By A/Prof Jimmy So, Senior Consultant, Department of Surgery, National University Hospital
Overview
Stomach is a part of digestive system, which located in the upper abdomen. It connects the esophagus (gullet) with the small intestine. It acts as a food reservoir and it mixes the food ingested and helps in digestion by its secretions. Stomach cancer (Gastric Cancer) is a common cancer especially in some countries in Asia. In Singapore, gastric cancer is the 3rd most common cancer for men and 5th for women. The cause of it is unknown. High salt diet, lack of Vitamin C and a bacterium named Helicobactor Pylori are well-known risk factors for gastric cancer.
Symptoms
Stomach cancer may have the following symptoms:
- Indigestion or Discomfort at upper abdomen
- Bloated feeling after eating
- Difficulty in swallowing
- Losing appetite
- Losing weight
- Black stools
- Tiredness due to anemia
Indigestion or discomfort at upper abdomen is the most common symptom. Occasionally, stomach cancer can have no symptoms especially when the tumor is at early stage. It makes the cancer difficulty to be found early.
Diagnosis
Patients with symptoms of stomach cancer should go to see a doctor. Other diseases such as peptic ulcer or gallstones may cause the above symptoms as well. Only a doctor can tell the diagnosis. The doctor may refer you to see a specialist after taking a history and doing a physical examination for you. The initial tests to diagnose a gastric cancer is either an endoscopy or barium x-rays of the gastrointestinal tract.
In endoscopy, it allows the doctor to look directly at the stomach through a thin flexible tube called an endoscope. The endoscope has a tiny camera at the end. If necessary, the doctor can take a small sample of the tissue (a biopsy) to be examined under a microscope.
For barium x-rays test, you will swallow a liquid containing barium. X ray pictures will be taken when the barium flows down the stomach. The pictures will reveal the structure of the stomach. The test will take about 15 minutes and it is not painful.
If a cancer is found, the next step is to find out whether the tumor has spread to other organs. The tests required may include chest x-rays, ultrasound scan, CT Scan (CAT Scan), endoscopic ultrasound and laparoscopy.
Treatment
Stomach cancer can be treated by surgery, radiotherapy or chemotherapy. The treatments can be used alone or in combination. The choice of treatment will depend on the stage (or extent) of the cancer, the type of cancer, its position, as well as your age and general health.
Surgery
Surgery is the most important treatment for stomach cancer especially when the tumor is confined to the stomach. Surgery can cure the cancer if the cancer is in an early stage. It can be used as the only treatment or in combination with chemotherapy or radiotherapy. It is a major operation. Before surgery, make sure that you have discussed it fully with your doctor.
The surgery is called gastrectomy. When only part of the stomach is removed, it is called partial gastrectomy. The remaining part of stomach is connected to the intestine. Occasionally, entire stomach needs to be removed. It is called total gastrectomy. In this case, the intestine is reconnected directly to the esophagus (gullet). During surgery, it is often that the lymph glands (nodes) close to the stomach are removed at the same time.
Sometimes the cancer may block the passage of food from the stomach to the bowel. If the cancer is too bulky to be removed, the surgeon may make a connection between the stomach and the small intestine to bypass the blockage. It will relieve the symptoms but cannot cure the cancer.
After Surgery
At first, you may be given no fluids or drink or only sips of liquid for a few days. This period allows the internal wound to be healed properly. Drips will be attached to your body to provide you with the fluid you required. Occasionally, a feeding tube will be inserted into the intestine to allow more calories to be given to you. There will be tubes and drains attached to the patients after gastric surgery. A nasogastric tube, which passes down from the nose to your stomach is commonly placed. It removes the excess fluid in the stomach.
You will be encouraged to start moving about as soon as possible. Leg movements and deep breathing exercise are important for your recovery. You will be seen by a physiotherapist who can advice you on the exercise.
Chemotherapy
Chemotherapy with cancer-killing drugs is another option for treatment of gastric cancer. Chemotherapy can be given alone or combined with radiotherapy before or after surgery. It can also be used if the patient is not suitable for surgery.
Chemotherapy is usually delivered to your body via a drip. It required multiple sessions. It can sometimes cause unpleasant side effects, but these can usually be well controlled with medicine. Our oncologists will discuss with you in details.
Radiotherapy
Radiotherapy kills the cancer cells by high-energy rays. It is commonly given after surgery, together with chemotherapy. It can be used alone. Radiotherapy is usually given externally, using high-powered x-rays machine.
The treatment is commonly given as outpatient session at the radiotherapy department. It needs carefully planning and it will take multiple sessions. Radiation Oncologists will discuss with you in details regarding the treatment and its possible side effects.
Diet and Nutrition
Nutrition is essential to you. Before any treatment, a good nutrition speeds up the recovery. You may be referred to see our dieticians for advice on diet. You may have difficulty in swallowing solid foods. Hence, a liquid diet may be necessary. Sometimes, a feeding tube may be required to deliver more nutrition to you before or during the treatment.
Possible Side-Effects after Surgery
After surgery, you may eat what you like as soon as the doctor says you may start eating again. You will have lost some weight after surgery. It is important to return to a balanced diet, or use high dietary supplements, as soon as possible to help to regain some weight. However, there will be changes in your dietary intake. It may take a few months for your body to adjust after the stomach surgery. Below are the possible dietary problems:
1.Loss of appetite
You may feel full quickly at meals. It is because the stomach is either smaller or absent to hold as much food as before. It is important to have several small meals and snacks during the days, rather than a few larger meals. It can be helpful to talk to dieticians for advice and information about possible changes to your diet.
2.Dumping syndrome
Another possible effects after surgery is called Dumping Syndrome. It is caused by rapid emptying of food into your stomach, which leads to a drop in blood sugar and blood pressure. You may feel weak or dizzy, or you may sweat and look pale. It usually happens after meals.
To avoid this problem, small frequent meals which contains high protein or starch (such as rice, potatoes, pasta etc.) may be helpful. Food contains high sugar should be avoided.
If you have this problem, you should let your doctor know. Usually, dumping syndrome will resolve after a while.
Our Approach and Expertise
Our approach is always multidisciplinary. Our team include surgeons, gastroenterologists, oncologists, radiotherapists and paramedical personnel's such as dieticians. At the National University Cancer Institutite, Singapore, we have an Upper GI Multi-disciplinary Tumor Clinic. It is a one-stop clinic, where patients will be seen by physicians and surgeons at one visit.
All information is intended for educational purposes only andshould not be used as a substitute for consultation with your doctor
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