|Q.What are the risks of cancer surgery?
A. As with any surgery, cancer surgery does carry risks. What side effects you might experience after cancer surgery will depend on your specific surgery. In general, most cancer operations carry a risk of:
Pain. Pain is a common side effect of most operations. Some cause more pain than others do. Your health care team will tell you how to keep your pain to a minimum and will provide medications to reduce or eliminate the pain.
Infection. The site of your surgery can become infected. Your health care team will show you how to care for your wound after surgery. Follow this routine closely to avoid infection, which can lengthen your recovery time after surgery. Doctors treat infections most often with antibiotics.
Loss of organ function. In order to remove your cancer, the surgeon may need to remove an entire organ. For example, a kidney may need to be removed (nephrectomy) if you have kidney cancer.
For some such operations, the remaining organ can function sufficiently to compensate for the loss, but in other situations you may be left with impairments. For instance, removal of a lung (pneumonectomy) may cause difficulty breathing.
Bleeding. All operations carry a risk of bleeding. Your surgeon will try to minimize this risk.
Blood clots. While you're recovering from surgery, you're at an increased risk of developing a blood clot. Though the risk is small, this complication can be serious.
Blood clots most commonly occur in the legs and may cause some swelling and pain.
A blood clot that breaks off and travels to a lung is called a pulmonary embolism, a dangerous and sometimes deadly condition.
Your surgeon will take precautions to prevent blood clots from developing, such as getting you up and out of bed as soon as possible after your operation or prescribing a blood-thinning medication to reduce the risk of a clot.
Altered bowel and bladder function. Immediately after your surgery, you may experience difficulty having a bowel movement or emptying your bladder. This typically resolves in a few days, depending on your specific operation.
Whatever cancer treatment your doctor recommends, you're likely to feel some anxiety about your condition and the treatment process. Knowing what to expect can help. Use this information to help you ask informed questions when you meet with your doctor.
Q. What is stomach cancer?
A. The stomach is a sack-like organ located just under the diaphragm (muscle under the lungs). Stomach cancer, also called gastric cancer, is the name for cancer that begins in the stomach, generally the stomach lining. This type of cancer can eventually spread to lymph nodes and organs such as the liver, pancreas, colon, lungs and ovaries. People occasionally confuse the stomach organ with the abdominal area, saying they have a "stomach ache" when really the pain could be occurring in the appendix, small intestine, colon (large intestine) or gall bladder, along with the actual stomach. The stomach can be divided into five sections, and the location of the cancer in the stomach can affect things like symptoms, prognosis and treatment options.
Q. What are the causes and risk factors for stomach cancer?
A. Risk factors are conditions that increase a person's chance of getting a type of cancer. Risk factors are different for various types of cancer. Doctors have determined a number of risk factors for stomach cancer:
Aging – There is a sharp increase in stomach cancer after 50. Most people diagnosed with stomach cancer are in the 60-70 age range.
Being male – Stomach cancer is about two times more common in men than in women.
Diet – Foods that are smoked, salted fish and meat, pickled vegetables, and foods that are at the same time high in starch and low in fiber have been identified as possible risk factors. Scientists believe that the dramatic decline in stomach cancer incidence in the United States from the 1930s may be due to the increased use of refrigeration for food storage, which replaced salting or smoking food for storage.
Tobacco and alcohol abuse – Increases the risk of cancers in the upper portion of the stomach, which can be difficult to treat successfully.
Previous stomach surgery – After surgery, more nitrite-producing bacteria are present in the stomach. Nitrites can be converted by other bacteria into compounds that have been found to cause stomach cancer in animals.
Family history of stomach cancer – Several close blood relatives who have or had stomach cancer increases a person's risk.
Helicobacter pylori infection – An infection that, if long-term, can lead to chronic atrophic gastritis, which is inflammation of the stomach's inner layer. Chronic atrophic gastritis is a possible precancerous change to the lining of the stomach.
Also, risk may be increased, to varying degrees, for people with pernicious anemia, achlorhydria, Menetrier's disease, familial cancer syndromes, stomach polyps and blood group A.
Q. What are the symptoms for stomach cancer?
A. These symptoms might be caused by stomach cancer:
- Indigestion or a burning sensation (heartburn)
- Discomfort or pain in the abdomen
- Nausea and vomiting
- Diarrhea or constipation
- Bloating of the stomach after meals
- Loss of appetite
- Weakness and fatigue
- Bleeding (vomiting blood or having blood in the stool)
- However, many of these symptoms are more often caused by other medical conditions. It is important to consult a physician to find out what is causing symptoms.
Q. How will my doctor know if I have stomach cancer?
A. There are some commonly used procedures to detect stomach cancer once it has been determined that risk factors or symptoms are present. To diagnose stomach cancer, a physician will conduct a complete medical history, a physical examination and laboratory studies that may include a fecal occult blood test or a complete blood count (CBC). For a fecal occult blood test, a stool sample is examined for hidden (occult) blood, since stomach cancer can sometimes cause bleeding that cannot be seen. However, other conditions can cause bleeding, so having blood in the stool does not necessarily mean a person has stomach cancer. A doctor may perform a CBC to determine if a patient has anemia, which is a risk factor for stomach cancer. A physician may also use the following procedures to detect stomach cancer:
Upper endoscopy – After sedating the patient, the doctor puts a lighted tube (endoscope) down the patient's throat to view the lining of the esophagus, stomach and first part of the small intestine. The doctor can also use this instrument to take a biopsy, or tissue sample. A biopsy is the only sure way to determine if tissue is cancerous.
Barium upper GI radiographs – With this test, patients drink a barium-containing solution that coats the esophagus, stomach, and part of the small intestine. The barium helps doctors spot abnormalities in the x-rays they take of the area. After the barium solution is taken, air is pumped into the stomach to make small tumors easier to see.
Q. What about treatment? What should I ask?
A. Three kinds of treatment are used to treat stomach cancer:
Surgery – taking out the cancer in an operation
Radiation therapy – using high-dose x-rays or other high-energy rays to kill cancer cells
Chemotherapy – using drugs to kill cancer cells
Surgery is the primary treatment for gastrointestinal cancer. Total gastrectomy, or removal of the entire stomach, is the most common treatment. However, sub-total – or removal of most, but not all, of the stomach – is also performed, depending on the location of the tumor. Surrounding lymph nodes are also removed during surgery. The gastrointestinal tract is then reconstructed to restore continuity.
Chemotherapy and radiation therapy are used after surgery to minimize the risk of recurrence.
Q. What are the side effects of treatment?
A. The side effects of cancer treatment vary, depending on the type of treatment. Also, each patient reacts differently. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects.
Gastrectomy (the removal of part or all of the stomach; the most effective treatment for stomach cancer) is major surgery, and patients will probably have to make temporary or permanent dietary changes. Those who have total gastrectomies can no longer absorb vitamin B12, which is necessary for healthy blood and nerves. These patients receive regular injections of B12. Some patients experience the dumping syndrome, when food and liquid enter the small intestine too quickly, causing cramps, nausea, diarrhea and dizziness shortly after eating. Foods containing high amounts of sugar often make this symptom worse. The symptoms usually disappear in 3 to 12 months, but they may be permanent.
Because chemotherapy drugs enter the bloodstream, they are able to reach all parts of the body, making this treatment useful for cancer that has metastasized, or spread, to organs beyond the stomach. Unfortunately, along with killing cancer cells, chemotherapy drugs also damage normal cells. This can lead to temporary side effects such as nausea and vomiting, loss of appetite, loss of hair, diarrhea, mouth sores, low blood count, increased chance of infection, bleeding or bruising after minor cuts/injuries, fatigue and shortness of breath.
Side effects to radiation therapy can include nausea, vomiting and diarrhea. The skin in the treated area may become red, dry, tender and itchy. Patients should not use lotions or creams to relieve symptoms without a doctor's advice.
Side effects for biological therapy vary depending on treatment, but can include flu-like symptoms (chills, fever, weakness, nausea, vomiting, diarrhea), a rash, bruising or bleeding. Patients may need to stay in the hospital while receiving some kinds of biological therapy. There are remedies for many of the side effects treatment and therapy can cause, and it is important for patients to communicate their side effects to their doctor and/or nurse.
Q. Will I be able to adjust to this disease well?
A. Each cancer survivor's recovery is different, and a person's adjustment after cancer treatment depends on a number of factors.
Since the stomach is an important organ for helping the body absorb vitamins, if a person undergoes gastrectomy, doctors routinely prescribe vitamin supplements, some of which must be taken by injection. Patients often have to change their diet after a partial or total gastrectomy. Doctors usually recommend smaller, more frequent meals.
It is important for people to seek support during and after cancer treatment. Taking advantage of a social support system, such as a cancer support group, helps patients by providing a forum of information and experiences. Maintain an open dialogue with your cancer care team to address any concerns you have.
Q. Are there clinical trials available for stomach cancer?
A. Yes, clinical trials are available for stomach cancer. Patients may consider clinical trials as a means of treatment. Clinical trials are studies of promising new or experimental treatments and are performed on patients. Clinical trials are performed only when the treatment being studied is likely to be of value to the patient. Participating in a clinical trial is up to the patient. Doctors and nurses will explain the study and its risks in detail and give the patient a form to read and sign, which is known as informed consent. Even after giving informed consent and beginning a clinical trial, a patient may leave the study at any time. Click here for more information on clinical trials.