Stomach cancer surgery

Therapy plan

The quality of diagnostic examinations such as gastroscopy (esophago-gastroscopy), histological and immunohistochemical examination of the tumor tissue, endosonography, computed tomography (CT) and positron emission tomography (PET) is not the only decisive factor in the successful treatment of gastric cancer.

The results must be discussed for each individual patient at a regular interdisciplinary meeting (tumor board). With the involvement of experts from various disciplines, a joint decision is then made and the individual treatment plan is determined. It is known that the best results in the treatment of gastric cancer are achieved in large esophageal centers with a high number of patients.

The University Hospital Zurich is the largest of these centers in Switzerland. Our team of internationally recognized surgeons, gastroenterologists, oncologists and radio-oncologists offers you integrated oncological care in line with the latest medical research.

Surgery for stomach cancer

Various procedures are available today for the treatment of stomach cancer, which are used depending on the stage. Careful clarification by means of endoscopy, endoscopic ultrasound and imaging procedures (CT, PET, PET-CT) and a subsequent decision in the interdisciplinary tumor board regarding the individual further therapy is therefore of particular importance.

• Surgical removal of the tumor together with the associated lymph nodes is the standard treatment for a malignant tumor of the stomach. Depending on the location of the tumor in the stomach and also on certain histological characteristics of the tissue, either the lower part of the stomach (subtotal gastrectomy), the entire stomach (gastrectomy) or part of the lower esophagus and the entire stomach (transhiatal extended gastrectomy) is resected. The small intestine is usually used as a substitute for the stomach. This enables a very good quality of life after a certain familiarization phase; most patients can eat solid and liquid food without any problems.
• Today, early stages of gastric carcinoma can be treated by local endoscopic treatment.
  (EMR = endoscopic mucosal resection; ESD = endoscopic submucosal dissection). These procedures are reserved for specialists, as assessing whether a tumor qualifies for such an alternative treatment requires a great deal of experience.
• The far more common advanced carcinomas are now usually treated with a combination of preoperative chemotherapy (neoadjuvant therapy) and subsequent surgery. A number of studies have shown that this strategy leads to a significant improvement in the chances of recovery compared to surgical therapy alone without appropriate pre-treatment.
• Some gastric carcinomas have surface antigens that can be treated with specific antibodies . The most important example of this treatment option, also known as “targeted therapy“, is the use of Herceptin (trastuzumab) in HER-2 expressing tumors.

Chemotherapy for stomach cancer

In the case of advanced stomach cancer, an operation that only tackles the cancer locally is usually not enough. This is particularly true if metastases have already formed in other organs. Doctors then use chemotherapy that affects the entire body. Patients are given strong cytotoxins (cytostatics or chemotherapeutics), which prevent the division and multiplication of cancer cells or kill them. They specifically attack cells that divide rapidly. These include cancer cells, but also the cells of the hair, skin, mucous membranes or blood cells. Hair loss during chemotherapy is probably the side effect that many people are familiar with. However, nausea, vomiting, diarrhea, a change in the blood count or an increased susceptibility to infection are also common.

During chemotherapy, doctors usually administer a combination of several cytostatic drugs at certain intervals. In between there are breaks in which the body can recover. Sometimes doctors use chemotherapy before surgery in order to shrink the tumor (neoadjuvant). Then the operation can be performed more gently. Cytostatic drugs are also used after an operation (adjuvant) to prevent the progression of stomach cancer. Some patients receive several cycles of chemotherapy both before and after the operation.

Radiotherapy (radiation therapy)

Radio-oncologists use high-energy X-rays to combat cancer cells. Radiotherapy is an important treatment option for many types of cancer. It is an option for stomach cancer, for example, if the stomach cancer cannot be operated on or does not respond to chemotherapy. Radiotherapy is also an option for metastases. Sometimes doctors also combine radio and chemotherapy. Here you will find details on radiotherapy for stomach cancer.

Targeted drugs: Antibodies

For some patients with advanced gastric cancer, special drugs are used that target a specific feature on the cancer cells (targeted therapy). The drugs are special proteins known as antibodies. The antibodies trastuzumab (also for breast cancer) or ramucirumab are effective for stomach cancer. The prerequisite for their effectiveness, however, is that the characteristic is also increasingly detectable on the tumor cells.

• Trastuzumab is directed against the HER-2 trait, which many cancer cells possess in very high numbers. The drug slows down cell division and thus tumor growth. Doctors usually use trastuzumab in combination with chemotherapy.
• Ramucirumab blocks the docking sites (receptors) for the vascular endothelial growth factor (VEGF). This growth factor normally stimulates the formation of new blood vessels. Ramucirumab ensures that the tumor can no longer form new blood vessels to supply it with oxygen and nutrients – it “starves”. Substances from this class of active substances are called angiogenesis inhibitors. The medication is suitable for patients who have already received other treatments. Doctors can use it alone or together with chemotherapy.

Supportive therapies for stomach cancer

In addition, there are some supportive treatments that are intended to alleviate the side effects of cancer and cancer therapies. These include, for example, pain (painkillers), chronic exhaustion (fatigue – exercise training helps) or anemia (medication that stimulates blood formation). Doctors can also correct a narrowing of the food ducts (stenosis) by performing a minor procedure and inserting a plastic tube. Such treatments are summarized under the term “supportive therapies”.

Nutrition for stomach cancer

After stomach cancer surgery, patients must pay attention to their diet. Either only part of the stomach is left or none at all. The food passage is shortened and the food reaches the intestine much faster. Doctors also try to counteract the loss of fat and muscle mass and weight loss. Emaciation or emaciation (tumor cachexia) occurs more frequently with stomach cancer. Some also have to take a high-calorie special diet as a supplement from time to time. Always seek advice from a nutrition specialist (oecotrophologist).

The following dietary tips can help with stomach cancer:

• Try out which foods you like and what you feel like eating. It is advisable to keep a food diary in which you note down what is good for you and what is not.
• Eat many small portions (six to eight) throughout the day instead of eating a few large meals.
• Avoid food that is too hot or too cold.
• Eat slowly and chew your food well to start the pre-digestion process in your mouth.
• Enjoy your meal, preferably in a relaxed atmosphere.
• Do not drink during the meal, but before (approx. 15 minutes) or after (30 to 45 minutes). Otherwise not much food will fit in the small stomach. It is better to drink between two meals.
• Do not choose drinks that contain a lot of carbon dioxide or sugar – many people tolerate still water, tea and vegetable juices better.
• Walk a few steps after eating – this will help your digestion.
• Eat a high-calorie diet, but watch your fats. Many people have problems digesting fat, which can lead to diarrhea and flatulence. Choose so-called MCT fats. They are rich in medium-chain fatty acids, which the small intestine can absorb particularly well. This makes them better tolerated. Margarines, oils or spreads with MTC fats are available in health food stores, for example.
• Be careful with raw vegetables (salads, stone fruits) and flatulent foods (cabbage, onions, pulses such as lentils, peas or beans).
• It is better to avoid smoked sausages altogether.
• Some people do not tolerate alcohol and strong coffee well, especially at the beginning.
• Some people need dietary supplements containing digestive enzymes.

Compile your meal plan according to your personal preferences, needs and any complaints you may have. Most people quickly find out what is good for them.

Ask the professor

Our expert for esophageal tumors (esophagus), stomach surgery, endocrine surgery) answers the most frequently asked questions about endocrine surgery online.