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Stomach Cancer

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This page has information about:

  • The tests we do to see if you have Stomach Cancer
  • The different ways that we treat the disease
  • The support that is on offer

Who we are

The stomach is a bag-like organ in the upper tummy connected to the gullet and the small bowel.

Each year approximately 9000 people are diagnosed with stomach cancer in the UK. Our team of cancer experts provide excellent, compassionate and timely care using the latest techniques.

What we do

If you visit us for investigation, diagnosis and possible treatment you can expect

  • Support - every step of the way - Every patient benefits from the support of our clinical nurse specialists. The nurses stay with you throughout the treatment journey - from your first clinic appointment to aftercare.
  • Cancer experts - Dr Harold Smart and Dr Sanchoy Sarkar are regional experts in the management of stomach cancer.
  • Specialist techniques - We train health professionals to use endoscopes to investigate stomach cancer. We perform over 14,000 endoscopic procedures a year. We also use the latest technology to diagnose pre-cancerous changes and early cancers of the gullet.
  • Access to the latest treatments - Our clinical trials programme makes new treatments available to patients – often giving them a better outcome. We aim to have a trial option open to patients at each step of the treatment path.
  • Commitment to research - As a university hospital, we lead research into oesophageal cancer diagnosis, treatment and prevention. We regularly publish research papers that help in the fight against cancer.
  • Collaborative working - We work closely with the Liverpool Heart and Chest Hospital and the Clatterbridge Cancer Centre. This means that our patients benefit from the combined expertise of leading hospitals in the region.

For some, stomach cancer is caused by an extended infection of the stomach by a bacterium called Helicobacter Pylori. However, for the vast majority, the exact cause remains unknown. Fresh fruit and vegetables seem to be protective and high salt intake, pickled foods and smoking seems to increase the risk.

  • Stomach cancer symptoms
  • indigestion which is new or gets worse; indigestion that does not get better with initial treatment
  • loss of appetite
  • feeling full very quickly after eating
  • weight-loss
  • feeling sick or vomiting
  • vomiting and bringing up fresh blood (or blood that looks like ground coffee)
  • excessive heartburn
  • a feeling of food getting stuck in the lower chest
  • passing black stools (while not taking any iron tablets)
  • anaemia

These symptoms are very common; a vast majority of people with these symptoms do not have cancer.

Being referred to us

Your GP or hospital consultant will arrange a gastroscopy test if you have stomach cancer symptoms. A fine tube with a camera on the end is passed through the mouth and into the stomach. The inside of gullet and stomach can be seen on a screen. The procedure takes a few minutes and is performed by a doctor or a specialist nurse. You won’t need to stay overnight.

What happens when you see us

: small pieces of tissue (biopsy) are taken from any abnormal areas seen in the stomach during the gastroscopy. Biopsies are then examined under the microscope by a tissue expert (pathologist). A biopsy is the only way to 100% confirm a diagnosis of cancer.

CT scan: a CT scanner takes lots of x-rays of the affected area. A computer then puts the x-rays together to make a 3D image of the body’s tissues and organs. This helps the doctor find out about the extent (spread) of cancer if diagnosed. It’s done within 7-10 days of your first clinic appointment - by which time the biopsy result is also available.

PET-CT scan: PET-CT scans produce 3D colour images that show how the tissues inside your body work - we are the only hospital in Merseyside and Cheshire to have a permanent PET-CT scanner for patients.

Endoscopic ultrasound (EUS): endoscopic ultrasound is where a long, thin, flexible tube (endoscope) is inserted into your body to examine areas such as your stomach, food pipe (oesophagus) and small bowel (duodenum).

You’ll see a specialist nurse immediately after the gastroscopy if cancer is suspected. The specialist nurse has lots of knowledge and experience of patients with stomach cancers. The nurse is your key-worker and will stay in close contact throughout your treatment.

You’ll be contacted by telephone and will also meet the nurse in the clinic. This will give you a chance to be updated about the progress of your cancer investigations and also ask questions. The nurse will also speak to your family members, but no specific information about your treatment will be given out without your consent. Your key-worker might change depending on the type of treatment you receive.

Your key worker will also ask the district nursing team to see you for support in the community. The district nurses liaise closely with your GP and can also call on the community Macmillan nurses for advice if required.

These can take seven to ten days. You’ll be seen in the gastroenterology clinic by the specialist nurse once the results of your biopsy and CT scan are available. The results are explained and your questions answered. Your symptoms will also be addressed.

The MDT is a group of cancer experts who meet every Wednesday to discuss the most appropriate treatment options for you.

The results of your tests are reviewed and the most appropriate treatment option for you is discussed. The final decision is made after discussion with you, usually at your next clinic visit.

What happens next

Further tests

If the cancer has not spread beyond your stomach on the CT scan – and you’re fit enough to have an operation – you’ll get further tests. This is to rule out any cancer spread that’s not been picked-up by CT scan.

A repeat gastroscopy: this may be necessary to reassess the cancer.

A laparoscopy: this looks for cancer spread inside tummy not picked up CT scan. It is an inspection of the internal organs of the stomach using instruments through keyholes sized incisions (cuts) in the stomach. Biopsy may be taken at this examination.

Patients who require these tests are discussed again at the MDT. Patients undergoing an operation will need further tests to have their heart and lungs assessed prior to operation. All of the tests are usually completed within four weeks from when the cancer was first suspected.

Stomach Cancer treatment

Planning your treatment

Your test results are discussed by the multi-disciplinary team (MDT). This is a team of doctors and health professionals who specialise in different aspects of treating stomach cancer.

The MDT gives advice on treatment options that would benefit you the most. Of course, you have the final decision about the type of treatment you receive. Your treatment options depend on

  • the exact location of cancer
  • the size and extent of cancer
  • your background health.

It will then be decided with you on the best course of action, which may include:

Surgery: depending on the location and size of stomach cancer, surgery will involve:

  • Total gastrectomy: removal of whole of your stomach; the small bowel is joined to the gullet (wind pipe).
  • Partial gastrectomy: removal of part of the stomach; the remaining stomach is joined to the small bowel.
  • You will be referred to Liverpool Heart and Chest Hospital (at Broadgreen Hospital) for a clinic appointment with a surgeon. The surgery will be carried out in Liverpool Heart and Chest Hospital.
  • These are major operations and patients are usually in hospital for a couple of weeks. You may be in the intensive care unit for some time after surgery.

Most patients receive chemotherapy before and after surgery - to make the cancer smaller and reduce the chance of cancer recurrence after surgery.

Chemotherapy - Chemotherapy is an option if your cancer can’t be removed by surgery, or if you’re not fit enough for an operation. It kills or slows cancer growth. Chemotherapy is given in the form of injections or tablets by a cancer specialist (oncologist) at the Clatterbridge Cancer Centre

Chemotherapy treatment is quite intense and has side-effects which will all be explained to you before you start treatment.

Radiotherapy (x-ray treatment) - This is used occasionally to help control symptoms (for example the pain caused by cancer in the bones). This involves shrinking the cancer with x-ray radiation. The treatment is painless and you may need a few sessions. Radiotherapy is performed at the Clatterbridge Cancer Centre under the supervision of an oncologist.

Trial treatments - Clinical trials give patients the chance to test new treatments. You may be offered the chance to take part if a trial is open. Find out more about clinical trials.

Stents - Stents are expanding metal meshwork that can be placed into narrowed areas to keep them open. This is important for stomach cancer where cancer growth may cause blockages that stop you swallowing or your stomach from emptying. Stent insertion is usually done as day case.

If stent placement is not possible, a small operation to bypass the blockage may be needed. This can usually be done via keyhole surgery.

Palliative care - For some patients, the cancer has usually spread and is beyond cure at the time of diagnosis. Some patients are also not fit for intense surgical or chemotherapy treatments due to their background health.

If this is the case, you’ll be offered palliative care. It involves the control of symptoms and improving the general sense of well-being. Because of this, it’s essential that you’re honest about any symptom or problem that is troubling you.

We have an excellent palliative care team at the hospital and many support services to help with your social and psychological needs.

The team

Members of the MDT include:

  • a clinical nurse specialist (your key worker)
  • consultant gastroenterologists
  • a gullet surgeon
  • an x-ray specialist (radiologist)
  • a gastrointestinal pathologist
  • a cancer specialist (oncologist)
  • a palliative care expert

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