more lymph nodes, or
• it has spread into the muscles and also to between three and six lymph nodes, or
• it has spread into the outer layer of the stomach and also into one or two lymph nodes, or
• the lymph nodes are still unaffected, but the cancer has spread outside the stomach

Stage 3A:

• the cancer has spread into surrounding muscles and into seven or more lymph nodes, or
• the cancer has spread into the outer layer of the stomach and also to between three and six lymph nodes, or
• the cancer has spread outside of the stomach and also into one or two lymph nodes

Stage 3B:

• the cancer has spread into the outer layer of the stomach and also into seven or more lymph nodes, or
• the cancer has spread outside of the stomach and also to between three and six lymph nodes, or
• the cancer has spread further outside of the stomach into surrounding tissue and may also affect up to two lymph nodes

Stage 3C:

• the cancer has spread beyond the stomach into nearby tissues, organs and also into three or more lymph nodes

Stage 4:

• the cancer has spread to another part of the body such as the liver or lungs

The majority of stomach cancers are at stage three or four when diagnosed, meaning a cure is not usually possible.

There are three grades of stomach cancer:

• low-grade – the cancer may grow slowly
• medium-grade – the cancer may grow faster
• high-grade – the cancer is more aggressive and likely to grow more quickly

Stomach cancer, or gastric cancer, is a relatively uncommon type of cancer that affects about 7,300 people each year in the UK.

The initial symptoms of stomach cancer are vague and easy to mistake for other less serious conditions. They include:

• persistent indigestion and heartburn
• trapped wind and frequent burping
• feeling very full or bloated after meals
• persistent stomach pain

Symptoms of advanced stomach cancer can include:

• blood in your stools, or black stools
• loss of appetite
• weight loss

As the early symptoms are similar to many conditions, stomach cancer is often advanced by the time it’s diagnosed. Therefore, it’s important to get any possible symptoms of stomach cancer checked out by your GP as soon as possible.

Read more about the symptoms of stomach cancer and diagnosing stomach cancer.

Who is affected

The exact cause of stomach cancer is still unclear, although a number of factors that increase your risk of developing the condition have been identified. These include:

• being aged 55 or older
• being male
• smoking
• eating a diet that contains a lot of salted and pickled foods
• having an infection in your stomach due to a type of bacteria known as Helicobacter pylori (H. pylori)

Read more about the causes of stomach cancer.

Types of stomach cancer

There are different types of stomach cancer. 95% develop in the cells of the stomach lining and are known as adenocarcinoma of the stomach.

Less common types include lymphoma of the stomach, which develops in the lymphatic tissue (tissue that drains away fluid and helps fight infection) and gastrointestinal stromal tumours (GISTs), which develop in the muscle or connective tissue of the stomach wall.

How stomach cancer is treated

Many cases of stomach cancer cannot be completely cured, but it is still possible to relieve symptoms and improve quality of life using chemotherapy and, in some cases, radiotherapy and surgery.

Surgery to remove some or all of the stomach is known as a gastrectomy. You will still be able to eat normally after a gastrectomy, but you will probably have to adjust the size of your portions. 

Chemotherapy can also be used before surgery to help shrink the tumour and sometimes after surgery to help prevent the cancer from returning.

Read more about treating stomach cancer.

Living with stomach cancer

Living with stomach cancer and then the effects of surgery can be tough, but there are a range of services that can provide social, psychological and, in some cases, financial support.

Read more about living with stomach cancer.

Outlook

The outlook for stomach cancer depends on several things, including your age, general health and how far the cancer has spread before it’s diagnosed. Unfortunately, as stomach cancer is often not picked up until the later stages, the outlook is not as good as for some other cancers.

Overall, around 15% of people with stomach cancer will live at least five years after diagnosis and about 11% will live at least 10 years.

In the UK, around 5,000 people die from stomach cancer each year.

Stomach cancer

Recovery and follow-up

Recovery

Getting back to normal after surgery can take time. It’s important to take things slowly and give yourself time to recover. During this time, avoid lifting things (such as children or heavy shopping bags) and heavy housework. You may also be advised not to drive.

Some other treatments, particularly radiotherapy and chemotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Do not be afraid to ask for practical help from family and friends.

Follow-up

After your treatment has finished, you will be invited for regular check-ups, usually every three months for the first year. During the check-up, your doctor will examine you and may arrange blood tests or scans to see how you are responding to treatment.

Diet after surgery

If you have had an operation to remove part of your stomach (partial gastrectomy), you will only be able to eat small amounts of food for a while after your operation. This is because your stomach will not be able to hold as much food as it could before the surgery, and your body will need to adjust to its new stomach capacity. You should gradually be able to increase the amount you eat as your stomach begins to expand.

If you have surgery to remove all of your stomach (total gastrectomy), it may be quite some time before you can eat normally again. As with a partial gastrectomy, you will only be able to eat small amounts of food until your body adjusts. You may have to eat little and often, and make changes to the types of food you eat. Your care team will be able to advise you about what and when you should eat.

Having surgery to remove your stomach also means you will need to have regular injections of vitamin B12. This is normally absorbed through your stomach from the food you eat and is needed to help prevent a condition called anaemia and nerve problems.

Read more about recovering from a gastrectomy.

Relationships with others

It’s not always easy to talk about cancer, either for you or your family and friends. You may sense that some people feel awkward around you or avoid you. Being open about how you feel and what your family and friends can do to help may put them at ease. Do not feel shy about telling them you need some time to yourself if that is what you need.

Money and financial support

If you have to stop work or cut down your hours because of your illness, you may find it hard to cope financially. If you have cancer, or you are caring for someone with cancer, you may be entitled to one of the following areas of financial support:

• If you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer.
• If you don’t have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance.
• If you are caring for someone with cancer, you may be entitled to Carer’s Allowance.
• You may be eligible for other benefits if you have children living at home or if you have a low household income.

Find out as early as possible what help is available to you. Speak to the social worker at your hospital, who can give you the information you need.

Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate, giving them free prescriptions for all medication, including medicine for unrelated conditions.

The certificate is valid for five years, and you can apply for it through your GP or cancer specialist.

Want to know more?

• Care and Support: benefits for carers and benefits for the person you care for
• GOV.UK: benefits
• Citizens Advice Bureau
• Free prescriptions Q&A
• Money Advice Service

Talk to others

If you have any questions, your GP or nurse can answer these and reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information on these. Some find it helpful to talk to other people who have stomach cancer, either at a local support group or in an internet chatroom.

Caring for someone with stomach cancer

Being a carer is not easy. When you are busy responding to the needs of others, it can lessen your emotional and physical energy and make it easy for you to forget your own health and mental wellbeing. Research on carers’ health shows that lots of carers suffer through their caring role. If you are also trying to combine caring with a paid job or looking after a family, this can cause even more stress.

Putting yourself last on the list does not work over the long term. If you are caring for someone else, it’s important to look after yourself and get as much help as possible. It’s in your best interests and those of the person you are caring for.

Look after your health

Eat regularly and healthily. You may not have time to sit down for every meal, but you should make time to do so for at least one a day. Instead of relying on fast food or snacks, go for healthier options, such as fruit.

Look after your emotional health

It’s understandable if there are times when you feel resentful, and then guilty for feeling so. You may also feel exhausted, isolated and worry greatly about the person you care for. Remember you are human, and those feelings are natural.

Look for support

Friends and family may not always understand what you’re going through, and it can help to talk to people in the same situation. Carers Direct has a lot of useful information on its website and runs a helpline, which can be reached on 0300 123 1053.

Find out what benefits you’re entitled to

If you are caring for someone with cancer, you may be entitled to Carer’s Allowance.

Other people to contact:

• your GP and primary care team
• social services    

Dealing with dying

If your stomach cancer can’t be cured, your GP will give you support and any necessary pain relief (often alongside chemotherapy or radiotherapy, which can be used to reduce your symptoms). This is called palliative care.

Support is also available for your family and friends.

The list below is a combination of the and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides) where you can find detailed information about the medicine. The information is provided as part of an on-going medicine information project between NHS Direct, Datapharm Communications Ltd and other organisations.

The medicines listed below hold a UK licence to allow their use in the treatment of this condition. medicines are not included.

The list is continually reviewed and updated but it may not be complete as the project is still in progress and guides for new medicines may still be in development.

If you are taking one of these medicines for a different condition, or your medicine for this condition is not mentioned here at all, speak to your prescriber, GP or pharmacist, or contact NHS Direct on 0845 46 47.

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: upper gastrointestinal (GI) cancer

Many symptoms of stomach cancer are similar to less serious conditions, so it can be difficult to recognise in the early stages.

Early stage symptoms include:

• persistent indigestion
• trapped wind and frequent burping
• heartburn
• feeling full very quickly when eating
• feeling bloated after eating
• feeling sick
• pain in your stomach or breastbone (sternum)
• difficulty swallowing (dysphagia)
• vomiting (which may be streaked with blood), although this is uncommon in the early stages

Advanced stomach cancer

Symptoms of more advanced stomach cancer include:

• blood in your stools, or black stools
• loss of appetite
• weight loss
• tiredness
• lumpiness and swelling in your stomach (caused by a build-up of fluid)
• anaemia (a reduction in red blood cells that can cause you to feel tired and out of breath)
• yellowing of your skin and the whites of your eyes (jaundice)

When to seek medical help

Stomach cancer is usually easier to treat if it’s diagnosed early, so you should see your GP as soon as possible if you notice any of the above symptoms.

Treatments used for stomach cancer depend on how far the cancer has spread and your general health.

Most hospitals use multidisciplinary teams containing different specialists to plan and carry out the best treatment, tailored to your circumstances.

Feel free to discuss treatment with your care team at any time and ask any questions.

Your treatment plan

The main treatments for stomach cancer are surgery, chemotherapy and radiotherapy. You may have one of these treatments or a combination, depending on your individual circumstances.

Surgery is mainly used if stomach cancer is diagnosed at an early stage, whereas chemotherapy and radiotherapy tend to be used when the condition is diagnosed at a later stage.

The primary aim of treatment, where possible, is to completely remove the tumour and any other cancerous cells in your body. It’s estimated that a cure is possible in 20-30% of stomach cancer cases.

If this is not possible, your doctors will focus on trying to prevent your tumour from getting any bigger and causing any further harm to your body. This may be done using surgery or chemotherapy. 

In some cases, it’s not possible to eliminate the cancer or slow it down. In this case, your treatment will aim to relieve your symptoms and make you as comfortable as possible, usually with surgery or radiotherapy.

A relatively new medication called trastuzumab can also be used to treat some types of advanced stomach cancer.

Your healthcare team will talk to you about which treatments are most suitable.

Surgery

If you are diagnosed with stomach cancer at an early stage, it may be possible for the cancer to be completely removed during surgery.

In some cases, this may involve passing a thin, flexible tube (endoscope) down your oesophagus, rather than incisions in your tummy. This is known as endoscopic surgery, and can be used to remove a sample of the tumour for testing (biopsy). It can also be used to remove the tumour completely if stomach cancer is diagnosed at an early stage.

However, if your cancer has spread beyond your stomach, it may not be possible to remove it completely during surgery. If this is the case, you may still have surgery to remove any cancer blocking your stomach, to ease your symptoms. This will depend on whether your symptoms can be controlled and the risks and side effects of undertaking a major surgical procedure.

Any kind of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, you will usually stay in hospital for around two weeks. You will also need several weeks at home to recover.

Surgery to remove stomach cancer

If you have surgery to remove the cancer in your stomach, you will probably need to have part or all of your stomach removed.

Surgery to remove part of your stomach is known as a partial gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may also remove part of your oesophagus (gullet), as well as the whole of your stomach, which is known as an oesophagogastrectomy.

These operations may be carried out using either a large incision in your tummy (known as “open surgery”), or a number of smaller incisions through which surgical tools can be passed (known as “laparoscopic” or “keyhole” surgery). Both these techniques are carried out under general anaesthetic, which means you will be asleep through the procedure.

During these operations, your surgeon will also remove the lymph nodes (small, oval glands that remove unwanted bacteria and particles from the body) nearest to the cancer. It’s possible that your stomach cancer may have spread to these lymph nodes, and removing them helps to prevent the cancer from coming back.

Partial gastrectomy

If your cancer is in the lower part of your stomach, you may have a partial gastrectomy to remove this.

After the operation, your stomach will be smaller than it was before surgery. However, the operation will not affect the top part of your stomach, where your oesophagus (gullet) feeds into it.

Total gastrectomy or oesophagogastrectomy

If your cancer is in the middle or at the top of your stomach, you may need to have a total gastrectomy to remove the whole of your stomach. If the cancer is close to the end of your oesophagus (gullet), where it meets your stomach, you may need to have an oesophagogastrectomy to remove part of your gullet.

If you have a total gastrectomy, your stomach will be removed, and the end of your gullet will be joined to the top of your duodenum (the top part of your small intestine). If you have an oesophagogastrectomy, your stomach and the end of your gullet will be removed, and the remaining part of your gullet will be joined to your duodenum.

For more information about life after a gastrectomy, see living with stomach cancer or recovering from a gastrectomy.

Surgery to ease your symptoms

If your stomach cancer has spread beyond your stomach, it may not be possible to remove it through surgery.

However, if you have a large amount of cancer in your stomach, it can cause a blockage, which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting and feeling very full after eating.

If you have a blocked stomach, there are a few options: 

• stenting – a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic; after insertion, it will expand and open up the stomach 
• partial or total gastrectomy – to remove the blockage and improve your symptoms
• bypass surgery – an operation where part of your stomach above the blockage is joined to your small intestine, leaving the blocked part of your stomach out of your digestive system; this allows food to move through the unblocked part of your stomach and into your intestines, without coming into contact with the blockage

Chemotherapy

Chemotherapy is a specialist treatment for cancer that uses medicines, called cytotoxic medicines, to stop cancer cells dividing and multiplying. As it circulates through your body, the medicine can target cancer cells in your stomach and any that may have spread to other parts of your body.

You may have chemotherapy for stomach cancer before surgery, as this will reduce the amount of cancer that has to be removed in your operation. You may also have chemotherapy after surgery to destroy any remaining cancer cells and prevent the cancer from coming back.

Chemotherapy can also be used to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery.

You may need chemotherapy. If you do, it may be given as tablets or intravenously (by injection or a drip through a vein directly into your bloodstream), or a combination of both.

Intravenous chemotherapy is usually given in hospital, while oral chemotherapy is taken at home.

Chemotherapy is often given in cycles, each usually lasting about three weeks.

Alternatively, chemotherapy may be administered through a small pump, which gives you a constant low dose over a few weeks or months. The pumps are portable and can be worn at home, which means fewer trips to hospital.

Side effects of chemotherapy

Chemotherapy works by preventing cells, including cancerous ones, from growing rapidly. However, there are other cells that occur naturally in your body that also divide and multiply rapidly, including hair follicles and red and white blood cells.

Chemotherapy destroys these non-cancerous cells, which can cause different side effects, including:

• tiredness
• feeling sick (nausea) and vomiting
• nerve damage (peripheral neuropathy)
• hair loss
• diarrhoea
• anaemia (a lack of red blood cells)
• weight loss
• skin changes – such as redness, swelling and a tingling sensation in the palms of the hands and/or soles of the feet

Your side effects to chemotherapy will depend on the type you are given, the number of treatment sessions you need to have and your individual reaction to the treatment. You will be told who to contact if you are experiencing serious side effects from chemotherapy, and it is very important that this contact information is recorded carefully.

If you experience nausea and vomiting as a result of chemotherapy, you may be able to take anti-sickness medication to counter it. This may be given intravenously (by injection directly into your bloodstream) at the same time as your chemotherapy.

The side effects of chemotherapy will only last for as long as your course of treatment lasts. Once your treatment is over, the rapidly growing cells that occur naturally in your body will repair themselves. This means your hair will grow back, although it might look or feel different from how it did before chemotherapy (for example, it may be a slightly different colour, or be softer or curlier than before).

Radiotherapy

Radiotherapy uses beams of high energy radiation to destroy cancer cells. It is not often used to treat stomach cancer because there is a risk that other organs close to your stomach might be damaged by the treatment.

However, if it’s advanced and causing bleeding or pain, you may need to have radiotherapy.

In some cases, following surgery, you may have chemotherapy and/or radiotherapy, to help prevent the stomach cancer from recurring.

If you need radiotherapy, your treatment will usually begin two or three months after your surgery or chemotherapy, to give your body a chance to recover. This is a painless procedure in which you lie under a radiotherapy machine while it directs radiation at your stomach. You will be positioned by your radiographer (a specialist in radiotherapy) so that the machine targets the cancer cells and avoids as much of your healthy tissue as possible.

Radiotherapy often involves treatment sessions five days a week. Each session will only last a few minutes. The radiation does not stay in your system afterwards, and it is perfectly safe to be around others between your treatments.

How long you will have radiotherapy for will depend on how it’s used. Radiotherapy used after surgery to help prevent stomach cancer coming back usually lasts five weeks. If is being used to control symptoms of advanced stomach cancer, it may only last one or two weeks.

Side effects of radiotherapy

If you have radiotherapy, you may experience the following side effects:

• tiredness
• nausea
• diarrhoea
• irritation and darkening of your skin where the treatment takes place

These side effects will usually improve within a few weeks of treatment finishing.

Trastuzumab

Trastuzumab (sold under the brand name Herceptin) is a medication first used to treat breast cancer and is also useful in treating some cases of advanced stomach cancers.

Some stomach cancers are stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2). Trastuzumab works by blocking the effects of this protein.

This does not cure stomach cancer, but can slow its growth and increase survival time.

If you are diagnosed with advanced stomach cancer and testing shows you have high levels of the HER2 protein in the cancerous cells, your doctors may recommend treatment with a combination of chemotherapy and trastuzumab.

Trastuzumab is given intravenously, through a drip, and you will have the treatment in hospital.

Each treatment session takes up to one hour, and you will usually need a session once every three weeks.

Trastuzumab can cause side effects, including heart problems. This means it may not be suitable if you have a heart problem, such as angina, uncontrolled high blood pressure (hypertension), or heart valve disease. If you need to take trastuzumab, you will need regular tests on your heart to check for any problems.

Other side effects of trastuzumab may include:

• an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever
• diarrhoea
• tiredness
• aches and pains

Read more about trastuzumab.